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New York

NYRx, the New York Medicaid Pharmacy Benefit Program, issued this update regarding the NYRx BLTG (Brand Less Than Generic) Program for Flovent® and Advair®.  

Also in New York, the Board of Pharmacy sent out two updates on January 2:  

  • The online Discontinuance Form discussed at the regular November meeting is now accessible to the public. Directions and further information regarding the online Discontinuance Form can be found online.  
  • The Board has finalized and posted the new Drug Retail Price list online.  

For more information, please contact NACDS’ Mike Sargent at 207-272-6435.

January 12, 2024|New York|

Oklahoma

The state filed a motion with the 10th Circuit Court of Appeals in PCMA v. Mulready asking the appellate court to stay the lower court’s enforcement of its original decision striking down the state’s PBM law, considering the state’s planned Supreme Court review of the appellate court’s refusal to overturn that lower court decision. While such a request is not often granted, a stay is needed to ensure the state can enforce its PBM laws while it petitions the Supreme Court for further review.

For more information, contact NACDS’ Mary Staples at 817-442-1155.

January 12, 2024|Oklahoma|

South Carolina

The Legislature convened on January 9. Legislation regarding reimbursement and scope issues that carried over from the 2023 session are expected to be heard during the 2024 session. 

For more information, contact NACDS’ Leigh Knotts at 803-243-7207.

January 12, 2024|South Carolina|

Tennessee

The Tennessee Nonresidential Buprenorphine Treatment Guidelines, providing details about medication-assisted treatment (MAT) in Tennessee, were recently updated following review by the Commissioners of TDMHSAS (Department of Mental Health & Substance Abuse Services) and TDH (Department of Health).  

Also in Tennessee, the Department of Health released an article, "Racial Disparities in Adolescent Flu Immunization Rates," highlighting public health concerns as factors such as socioeconomic status, limited access to health care, mistrust of medical systems and systemic barriers disproportionately affect minority communities and their immunization coverage rates.  

For more information, contact NACDS’ Leigh Knotts at 803-243-7207.

January 12, 2024|Tennessee|

Texas

Gov. Greg Abbott (R) appointed Mike McKinney, M.D., Golinda Erowele, PharmD, and Tony Schell to the Texas Pharmaceutical Initiative Governing Board. McKinney will serve as the Chair of the Board tasked with developing a business plan to provide cost effective drugs and other medical supplies for the public employee sector. 

Also in Texas, the Governor reappointed two chain pharmacists, Rick Fernandez with Walgreens, and Julie Spier with Albertsons Companies to additional 6-year terms to the State Board of Pharmacy. Gov. Abbott also appointed two new members to the Board, Randy Martin, a pharmacist and clinical services manager at Texas Health Harris Methodist Hospital Fort Worth, and public member Garrett Marquis, chief communications officer for the Bank of New York Mellon. 

Also in Texas, the Health and Human Services Commission (HHSC) alerted providers that beginning January 1, 2024, the managed care organization Amerigroup, began operating under a new name Wellpoint.  

Finally in Texas, the State Board of Pharmacy updated licensing and renewal fees effective January 1, 2024. Fees for pharmacists and pharmacies have increased, but there was no change to pharmacy technician fees. The Board of Pharmacy also established new fees for remote pharmacies. 

For more information, contact NACDS’ Mary Staples at 817-442-1155.

January 12, 2024|Texas|

Vermont

On January 11, the Department of Health released the following notice regarding increased RSV cases and its strain on the health system. Reports have been sent to the Department that pregnant patients have been turned away from pharmacies. The Department asked that pharmacies are aware that: 

  • Pregnant individuals are eligible for Abrysvo.  
    • If a particular pharmacy does not have Abrysvo, please refer the pregnant individual to a location that does have it.  
    • We have Immunization Registry (IMR) data showing that pharmacies are administering Abrysvo to women of childbearing age. The IMR does not collect pregnancy status.  
  • Adults 60 years of age and older are eligible and encouraged to receive either Arexvy or Abrysvo vaccine.  
    • IMR data shows that pharmacies are giving doses to older adults.        

For more information, please contact NACDS’ Mike Sargent at 207-272-6435.

January 12, 2024|Vermont|

Washington

The legislature convened on January 8. Lawmakers will need to agree to a supplemental budget.

Also in Washington, legislation to expand pharmacists' prescriptive authority was filed in both chambers. HB 2116 by Reps. My-LinhThai (D) and Vandana Slatter (D) was referred to the Health and Wellness Committee, and SB 6019 by Sen. Ron Muzzall (R) was referred to the Senate Health Long-Term Care Committee. 

Also in Washington, SB 5213 by Sen. Patty Kurderer (D), pharmacy's PBM reform bill, was carried over from the 2023 session. 

Also in Washington, in compliance with the Settlement Agreement in the case of National Association of Chain Drug Stores, et al., v. Health Care Authority (Washington State Court of Appeals No. 51489-3-II), the Health Care Authority (HCA) updated the professional dispensing fees for pharmacies and began issuing adjusted dispensing fee payments December 29, 2023. For more information regarding the updated professional dispensing fees for pharmacies and adjusted dispensing fee payments, the HCA provided a FAQ. Questions can be emailed to applehealthpharmacypolicy@hca.wa.gov. 

 Also in Washington, the Pharmacy Quality Assurance Commission (PQAC) filed for Emergency Rulemaking to codify in rule the FDA's approval of certain naloxone hydrochloride nasal sprays as over the counter. The rule was effective immediately and will remain in effect for 120 days but will be refiled as needed while permanent rulemaking is in progress. 

Also in Washington, the Pharmacy Quality Assurance Commission (PQAC) adopted rules on Opioid Use Disorder (OUD) Remote Dispensing Sites implementing SSB 6086 (Chapter 244, Laws of 2020) allowing a pharmacy to extend its pharmacy license to a remote dispensing site where technology is used to dispense medications used for the treatment of OUD or its symptoms, effective January 18. 

Also in Washington, the Pharmacy Quality Assurance Commission (PQAC) issued an FAQ in response to questions regarding health care entities (HCEs) and the 72-hour dispensing limitation.  

Finally in Washington, the five-member Prescription Drug Affordability Board (PDAB) that was enacted to reduce Rx costs to consumers issued its 2023 Annual Report. 

For more information, contact NACDS’ Mary Staples at 817-442-1155.

January 12, 2024|Washington|

Alaska

The Board of Pharmacy approved a training resource from the Asthma and Allergy Foundation of America – Alaska Chapter for the prescribing and dispensing of epinephrine. 

For more information, contact NACDS’ Mary Staples at 817-442-1155.

December 15, 2023|Alaska|

California

The Department of Health Care Services posted the following alerts and weekly notices on the Medi-Cal Rx Web Portal.  

Also in California, the Department of Health Care Services posted the following:  

Also in California, the Board of Pharmacy proposed modifications to the following. To view all documents associated with these proposed regulatory actions and other pending regulations, visit the board’s “Pending Regulations” webpage.  

  • Designation of Pharmacist-in-Charge 
  • Temporary License for Military Spouses 
  • Modified Text 
  • 15-Day Comment Period: December 13, 2023-December 28, 2023 
  • Notice to Consumers 

Also in California, Gov. Gavin Newsom (D) appointed Sarah Brooks, as Chief Deputy Director of Health Care Programs at the Department of Health Care Services. Given the capacity to manage program growth and increased complexity of the programs, moving forward, the Chief Deputy Director for Health Care Programs and State Medicaid Director will be two separate roles. The Chief Deputy Director for Health Care Programs will focus on internal program implementation and operations in California’s health care programs, whereas the State Medicaid Director will focus on Medi-Cal policy development and relationships with its external partners, including the federal Centers for Medicare & Medicaid Services (CMS). Recruitment efforts are ongoing for a State Medicaid Director. 

Finally in California, Gov. Gavin Newsom (D) announced the launch of a new tool to continue the state’s efforts to fight the ongoing opioid crisis – a comprehensive website with resources for Californians: Opioids.CA.GOV. This website serves as a reliable source of information on prevention, data, treatment and support. Also, Californians can access information related to the state’s use of opioid settlement funds and efforts to hold drug-traffickers accountable.  

For more information, contact NACDS’ Sandra Guckian at 703-774-4801.

December 15, 2023|California|

Iowa

The Department of Health and Human Services, Iowa Medicaid posted the following:  

For more information, contact NACDS’ Sandra Guckian at 703-774-4801.

December 15, 2023|Iowa|

Louisiana

The Department of Health issued an informational bulletin on tobacco cessation counseling. 

Also in Louisiana, the Department of Health (LDH) updated the available options to providers for pursuing resolution of issues with Medicaid managed care organizations (MCO) and the state's fee-for-service (FFS) claims processor, Gainwell Technologies. Unless explicitly notated, providers should first seek resolution with the MCO or Gainwell directly, prior to engaging LDH or other third parties. 

Finally in Louisiana, the Board of Pharmacy is soliciting comments and holding a Public Hearing on December 28 on three proposed rule changes: 

  1. Regulatory Project 2023-09 ~ Product Integrity – (temperature control for mail order) 
  2. Regulatory Project 2023-10 ~ Prescription Monitoring Program (PMP)  
  3. Regulatory Project 2023-11 ~ Pharmacists Application 

For more information, contact NACDS’ Mary Staples at 817-442-1155.

December 15, 2023|Louisiana|

Maine

The Board of Pharmacy held its monthly meeting on December 7. The agenda covered the following policies and updates: 

  • Access to HIV Prevention Medications, including PEP and PrEP Protocols 
  • Access to Birth Control by Making Certain Contraception Accessible from a Pharmacist 
  • Authorize Vaccine Administration by Pharmacy Technicians and Reduce Vaccine Administration Training Requirements for Pharmacists 
  • Licensure by Endorsement  
  • Board Rule Chapter Amend Limits on Medication in Vending Machines 
  • Pharmacists Dispense an Emergency Supply of Chronic Maintenance Drugs 
  • Telehealth Rulemaking Status – Update 

For more information, please contact NACDS’ Mike Sargent at 207-272-6435.

December 15, 2023|Maine|

Maryland

Medicaid published an advisory regarding upcoming denials of prescription claims due to the prescribing provider not completing revalidation. The advisory also contains email and phone contacts for patients and provider issues. 

For more information, contact NACDS’ Jill McCormack at 717-592-8977.

December 15, 2023|Maryland|

Massachusetts

MassHealth has issued a new draft of the Pharmacy Manual at 130 CMR 406. The new regulations make the following changes:  

  • Adds compounded drugs, and medically necessary cosmetic drugs for the treatment of alopecia or gender identity that are listed on the MassHealth Drug list, to the list of Covered Drugs and Medical Supplies at 406.412. 
  • Deletes the language in the current regulations at 406.413 that prohibits MassHealth from paying for any drug used for the treatment of obesity. The prohibition has been eliminated and MassHealth will now pay for drugs to treat obesity that are included on the MassHealth Drug List. 
  • Adds the new section 406.446 relative to Pharmacy Drug Review and Counseling that requires pharmacies that are servicing MassHealth patients to offer prospective drug review and counseling that are consistent with the current MA law that requires pharmacists to make an offer to counsel. Only a patient's refusal of counseling must be documented. 

These changes will become effective on January 1, 2024. 

For more information, please contact NACDS’ Mike Sargent at 207-272-6435.

December 15, 2023|Massachusetts|

Michigan

Gov. Gretchen Whitmer (D) signed HB 4276. The bill requires PBMs to reimburse pharmacies with no more than seven retail outlets at NADAC plus a professional dispensing fee comparable to the state Medicaid Dispensing Fee. It also prohibits the Department of Health and Human Services (department) from entering into a contract with a Medicaid managed care organization if its pharmacy benefit manager (PBM) does not do the following: reimburse for a legally valid claim at a rate not less than the rate in effect at the time the original claim adjudication was submitted at the point of sale; agree to move to a transparent pass-through pricing model, in which the PBM discloses the administrative fee as a percentage of the professional dispensing costs to the department; agree to not create new pharmacy administration fees and to not increase current fees more than the rate of inflation; and, agree to not terminate an existing contract with a pharmacy with no more than seven retail outlets for the sole reason of the additional professional dispensing fee authorized.

For more information, contact NACDS’ Jill McCormack at 717-592-8977.

December 15, 2023|Michigan|

Nebraska

The Department of Health and Human Services issued the following provider bulletins: 

Also in Nebraska, the Department of Health and Human Services posted the Excel file of the fee schedule for Injectables October 1, 2023 (Revised). 

Also in Nebraska, the Department of Health and Human Services received approval from CMS for State Plan Amendment 23-0015: Adult Vaccines related to coverage of vaccines and vaccine administration in accordance with current Advisory Committee on Immunization Practices (ACIP) recommendations. 

Finally in Nebraska, the Department of Health and Human Services posted the meeting recording from the December 6 COVID-19 Provider Call. The next meeting will be held on January 3, 2024, at noon (Central). To participate, use either the meeting link or phone number and access code below. 

Join from the meeting link:
https://sonvideo.webex.com/sonvideo/j.php?MTID=mc307e2dda218d1060adfed7f454cfc16
Join by phone:
408-418-9388 (access code: 2480 661 3098 ) 

For more information, contact NACDS’ Sandra Guckian at 703-774-4801.

December 15, 2023|Nebraska|

New York

NYRx, the State Department of Health Medicaid Pharmacy Benefit Program, released updates to the NYRx Prior Authorization Programs and updated preferred drug list, changes were effective December 14. 

The State Department of Health also released a reminder regarding pharmacy providers and members out-of-pocket costs. This communication was sent to all pharmacies to remind them of their responsibility for continued enrollment, to adhere to the policies and procedures of the Medicaid Program. Specifically, it is inappropriate to allow an eligible member to pay out-of-pocket for services that are covered by NY Medicaid (NYRx) beyond copay. Please be advised that out-of-pocket expenses are only reimbursable by Medicaid for Medicaid covered services when one of these three situations applies:  

  • Reimbursement can be made for both participating and non-participating Medicaid Providers during the three-month retro period up until they submit the application. 
  • Reimbursement can be made for only Medicaid participating Providers from the date the application is submitted up until they receive the Common Benefit Identification Card (CBIC). 
  • Reimbursement can be made for both participating and non-participating Medicaid Providers due to agency error or delay. 

If there is an eligibility issue that is corrected in a timely manner, pharmacists should resubmit the claim when the issue is resolved and reimburse the member directly if the member paid out of pocket. There is support available to pharmacists to assist with claim issues. Questions regarding this communication may be directed to NYRx@health.ny.gov. 

On December 12, A6779, a bill NACDS and the Community Pharmacy Association of New York (CPANY) had been supporting to expand the 2022 law allowing pharmacists to administer long-acting injectables, was sent to the Governor's desk by the legislature. Gov. Kathy Hochul (D) has until December 22 to act on the legislation. 

For more information, please contact NACDS’ Mike Sargent at 207-272-6435.

December 15, 2023|New York|

Ohio

The Board of Pharmacy published a series of proposed rule changes and rescissions they intend to work on this winter. Comments are due to the board on January 17, 2024.

For more information, contact NACDS’ Jill McCormack at 717-592-8977.

December 15, 2023|Ohio|

Oklahoma

The Tenth Circuit Court of Appeals denied the State of Oklahoma’s petition for rehearing in PCMA v. Mulready. The state now has 90 days to petition the Supreme Court for further review. 

For more information, contact NACDS’ Mary Staples at 817-442-1155.

December 15, 2023|Oklahoma|

Texas

The Health and Human Services Commission (HHSC) Vendor Drug Program (VDP) now covers the 2023-2024 Pfizer-BioNTech, Moderna and Novavax commercial COVID-19 vaccines as a pharmacy benefit for both Medicaid managed care and fee-for-service, as well as the Children's Health Insurance Program (CHIP). 

Also in Texas, Medicaid will perform the semi-annual update of the Medicaid preferred drug list on January 25, 2024. The Health and Human Services Commission (HHSC) made the PDL changes based on recommendations made at the October 2023 Drug Utilization Review Board meeting. Drug list recommendations from the meeting are available. Drugs with preferred status drugs may include brand name medication which would not require a PDL prior authorization nor the value of "1" in the "Dispense as Written (DAW) Product Selection code" field (408-D8). Refer to the Dispense as Written section of the Formulary Coverage chapter of the Pharmacy Provider Procedure Manual for more information. 

Also in Texas, the Health and Human Services Commission (HHSC) is soliciting comments on the prospective clinical prior authorization proposals likely to be presented at the Texas Drug Utilization Review (DUR) Board meeting on January 26, 2024. The board reviews and recommends clinical criteria and the preferred or non-preferred drug status on the Medicaid formulary.  

Also in Texas, December 11 was the filing deadline for the March 5, 2024, primary election.  

For more information, contact NACDS’ Mary Staples at 817-442-1155.

December 15, 2023|Texas|

Vermont

The Board of Pharmacy is scheduled to hold its regular meeting on December 20; the agenda has been posted.

For more information, please contact NACDS’ Mike Sargent at 207-272-6435.

December 15, 2023|Vermont|
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