Oregon
The Board of Pharmacy posted the November 2023 Newsletter including the following headlines:
- No. 723 New Rules for Pharmacists, Interns/Preceptors, Certified Oregon Pharmacy Technicians/Pharmacy Technicians, Board Administration, and Universal Rules – Effective March 1, 2024
- No. 724 Coming Soon! Updated and New Rules Related to Short-Acting Opioid Antagonists and Immunizations
- No. 725 Rulemaking
- No. 726 Compliance: Updated Inspection Processes, Requests for Additional On-Site Inspections, and a Reminder About Prescriptions from Veterinarians
- No. 727 Licensing: How to Update Outlet Contact Information and Pharmacist Work Email in e-Gov
- No. 728 Minutes for Board-Related Meetings
Also in Oregon, the Oregon Health Authority announced the Immunization Policy Advisory Team (IPAT) will meet on December 7 and posted an agenda for this meeting.
Finally in Oregon, the Department of Consumer and Business Services will be hosting a public hearing on prescription drug prices on December 7 from 1:30 pm to 4:00 pm via Zoom.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Pennsylvania
Medicaid plans to implement a system to reimburse pharmacies for a variety of services within their current scope of practice by the end of the first quarter of 2024. We understand these would include immunizations, counseling, and diabetes management and would apply to the Fee-For- Service and the Managed Care Program. We expect DHS (Department of Human Services) (Department of Human Services) to release a Bulletin announcing the new program in December. NACDS will provide updates as we receive them, including instructions on enrollment. NACDS has been supporting member and in-state efforts to develop the program.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Tennessee
TennCare’s updated dispensing fees took effect on November 1. TPA (Tennessee Pharmacists Association) is interested in collecting feedback on whether your pharmacy is receiving the updated dispensing fees from TennCare and other obligated payors. Please reach out to olivia@tnpharm.org with any feedback or questions
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Texas
NACDS sponsored the Texas Federation of Drug Stores' (TFDS) Legislative Champions reception and dinner in Austin last week, honoring State Sen. Pete Flores (R) and State Rep. Four Price (R), sponsors of the immunization bill that would have made PREP Act permanent, and State Rep Stephanie Klick (R), the House Public Health Committee Chair and sponsor of our Medicaid U&C (usual & customary) bill.
Also in Texas, the Board of Pharmacy held a quarterly meeting on November 7. The new Executive Director/Secretary Danny Carroll Pharm.D., R.Ph., presided over his first Board meeting.
Also, in Texas, before the third 30-day special session adjournment, the Legislature sent Gov. Greg Abbott (R) two pieces of legislation before adjourning the third Special Session on November 7. SB 4 by Sen. Pete Flores (R) addressed border security, and HB (House Bill) 7 by Rep. Jeff Leach (R) and Sen. Mayes Middleton (R) prohibits private employers from adopting policies that require the COVID-19 vaccine as a condition of employment. The Governor is expected to sign both bills into law.
Also in Texas, immediately after the end of the third special session. Gov. Greg Abbott (R) announced a fourth special session on school choice and border security.
Also in Texas, the Health, and Human Services Commission (HHSC) published an annual report on the Prescription Drug Rebate Program for health benefit programs administered by HHSC System: Texas Medicaid Program, Children's Health Insurance Program (CHIP), Kidney Health Care (KHC) Program, Children with Special Health Care Needs (CSHCN) Services Program and the Healthy Texas Women (HTW) Program.
Also in Texas, Medicaid clarified the new policy implementing HB 916 passed earlier this year that amends Section 1369.102 of the Texas Insurance Code to require health benefit plans, including Medicaid fee-for-service and managed care, to follow certain quantity supply criteria for prescription contraceptive drugs. The Medicaid fee-for-service and managed care policy is effective January 1, 2024.
Finally in Texas, the November 7 election results:
- Texas voters approved 13 of the 14 constitutional amendments.
- State Sen. John Whitmire (D) and U.S. Congresswoman Sheila Jackson Lee (D) are headed to a December runoff in Houston's mayoral race.
- In Texas State House District 2, Jill Dutton (R) and Brent Money (R) advance to runoff for a House special election replacing expelled former state Rep. Bryan Slaton (R).
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Virginia
Pursuant to passage SB 1538 of 2023, DMAS (Department of Medical Assistance Services) is building and implementing a pharmacy payment for services claims they have dubbed "PAP" (Pharmacists as Providers) system. Tomorrow they will publish a new Supplement to the Pharmacy and Practitioner Manuals adding billing instructions for the new system. Please review the Supplement and share your comments with Jill McCormack as soon as possible. Comments are due to DMAS on November 30.
DMAS is hosting a Pharmacists as Providers (PAP) educational session for interested parties (in-person and virtually) on November 30 from 1:00 pm to 4:00 pm at 600 E. Broad Street in Richmond. To attend virtually, register here. here.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Washington
CMS approved the Washington State SPA (State Plan Amendment), implementing the new updated July 1, 2023, dispensing fees based on the Oregon dispensing fee tiers. Washington Medicaid will soon be paying pharmacies the higher dispensing fees as well as making retroactive payments.
Also in Washington, the Pharmacy and Family Planning Programs within the Clinical Quality Care Transformation division at the Health Care Authority is requesting pharmacy staff complete this pharmacy contraceptive access survey about barriers and solutions in prescribing and dispensing contraception.
Also in Washington, in observance of Thanksgiving, the Health Care Authority's offices will be closed on November 23 and 24. Provider payments for the week of November 20 will be made on November 22, including the delivery of Remittance Advices (RAs) and HIPAA (Health Insurance Portability and Accountability) 835 remittance files.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
California
The Department of Health Care Services (DHCS) posted the following alerts and monthly bulletin on the Medi-Cal Rx Web Portal.
- 30-Day Countdown: Changes to Continuous Glucose Monitoring Systems Coverage Criteria and Prior Authorization Bundling (November 1)
- Policy Update: Use of "Inner" and "Outer" NDCs for Claim Submission (November 1)
- How to Resolve Reject Code A6 for Orally Administered Enteral Nutrition Claims (November 1)
- Medi-Cal Rx Monthly Bulletin for November (November 1)
- Changes to the Medi-Cal Rx Contract Drugs List (November 1)
- Changes to the Medi-Cal Rx Contract Drugs List – Over-the-Counter Drugs and Cough/Cold Preparations (November 1)
- Changes to the Medi-Cal Rx Pharmacy Reimbursable Physician Administered Drugs (November 1)
- Updates to the Medi-Cal Rx Provider Manual (November 1)
- Updates to Medi-Cal Rx Web Portal Appearance and Resources (October 29)
- Medi-Cal Rx Weekly Wrap-up for October 20-26 (October 27)
- Reinstatement Spotlight (October 27)
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Florida
Eleven entities have responded to the statewide Medicaid Managed care invitation to negotiate, including all of the health plans that currently participate in the program. Two of the respondents, ImagineCare and Sentara Care Alliance, do not currently participate in the program. The Agency of Health Care Administration is soliciting comments from providers who have experience with the 11 respondents. The comments are a component of the Invitation to negotiate and are considered when the state decides which entities to award contracts. Providers have until 5:00 pm on November 9 to electronically submit their comments to the state. The agency will only consider comments submitted by providers in the same region as the plan.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Iowa
The Board of Pharmacy offices will move effective November 6 to 6200 Park Ave., Suite 100, in Des Moines, Iowa 50321. The move is the result of the Board now being part of the Department of Inspections, Appeals, and Licensing. The Board's goal is to have no disruption in service during the move. Online services will not be affected.
Also in Iowa, the Board of Pharmacy posted the November 7 meeting agenda. The meeting will be held via Zoom. To access the meeting, see the details below:
Join Zoom Meeting https://us02web.zoom.us/j/88584737545?pwd=RzdsREtyVkpkcUFUeWtNMHRmWmNxUT09
Meeting ID: 885 8473 7545
Passcode: 746325
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Kentucky
MedImpact will host its quarterly pharmacy webinar on November. 16 from 11 to 12am Eastern. The meeting provides a forum for pharmacies to ask questions about the SPBM (Single Pharmacy Benefit Manager) program. Click here to join.
Also in Kentucky, in preparation for the 2024 legislative session, NACDS will host a joint conference call to discuss legislative and regulatory issues with the Kentucky Retail Federation and the Kentucky Pharmacists Association on November 13 at 2:30pm Eastern. If you have not received the invitation and would like to join, please contact NACDS' Jill McCormack.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Maryland
The Prescription Drug Affordability Board posted the presentation from their October meeting. They are in the process of developing a plan to implement Upper Payment Limits on certain drugs in the commercial market. NACDS intends to submit comments to the PDAB prior to their November meeting urging them to consider the impact on pharmacy as they move forward. The next meeting is scheduled for November 27. To register, click here.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Massachusetts
On October 30th, the Massachusetts Joint Committee on Health Care Financing reported a bill favorably to the Senate. The bill, S 2492 "An Act relative to pharmaceutical access, costs and transparency," combined several previously pending bills that NACDS had been monitoring and advocating. The new bill includes PBM (Pharmacy Benefit Manager) regulation, PBM transparency, and drug cost containment. The bill is now pending action before the Senate Ways and Means Committee. The Massachusetts legislative session will continue until July 31, 2024.
The Massachusetts Board of Pharmacy announced three new updated policies on November 2nd:
- Prescribing and Dispensing of Contraceptives;
Update on Compliance Packaging and Reusable Dose Planners; and - CE requirements for pain management training for CDTM pharmacists
For more information, please contact NACDS’ Mike Sargent at 207-272-6435.
Minnesota
The Department of Health (MDH (Minnesota Department of Health)) shared the implementation timeline for expanded prescription drug price transparency reporting on drugs of significant public interest and ways to stay connected. Beginning in January 2024, pharmacies will be required to report pricing information.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Mississippi
Telligen to replace Alliant Health Solutions and Kepro as Medicaid UM/QIO Vendors:
Early in 2024, the Division of Medicaid (DOM) will transition to a new Utilization Management/Quality Improvement Organization (UM/QIO) vendor, Telligen.
Telligen will replace the following vendors:
- Alliant Health Solutions, who was responsible for medical authorization requests for fee-for-service (FFS) Medicaid members, and
- Kepro (formerly eQHealth Solutions), who was responsible for advanced imaging authorization requests for FFS Medicaid members.
To ensure a smooth transition, Telligen web portal registration instructions and educational materials will be shared in the upcoming weeks through a variety of communication avenues to ensure no provider lacks access to necessary resources and assistance. Updates will also be publicized on the DOM website and Late Breaking News.
Please note: Prior authorizations for members enrolled in MississippiCAN and CHIP will continue to be handled by the respective coordinated care organization.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Montana
On November 28 at 1:00 pm, a public hearing will be held via remote conferencing to consider proposed adoption of New Rule I pertaining to pharmacist prescribing [MAR Notice No. 24-174-80]. The 2023 legislature passed SB 112, allowing for independent prescribing authority for pharmacists in limited situations; it is necessary to set standards for patient care, evaluation, recordkeeping, and provider notification required of pharmacists prescribing under SB 112’s authority. In addition to oral testimony at the hearing, written comments may be submitted at dli.mt.gov/rules or P.O. Box 1728; Helena, MT 59624-1728; comments must be received no later than 5:00 pm on December 1.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
New York
On November 1st, the New York Department of Financial Services pulled back on regulations regarding PBMs (Pharmacy Benefit Manager). This was in response to an "overwhelming" number of comments submitted in opposition to the regulation from unions, employers, and health plans. The legislative objectives driving the regulations were 'licensing standards for PBMs, including minimum standards related to market conduct practices, conflicts of interest, deceptive, anti-competitive, and unfair claims practices in connection with the performance of pharmacy benefit management services, predatory audit practices, and actions or procedures in the PBM industry that go against the best interests of the public.' While the full regulations were pulled back, the Department did move part of the rule-making process and fully adopted the registration requirement for PBMs.
On November 8th, the New York State Board of Pharmacy will be holding their regular scheduled meeting in person in Albany. The agenda is as follows:
Executive Session 9:30 a.m.
- Proprietary matters relating to licensing exam development, administration, and assessment.
- Disciplinary and Professional Assistance Program discussions that address confidential processes, investigations, and prosecutions.
Public Session 1:00 p.m.
- Welcome and Introduction
- Review and approval of June meeting minutes
- Report of the Chair
- Report of the Executive Secretary
- NABP (National Association of Boards of Pharmacy) Presentation: Drug Supply Chain Security Act
- Report: Jurisprudence Committee
- New business
o Discussion: Online Discontinuance Form
o Discussion: Drug Price List
o Upcoming 2024 Meeting Dates
- Closing remarks and adjournment
For more information, please contact NACDS’ Mike Sargent at 207-272-6435.
North Carolina
The Board of Pharmacy has completed its rulemaking on the authorization for, and regulation of, the use of direct-to-patient (DTP) dispensing systems. Board Rule .1821 provides that authorization and the standards that apply to the use of DTP systems. Board Rule .1616 authorizes limited service permits to be issued for operation of a DTP system when the system is not located on-site at the home pharmacy.
The board staff has completed programming to implement a limited-service permit application for an off-site DTP system and to allow an existing pharmacy to notify the Board that it will deploy an on-site DTP system.
Detailed guidance on the rules and standards governing DTP systems, as well as step-by-step instructions to add an on-site DTP system to an existing pharmacy's services or to apply for an off-site DTP system limited-service permit are found here.
The general limited-service permit guidance document has also been updated to include information on DTP system permits.
Also in North Carolina, effective November 1, Medicaid waived the copay for antiretrovirals used to decrease viral load in members living with HIV (Human Immunodeficiency Virus).
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Ohio
The Board of Pharmacy announced that the November board meeting will be held on Monday, November 6th starting at 10:00 am; and Tuesday, November 7th and Wednesday, November 8th starting at 9:00 am. See the monthly agenda, which will be posted on Friday, November 3rd, for more specific information. The link to join the meeting will be available here Monday. The Board also posted the following items and updates on their webpage:
- Board of Pharmacy Adds Nalmefene as an Overdose Reversal Drug
- Distribution Overdose Reversal Drugs in Ohio
- Registered Technician Renewal 2024
- Pharmacy Technician Continuing Education
- 202307 – July 10-11, 2023 Board Meeting Minutes.pdf
- 202308 – August 7, 2023 Board Meeting Minutes.pdf
202308 – August 7, 2023 Probation Committee Meeting Minutes.pdf - 202308- August 16, 2023 Conference Call Minutes.pdf
- 202309 – September 27, 2023 Conference Call Minutes.pdf
- 202309- September 6, 2023 Conference Call Minutes.pdf
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Oregon
The Prescription Drug Affordability Board (PDAB) posted its November 15 meeting draft agenda. The PDAB will also review an updated working drug list during the November 15 meeting; the updated list has been posted on the PDAB data page. Below are links to information for the next meeting including current rules referenced in the draft agenda. The board calendar and minutes from past meetings are also available online.
Also in Oregon, the Oregon Health Authority proposed minor housekeeping edits to align with Federal requirements, clarify language, remove outdated references, and correct typos. Comments are due November 21 at 5:00 pm Pacific.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Pennsylvania
Medicaid plans to implement a system to reimburse pharmacies for a variety of services within their current scope of practice in 2024. We understand these would include immunizations, counseling, and diabetes management; and would apply to both the Fee-For- Service and Managed Care Program. We understand a Bulletin announcing the new program will be released the first week of December. NACDS will provide updates as we receive them, including instructions on enrollment. NACDS has been supporting member and in-state efforts to develop the program.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Rhode Island
Please see the November 2023 provider update. Previous updates can also be found on the Executive Officer of Health and Human Services (EOHHS) Provider Updates web page.
Also in Rhode Island, Medicaid has noticed an increase in the number of Continuous Glucose Monitors (CGMs) submitted via pharmacy claims. Please note that Medicaid considers CGMs as DME products and requires prior authorization for all CGM-related items. All prior authorization requests must be submitted by the dispensing provider and must include a prescription and recent clinical notes. Requests submitted directly by ordering physicians will be returned.
- Coverage guidelines can be found here: CGM Policy Final 091222.pdf (ri.gov)
- Prior authorization forms and instructions can be found here: Prior Authorization | Executive Office of Health and Human Services
In adherence with recent Medicare HCPCS code updates, Medicaid activated the following CGM codes:
- A4239 – SUPPLY ALLOWANCE FOR NON-ADJUNCTIVE, NON-IMPLANTED CONTINUOUS GLUCOSE MONITOR (CGM), INCLUDES ALL SUPPLIES AND ACCESSORIES, 1 MONTH SUPPLY = 1 UNIT OF SERVICE
- E2103 – NON-ADJUNCTIVE, NON-IMPLANTED CONTINUOUS GLUCOSE MONITOR OR RECEIVER
Effective October 1, 2023, prior authorization requests submitted under codes K0553 and/or K0554 are being returned and must be resubmitted with the proper codes.
Claim submission for reimbursement must be done using either the 837 professional file format or via the CMS 1500 paper claim. Claims submitted otherwise will be denied.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
South Carolina
The City of Columbia is launching a pilot program to address food deserts through subsidized delivery of groceries in certain parts of the city to eligible residents. The pilot is limited to Instacart delivery service and those retailers who operate on that platform; however, the goal of the city is to expand the program after the pilot to include more retailers and delivery services. For more information on the program, click here.
Also in South Carolina, the Department of Health and Human Services will operate on an updated schedule for Healthy Connections Medicaid claims submission and payments to accommodate the November 2023 state holiday schedule. Due to observance of the Thanksgiving holiday, November 17 at 5:00 pm is the deadline to submit claims for payment date November 24. Payments will run November 20 and electronic remittance advice will be available November 21. Payments will be dated November 24, as usual. The schedule will return to the normal payment cycle on the payment date December 1.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Tennessee
Effective November 1, BD is the sole preferred manufacturer of insulin syringes and pen needles. Please refer to the OTC list for a list of covered NDCs. The updated OTC list, including covered NDCs, was posted to the Optum Rx TennCare website on November 1, 2023. Please refer to the November Provider Notice and contact TNRxEducation@optum.com with any questions.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
California
The Board of Pharmacy posted the agenda and meeting materials for its November 1-2 Board Meeting. Please note the committee reports, particularly Enforcement & Compounding with respect to legislation recently signed by Gov. Gavin Newsom (D) and the Licensing Committee meeting items, e.g., remote processing, ratio, CLIA-waived tests, and central fill pharmacies.
Also in California, the Department of Health Care Services (DHCS) posted the following alerts and weekly notices on the Medi-Cal Rx Web Portal. Please note the alert about the quantity limit restrictions for certain continuous glucose monitoring devices.
- Reminder: Reject Code 76 Point-of-Sale Messaging (October 25)
- Reminder: Quantity Limit Restrictions for Common Continuous Glucose Monitoring Devices (October 24)
- Medi-Cal Rx Provider Prior Authorization Submission Processing – System Issue Resolved (October 23)
- Medi-Cal Rx Weekly Wrap-up for October 13-19 (October 20)
- Reinstatement Spotlight (October 20)
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Georgia
The House Rural Development Council, chaired by Rep. Gerald Greene (R), met this week, and heard comments from Michael Power, the Senior Director for State Government Affairs at the Pharmaceutical Care Management Association on PBMs (Pharmacy Benefit Managers) and their role in drug spending. A recording of the meeting has been posted online.
Also in Georgia, the Board of Pharmacy has voted to initiate a public comment period for proposed changes to the Remote Prescription Drug Order Processing Rules (Rule 480-36-.01 and Rule 480-36-.07). The changes posted for public comment include the following. These changes will undergo a 30-day public comment period and are expected to be officially approved by the Board in December
- Removing Rule 480-36-.07: This removes the requirement for notifying patients when utilizing remote prescription drug order processing.
- Modifying Rule 480-36-.01: The final sentence that restricted the number of secondary remote entry pharmacists assisting the primary dispensing pharmacy has been struck.
Finally in Georgia, the Board of Pharmacy has provided clarification regarding the administration of the RSV (Respiratory Syncytial Virus) vaccine. They have confirmed that it can be administered in accordance with the statute, as it is now included in the recent update of the adult immunization schedule appendix.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.