Massachusetts

Gov. Maura Healey (D) released her Fiscal Year 2025 budget. Included in the proposal are the following policy changes impactful to retail pharmacies: 

  • Authorizing pharmacies to administer injections for those persons with prescriptions for testosterone for gender affirming care and for treatment of sexually transmitted infections. This language builds on the previous expansion of pharmacist practice that authorized pharmacists to administer medications for the treatment of behavioral health conditions and substance use disorders. 
  • Enabling pharmacies to fill prescriptions for expedited partner therapy beyond the current authorization for Chlamydia to include other sexually transmitted infections based on national standards including the Centers for Disease Control and Prevention Sexually Transmitted Infections Treatment Guidelines. 
  • Increasing the maximum fill for certain classes of medication to increase access, including testosterone for gender-affirming care, stimulants for ADD (attention deficit disorder)/ADHD (attention deficit hyperactivity disorder) and medications for opioid use disorder which do not have a potential for abuse. 
  • Authorizing a standing order for prenatal vitamins and oral contraceptives so that federal financial participation is available for these products when pharmacies dispense them to MassHealth members and persons whose claims are paid by the Health Safety Net. 
  • Eliminating co-payments for persons enrolled in the Children’s Medical Security Plan.  
  • Authorizing MassHealth to negotiate drug rebate agreements for drugs not subject to the Medicaid Drug Rebate Program such as certain non-drug products and durable medical equipment (DME). 

The Governor’s proposal will be considered and redrafted by the House Committee on Ways and Means over the next two months.  

For more information, please contact NACDS’ Ben Pearlman at 617-515-2603.

2024-01-26T10:17:18-05:00January 26, 2024|Massachusetts|

Missouri

The Missouri Pharmacy Association (MPA) is asking pharmacies to distribute this one-pager to educate and help facilitate action on PBM reform legislation.  

Also in Missouri, the Centers for Medicare & Medicaid Services (CMS) approved the MO HealthNet Division’s (MHD) application for substance use disorders (SUD) 1115 Demonstration Waiver, effective January 1, 2024. 

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

2024-01-26T10:16:42-05:00January 26, 2024|Missouri|

New Mexico

The short 30-day legislative session focuses primarily on the budget tax and spending bills, reconciling Gov. Michelle Lujan Grisham’s (D) proposed $10.5 billion budget and lawmakers proposed $10.1 billion spending plan.

Also in New Mexico, HB 33, prescription drug transparency legislation, requires reporting to the Superintendent of Insurance (SOI) and the Legislature. Failure to comply could result in the Superintendent assessing a penalty. The bill was heard in the House Health and Human Services Committee on January 22. 

Finally in New Mexico, HB 35 is legislation seeking to appropriate $1.1 million to the University of New Mexico Health Sciences Center’s Office for Diversity, Equity, and Inclusion communities to develop a careers program aimed at addressing shortages in the healthcare industry in New Mexico. 

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

2024-01-26T10:16:12-05:00January 26, 2024|New Mexico|

New York

NYRx, the Medicaid Pharmacy Benefit Program, updated the preferred drug list, impacting Albuterol HFA formulations. The following are preferred in the NYRx Preferred Drug Program: 

  • albuterol HFA – generic ProAir® HFA (8.5 grams) 
  • albuterol HFA – generic Proventil® HFA (6.7 grams) 
  • Proventil® HFA 
  • Ventolin® HFA BLTG (Ventolin® HFA is subject to the Brand-Less-Than-Generic Program. The generic formulation of Ventolin® HFA, albuterol HFA (18 grams), is non-preferred and will require prior authorization.) 

Effective February 7, NYRx will make the following changes to the Brand Name Drug When Less Expensive Than the Generic Program: 

  • Alphagan P® 0.1%, Forteo® and Votrient® will be ADDED to the program. 
  • Flovent® HFA and Pennsaid® pump will be REMOVED from the program. 

For more information, please contact NACDS’ Ben Pearlman at 617-515-2603.

2024-01-26T10:15:21-05:00January 26, 2024|New York|

North Carolina

Medicaid has been informed that Wellcare and Carolina Complete have experienced an issue with their new PBM (Express Scripts), being set up to pay at 30 days instead of 14 days, resulting in pharmacies not being paid timely.  

Payments for the first week in January are going out in the coming week. Payments for the second and third weeks will be on a 30-day cycle and will come out in mid-February, payments for the fourth week in January will also come out by mid-February. Pharmacies should be “caught up” in mid-February.  

Penalties and interest will be paid in accordance with Section V. H.1.d of the NC PHP Contract. For more information, please see the Medicaid bulletin Prepaid Health Plan Interest and Penalties for Provider Claims.  

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

2024-01-26T10:10:38-05:00January 26, 2024|North Carolina|

Oregon

The Board of Pharmacy posted the agenda and meeting materials for its February 7-9 meeting. Please note the board will meet in Executive Session immediately after roll call for most of the day on February 7 and February 8 and anticipates resuming “Open Session” between 4:30 pm and 5:00 pm on both days.

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

2024-01-26T10:09:53-05:00January 26, 2024|Oregon|

Pennsylvania

The Department of Human Services (DHS) continues to work with pharmacy stakeholders on the launch of a new program that will allow pharmacists to bill for a wide variety of clinical services, including MTM (Medication Therapy Management), immunizations and patient counseling. On February 15 from 10:00 am – 12:00 noon, DHS is hosting a pharmacists enrollment training online seminar. You must register to attend. DHS will be requiring each individual pharmacist providing billable services to enroll as a provider, even those in a chain environment. They expect enrollment to open on March 1. We expect a final Bulletin to be published in the next few days with more details about the program, billing instructions and covered services. 

Also in Pennsylvania, a bill to reform PBM practices in Medicaid Managed Care and set a rate floor in the state employees’ benefit program has been introduced. SB 1000, cosponsored by Senators Judy Ward (R) and Tina Tartaglione (D), has been referred to the Health and Human Services Committee for consideration. NACDS assisted in-state partners in drafting the bill and will be actively involved in advocating for its passage. 

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

2024-01-26T10:09:17-05:00January 26, 2024|Pennsylvania|

South Carolina

The Department of Health and Human Services (SCDHHS) consistently offers free Healthy Connections Medicaid training to enrolled Healthy Connections Medicaid providers and their billing agents. These recurring trainings are conducted by SCDHHS’ contracted vendors. Information about the upcoming February-April 2024 training is available online.  

Also in South Carolina, some Healthy Connections Medicaid-enrolled providers were mailed an IRS 1099-MISC form from the Department of Health and Human Services (SCDHHS). The IRS 1099-MISC form providers received in the mail in January 2024 from SCDHHS contains an error. While the dollar amount of “Medical and health care payments” listed in block six of the IRS 1099-MISC form is correct for calendar year 2023, the form indicates it is for calendar year 2022.

Corrected forms are currently being printed and will be mailed in the next two business days. Providers should receive the replacement IRS 1099-MISC forms for 2023 within the next three to seven business days.

The incorrect form showing the 2022 date should be disregarded and not used to file taxes for the 2022 or 2023 calendar years. The error occurred while printing the forms mailed to providers. The forms with the correct calendar year were submitted to the IRS.

If you have any questions, please contact the Provider Service Center at (888) 289-0709, extension four, option one. The Provider Service Center is open Monday through Thursday from 7:30 am to 5:00 pm and Friday from 8:30 am to 5:00 pm. 

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

2024-01-26T10:08:46-05:00January 26, 2024|South Carolina|

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