Maine
The Board of Pharmacy updated its rulemaking for pharmacists to administer vaccines, consistent with Public Law 2023 Chapter 170. On October 6, 2023, the Board issued Written Statement #01-2023 indicating that the Board does not believe rulemaking is necessary before an appropriately licensed and ADV-certified pharmacist is permitted to administer vaccines consistent with the above-stated authorizations.
For more information, please contact NACDS’ Ben Pearlman at 617-515-2603.
Massachusetts
On October 19, MassHealth updated a previous notice that outlined the upcoming discontinuation of brand Flovent products and several associated changes to MassHealth's coverage of inhaled respiratory agents. To facilitate transition from Flovent products to alternative inhalers, MassHealth has removed the PA (prior authorization) requirement from Arnuity Ellipta (fluticasone furoate inhalation powder) earlier than anticipated. Claims for Arnuity Ellipta processed through the Pharmacy Online Processing System (POPS) will be paid without PA beginning October 19, 2023. The MassHealth Drug List will be updated to reflect this change in PA status on December 4, 2023.
The previously approved emergency regulations for pharmacists prescribing hormonal contraceptives were not published in the Friday, October 13 register by the Massachusetts Secretary of State. The next publishing date will be October 27, at which time they are expected to be published and will become effective upon publication. In the meantime, the Board of Pharmacy is developing a circular letter which will deal with all the operations issues regarding these regulations, including training and the screening risk assessment tools. These regulations come straight from the law that was signed as part of the Fiscal Year 23 Annual State Budget.
For more information, please contact NACDS’ Ben Pearlman at 617-515-2603.
Montana
The Department of Public Health and Human Services (DPHHS) has received calls regarding denials and prior authorization requirements on stimulants due to the shortages. Many of these can be handled by the pharmacy by calling the prior authorization (PA) call center at 1-800-395-7961. Please try the PA call center before involving the provider or turning the patient away. The DPHHS is approving short term prior authorization to mitigate some of the issues caused by these shortages. If you have questions, please contact Dani Feist, Pharmacy and Home Infusion Program Officer at 406–444–2738.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Nebraska
The Department of Health and Human Services issued Provider Bulletin 23-26 announcing changes to the Coverage and Payment of Adult Vaccines effective October 1, 2023.
Also in Nebraska, the Department of Health and Human Services announced the next COVID-19 Provider call will be held on November 1 at noon (Central); see details below to join the call. Also, the recording from October 4 COVID-19 Provider call has been posted.
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)
Also in Nebraska, the Department of Health and Human Services posted the 471-000-540 Medicaid Practitioners Fee Schedule for Injectables (October 1, 2023).
Also in Nebraska, the Department of Health and Human Services posted the draft minutes from the September 12 Drug Utilization Review (DUR) Board Meeting. The next DUR Board Meeting will be held on November 14.
Also in Nebraska, the Department of Health and Human Services launched the iServe Nebraska Portal's new integrated benefit application that will make it easier for Nebraskans to apply for Medicaid and Economic Assistance benefit programs. Nebraskans can apply for benefits such as food, heat, electricity, healthcare, childcare, and other essential needs at the same time using the single, online iServe Nebraska application.
Also in Nebraska, Gov. Jim Pillen (R) approved emergency regulations related to the Let Them Grow Act. Please note the requirements for picking up prescribed medications from a pharmacy. For both puberty blocking drug prescriptions and cross-sex hormone prescriptions for a patient who has not reached the age of majority, these prescribed medications picked up from a pharmacy are required to be picked up by the patient's parent, legal guardian, or the patient if the patient is an emancipated minor. Additionally, these prescriptions must identify the drugs being prescribed are for the treatment of gender nonconformity or gender dysphoria. The process to implement final regulations for LB 574 will proceed pursuant to the Administrative Procedure Act. The anticipated public hearing date is November 28; a draft of the proposed final regulations will be posted at least 30 days prior to that hearing.
Finally in Nebraska, the Department of Health and Human Services (DHHS) released the final draft of regulations for the Let Them Grow Act. A public hearing will be held on November 28 from 7:00 AM to 7:00 PM at the Lancaster Event Center – Lincoln Room at 4100 N 84th St., Lincoln, NE 68507. People interested are encouraged to provide written comments via mail, fax, or email, no later than 11:59 PM on the day of the hearing. Comments may be faxed to 402-742-2382, emailed to dhhs.regulations@nebraska.gov or mailed to: DHHS Legal Services, PO Box 95026, Lincoln NE 68509-5026. Additional information can be found on the Frequently Asked Questions page on the DHHS website.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
New York
NACDS submitted a comment letter in support of the Proposed Rule published in the State Register by the Department of Financial Services on August 16, 2023, related to Definitions, Licensing of Pharmacy Benefit Managers (PBMs), Contracting with Network Pharmacies, Acquisition of PBMs, Consumer Protections and Audits
The Department of Health (NYSDOH (New York State Department of Health)) reported an update to the State Plan Amendment (SPA) allowing reimbursement for Medicaid covered professional services included within the pharmacist / pharmacy intern scope of practice and provided by a pharmacist / intern. For instance, once the new law on oral contraception is effective, this will apply to pharmacists dispensed oral contraception. Also, according to NYSDOH, the reimbursement will be provided to pharmacies, not to pharmacists per the New York SPA 23-0037: "This amendment proposes to allow pharmacists and pharmacy interns to provide Medicaid covered services to the limits of their scope of practice. We conducted our review of your submittal according to statutory requirements in Title XIX of the Social Security Act. This letter is to inform you that New York Medicaid SPA 23-0037 was approved on August 24, 2023, with an effective date of April 1, 2023."
For more information, please contact NACDS’ Ben Pearlman at 617-515-2603.
North Carolina
IMMUNIZING PHARMACISTS' AUTHORITY TO ADMINISTER COVID-19 AND FLU VACCINES TO PEDIATRIC PATIENTS. With flu and COVID vaccine season upon us, several pharmacists have reached out to Board staff about immunizing pharmacist authority to administer flu and COVID vaccine to pediatric patients. With all the recent changes to North Carolina law and PREP (Public Readiness and Emergency Preparedness) Act declarations, it can be confusing. Here is the skinny on flu and COVID vaccine authority:
- PREP Act declarations authorizing pharmacists to administer flu and COVID vaccine to patients aged 3 years and older are still in effect and will be until December 31, 2024.
- State law now allows immunizing pharmacists to administer flu and COVID vaccine to patients aged 7 years and older pursuant to protocol and parental permission. State law allows immunizing pharmacists to administer any ACIP-recommended vaccine to patients 6 and older pursuant to prescription and parental permission.
- So, for flu and COVID – immunizing pharmacists can administer to patients 3 years and older and can do that under their own authority under the PREP Act. Immunizing pharmacists can also use Dr. Tilson's statewide standing order to do this for COVID vaccine (which typically makes billing and recordkeeping easier). These paths are available until December 31, 2024.
- After December 31, 2024, immunizing pharmacists can administer flu and COVID vaccine pursuant to protocol, but only to patients aged 7 years or older, or pursuant to prescription for patients aged 6 years or older.
For a comprehensive overview of immunizing pharmacist authority, see the FAQ guidance.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Oklahoma
Effective September 1, 2023, pharmacy technicians may administer any vaccine that is approved or licensed by Food and Drug Administration (FDA) if they have successfully completed an Accreditation Council for Pharmacy Education (ACPE)-accredited training program and have current CPR (cardiopulmonary resuscitation) certification. Also, the pharmacy technician must complete one hour of immunization-related ACPE-accredited or Oklahoma State Board of Pharmacy-approved continuing education every year.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Oregon
The Board of Pharmacy permanently adopted the following rules at the October 2023 Board Meeting effective October 17, 2023, unless otherwise noted:
- Division 007 related to Compliance w/OHA COVID-19 rules – Repealed
- Divisions 019/041/043/044/139 related to Short-acting Opioid Antagonist
- Division 045 related to USP (United States Pharmacopeia) <795> and USP <797> Standards adopted by Reference
- Division 115 related to Short-acting Opioid Antagonist – Effective March 1, 2024
Also in Oregon, the Board of Pharmacy announced the agency's new director, Jamal Fox. Fox has more than 20 years of experience in the public and private sectors. Fox will start his new role with the agency beginning October 25.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Rhode Island
Please see the most recent Provider Update for Medicaid. All provider updates may also be found here.
Also in Rhode Island, effective October 1, 2023, Katie Beckett recipients will now be enrolled in a managed care organization for Case Management Services only. Case Management services are provided by CEDARR Center Providers. All other services will still be reimbursed through Medicaid fee for service.
When checking eligibility on the Healthcare Portal (HCP) you will see the following (see sample picture below):
- A new row under Benefit Plan Details – Katie Beckett Case Management
- A new row under Managed Care Details – Displays the name and dates of the Managed Care Plan the recipient is enrolled in.
If you are a CEDARR provider and the recipient is enrolled in the Katie Beckett case management program, then you must bill your services to the managed care plan on file. All other providers will continue to bill Medicaid Fee for Service.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
South Dakota
The Board of Pharmacy posted their October 2023 Newsletter including the following sections:
- South Dakota Board Welcomes Newly Registered Pharmacists and Pharmacies
- DSCSA (Drug Supply Chain Security Act) Interoperability Standards Delayed Until November 2024
- USP Compounding Chapters Update
- Does a Pharmacy Need to be Licensed to Ship Medications to Other States?
- The Board Has a New Website
- The Board Will Propose a Bill to Increase License Fees in the 2024 Session
- DEA (Drug Enforcement Administration) Issues Multiple Guidance Documents in Recent Months
- PDMP (Prescription Drug Monitoring Program) Update
- Board Meeting Dates, Board of Pharmacy Members and Board of Pharmacy Staff Directory
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Tennessee
To assist prescribers and providers, prior authorization (PA) requirements can be bypassed for certain medications when specific medical conditions exist. Those specific medications and diagnoses can be found here. Prescribers are encouraged to include the applicable diagnosis code on written prescriptions for inclusion on the electronic pharmacy claim. The submitted claim should include a Diagnosis Code Qualifier (Field # 492-WE) of "02," indicating ICD-10, as well as the appropriate Diagnosis Code (Field # 424-DO).
If you have any questions, contact the OptumRx Pharmacy Supports Center at 866-434-5520 or tnrxeducation@optum.com.
Also in Tennessee, the October 31 Drug Utilization Committee (DUR) Board meeting will be held virtually via Microsoft Teams. Please Click Here or Phone number: +1 952-222-7450 Phone Conference ID: 857 579 147#
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Texas
Gov. Greg Abbott (R) called lawmakers back to Austin this week for a third 30-day special session to advance border security measures, address school choice/vouchers and education savings accounts and tackle private employer COVID vaccine mandates.
Also in Texas, prior to the third special session, State Comptroller of Public Accounts Glenn Hegar (R) announced a certification revenue estimate (CRE) for the Fiscal Year 2024-25 biennium projecting a Rainy-Day Fund balance of $23.77 billion.
Also in Texas, the Health, and Human Services Commission (HHSC) Medicaid posted the September 2023 End of Continuous Medicaid Coverage Dashboard.
Also in Texas, the next quarterly meeting of the Board of Pharmacy (TSBP) is on November 7 in Austin. This will be the first meeting with the new Executive Director/Secretary Danny Carroll, PharmD.
Also in Texas, NACDS submitted comments to the State Board of Pharmacy (TSBP) on its strategic plan for fiscal years 2025-29, recommending statutory and regulatory changes to expand upon the temporary flexibilities under the federal PREP Act related to vaccinations and Test & Treat services. NACDS also urged TSBP to eliminate the ratio at a central fill Class A pharmacy and expand telepharmacy services beyond FQHCs (Federally Qualified Health Centers).
Finally in Texas, the Health, and Humans Services Commission (HHSC) Vendor Drug Program (VDP) Medicaid announced several changes in Preferred Drug list status effective on October 16, 2023, needed because of the shortage of several preferred brand name medications.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Washington
The five-member Prescription Affordability Board (PDAB) held its first hybrid meeting on October 20.
Also in Washington, the State Chief Science Officer Dr Tao Sheng Kwan-Gett signed an updated statewide standing order to dispense naloxone.
Also in Washington, the Department of Health (DOH) Immunization Division is hosting a COVID-19 and RSV Vaccine Updates Webinar (online registration) on Tuesday, October 24 from 12:00 PM – 1:00 PM Pacific. Topics will include COVID-19 vaccine updates and RSV vaccine recommendations for older adults and pregnant persons, as well as recommendations for infants. The online seminar will be recorded.
Finally in Washington, the Health Care Authority's Health Care Cost Transparency Board met on October 18.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Alaska
Effective July 15, 2023, there is no longer a requirement for facilities or pharmacies to submit an application for changes to ownership, location or names.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Arizona
The Board of Pharmacy’s final rule to permanently authorize pharmacy technicians to administer vaccines under the delegation and supervision of a pharmacist was published in the Arizona Administrative Register, Volume 29, Issue 38 (see pages 2191-2195) with an effective date of September 6, 2023.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
California
The Department of Health Care Services (DHCS) posted the following alerts and monthly bulleting on the Medi-Cal Rx Web Portal:
- Diabetic Supplies: Updates to the Quantity and Fill Limitations for Diabetic Testing Supplies (October 5)
- Updates to Enteral Nutrition Prescription Requirements (October 4)
- 90-Day Countdown: Medi-Cal Managed Care Plan Transition (October 3)
- Respiratory Syncytial Virus (RSV) Vaccines ArexvyTM and AbrysvoTM Now on the Contract Drugs List (October 3)
- How to Resolve Reject Code 76 – Plan Limitations Exceeded (October 2)
- COVID-19 Antigen Over-the-Counter Test Coverage Updates, Effective November 1, 2023 (October 1)
- Medical Supplies: Future Changes to Continuous Glucose Monitoring Systems Coverage Criteria and Prior Authorization Bundling (October 1)
- Diabetic Supplies: Updates to the Dexcom G7® Continuous Glucose Monitoring Sensor Package Size Description, Effective October 1, 2023 (October 1)
- Medi-Cal Rx Monthly Bulletin for October (October 1)
- Changes to the Medi-Cal Rx Contract Drugs List (October 1)
- Changes to Medi-Cal Rx Contract Drugs List – Authorized Drug Manufacturer Labeler Codes (October 1)
- Changes to Medi-Cal Rx Pharmacy Reimbursable Physician Administered Drugs (October 1)
- Updates to the Medi-Cal Rx Provider Manual (October 1)
- Medi-Cal Rx Weekly Wrap-up for September 22-28 (September 29)
- Reinstatement Spotlight (September 29)
- Update: Reimbursement for New Commercial COVID-19 Vaccines (September 22).
Also in California, NACDS submitted a letter of support to Gov. Gavin Newsom (D) urging him to sign AB 1341. The governor subsequently signed AB 1341 (Chapter 276, Statutes of 2023) on September 30. The newly bill enacted permits pharmacists to provide COVID-19 medication as well as offer broader options of substance use disorder treatments as specified in the bill.
Also in California, NACDS submitted a letter to Gov. Gavin Newsom (D) urging him to veto AB 1286, legislation that would impose arbitrary staffing limits and impede pharmacies’ ability to optimize the use of pharmacy technicians to assist with technical duties that do not require a pharmacist’s professional judgement.
Finally in California, NACDS submitted a letter of support to Gov. Gavin Newsom (D) urging him to sign AB 317, legislation helping to support patient access to essential healthcare services provided by pharmacists by requiring healthcare service plans that cover care that is otherwise within pharmacists’ scope of practice to reimbursement pharmacy providers for delivering those services.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Connecticut
The Department of Consumer Protection urges pharmacists to continue to offer to prescribe naloxone for patients, when appropriate. This includes when filling prescriptions for:
- Medications within the opioid class of drugs;
- Patients with a history of opioid use disorder;
- Family members and friends of individuals with a history of opioid use disorder and
- Upon request by a patient.
As some insurance providers, including Medicaid, may continue to cover Narcan and ReVive, pharmacists should continue to submit claims when dispensing naloxone prescribed by a pharmacist or other authorized prescriber. Patients whose insurance providers do not cover these medications should contact their insurance provider for more information. Additional information can be found on the Drug Control Division website.
For more information, please contact NACDS’ Ben Pearlman at 617-515-2603.
Florida
Gov. Ron DeSantis (R) and members of the Florida Cabinet approved rules to implement several provisions of the Prescription Drug Reform Act (SB 1550). The rules increase accountability among pharmaceutical middlemen known as pharmacy benefit managers (PBMs). As signed by the Governor earlier this year, SB 1550 institutes the most comprehensive reforms to Florida’s prescription drug market in state history. Additional information on the bill can be found here.
Also in Florida, the Agency for Health Care Administration (Agency), along with its fiscal agent, Gainwell Technologies, is introducing enhancements implemented as part of the new NPI initiative. A new Taxonomy Master List (TML) Tip Sheet, an updated Provider Master List (PML) Tip Sheet and an updated Pending Provider List (PPL) Tip Sheet is now available. The updated PML and PPL test examples are now available. The release of the updated PML and PPL changes will occur on October 26, 2023. After the release, a copy of the former version of the PML and PPL will remain archived on the Registration page of the Managed Care section of the Florida Medicaid Public Web Portal for reference. The release of the updated TML changes occurred on September 28, 2023. The release will replace the current version of the TML on the Florida Medicaid Public Web Portal. To access a copy of the new TML Tip Sheet and the updated PML and PPL Tip Sheets, please visit the Florida Medicaid Public Web Portal at mymedicaid-florida.com, navigate to the Agency Initiatives tab, and select NPI Initiative.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Indiana
The Department of Health issued the standing order and protocol for pharmacists to provide without a prescription self-administered hormonal contraceptives products.
- Statewide Standing Order for Administration of Hormonal Contraceptives (updated 9/1/23)
- Appendix A
- Appendix B
- Appendix C
- Appendix D
- Statewide Protocol for Hormonal Contraceptives (updated 9/1/23)
Also in Indiana, the state’s Health Coverage Programs (IHCP) Medicaid issued several bulletins:
- Pharmacy updates approved by Drug Utilization Review Board September 2023
- IHCP updates Preferred Diabetes Supplies List
- IHCP expands coverage for Vaxneuvance to the pediatric population
- Correcting the ages covered through the VFC (Vaccines for Children) program for members ages 6 weeks through 18 years of age
- IHCP updates pharmacy benefit long-acting reversible contraceptive coverage
IHCP removes cost-sharing obligations for pharmacist-administered adult vaccines
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Iowa
The Department of Health and Human Services, Iowa Medicaid posted INFORMATION LETTER NO. 2503-MC-FFS – 2023 Annual Provider Training.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Kansas
The Board of Pharmacy announced that the Collaborative Drug Therapy Management Committee adopted several protocols for testing and initiation of therapy for:
– Suspected Influenza in Adult Patients
– Suspected Influenza in Patients under 18 years of age
– Suspected Acute Group A Streptococcal Pharyngitis in Adult Patients
– Suspected Acute Group A Streptococcal Pharyngitis in Patients under 18 years of age
– Suspected Acute Uncomplicated Lower Urinary Tract Infection in Women
Also in Kansas, the Board of Pharmacy approved a new emergency opioid antagonist (EOA) protocol adding an opioid antagonist drug ready-to-use nasal spray device to the drugs that may be dispensed.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Kentucky
It is NACDS’ understanding that pharmacy claims for the updated Pfizer-BioNTech and Moderna COVID-19 vaccines have been rejecting under the pharmacy benefit through MedImpact. The Kentucky Pharmacy Association shared with us that Medicaid has decided to cover the new vaccines under the pharmacy benefit. MedImpact is working on system edits to accommodate pharmacy billing and will notify pharmacies when it is implemented. Additionally, managed care coverage will begin for the Abrysvo (Pfizer) and Arexvy (GSK) RSV vaccines effective October 6. For more information on Medicaid vaccine coverage, please see the updated version of MedImpact’s Vaccine Coverage Expansion.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Louisiana
Effective October 1, 2023, the Department of Health (LHD) is increasing the professional dispensing fee (PDF) $0.82 to $11.81 for local pharmacies only for all Medicaid Fee-for-Service (FFS) and Managed Care Organization (MCO)claims. The current PDF is $10.99.
Also in Louisiana, the Department of Health (LDH) Bureau of Health Services Financing’s Interim Medicaid Executive Director Kimberly Sullivan announced the new implementation date for the Single Pharmacy Benefits Manager (PBM) for Managed Care Organizations (MCOs) is now October 28, 2023. Magellan Medicaid Administration Inc. will serve as the single PBM processor for all six MCOs (Aetna, AmeriHealth Caritas, Healthy Blue, Humana Healthy Horizons, Louisiana Healthcare Connections and United Healthcare).
Also in Louisiana, the Board published five final rules in the September 20, 2023, edition of the Louisiana Register, with immediate effective dates.
- Regulatory Project 2023-03 – Pharmacy Benefit Managers
- Regulatory Project 2023-04 – Healthcare Workplace Violence Prevention
- Regulatory Project 2023-05 – Pharmacy Change of Ownership
- Regulatory Project 2023-06 – Staffing Ratios
- Regulatory Project 2023-08 – DATA-Waiver Registration Elimination
Finally in Louisiana, the Department of Health (LDH) Medicaid issued several documents detailing changes also effective October 1:
- Louisiana Medicaid Pharmacy Maintenance Medications Professional Dispensing Fee for Managed Care Organizations (MCOs) – Effective October 1, 2023
- Louisiana Medicaid Pharmacy Single Pharmacy Benefits Manager (PBM) for Medicaid Managed Care – Effective October 1, 2023
- Louisiana Medicaid Pharmacy Clotting Factor Products Update – Effective October 1, 2023
- Louisiana Medicaid Pharmacy Counseling for Vaccines – Effective October 1, 2023
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Maryland
Medicaid has issued Advisory #251 from the Office of Pharmacy Services in reference to the COVID-19 Home Test Kit Coverage for The Maryland Medicaid Fee-for-Service (FFS) Program. Anyone interested in directly receiving upcoming Advisories may forward his/her name, company affiliation and email address directly to: Deborah.washington@maryland.gov.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Michigan
The Board of Pharmacy has posted the public notice and agenda for the October 30 Rules Committee Work Group meeting and the minutes from the September 11 Rules Committee Work Group meeting.
Also in Michigan, MDHHS (Michigan Department of Health and Human Services) has proposed a rule regarding documenting patient consent for automatic refills that aligns with 2014 CMS guidance. Comments are due November 7 to the email noted on the policy’s transmittal sheet.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.