New York
On February 21, NYRx, the New York State Medicaid Pharmacy Benefit Program, held its monthly pharmacy sector meeting. On the agenda were the following:
- AIDS Institute – HCV (hepatitis C virus) drugs & test to treat model.
- DOH (Department of Health) asked the following of pharmacies:
- Does your pharmacy stock hepatitis C medications? How long does it take to get in stock?
- How can we get medications in the client's hands more quickly?
- How can providers build collaborations with their local pharmacies to ensure timely access to hepatitis C medications?
- How have you worked with hepatitis C providers in your community?
- Feedback can be shared with Colleen Flanigan (colleen.flanigan@health.ny.gov)
- DOH (Department of Health) asked the following of pharmacies:
- OMIG (Office of the Medicaid Inspector General) Pharmacy Audit Protocols.
- OMIG utilizes a stakeholder process for updated regulations that includes feedback from DOH and professional associations. OMIG reviews and considers all comments that are submitted before issuing a revised protocol set.
- Bill Schwarz with OMIG added that updated protocols are in development. Feedback may be shared at information@omig.ny.gov.
- Bureau of Medical Review – Incontinence Supplies.
- Incontinence products claims have doubled since 2019 and require a valid diagnosis code that directly relates to incontinence for reimbursement.
- Incontinence products info can be found in the DMEPOS (Durable Medical Equipment, Prosthetics, Orthotics and Supplies) Procedure Manual.
- Starting in April, the DME (Durable Medical Equipment) Procedure Manual will be updated with a separate pharmacy manual. DMPOS Procedure Manual will contain everything that Managed Care Plans are still responsible for.
- Questions: OHIPMedPA@health.ny.gov (1-800-342-3005)
For more information, please contact NACDS’ Mike Sargent at 207-272-6435.
Ohio
The Board of Pharmacy issued updated the Pharmacy Technician Continuing Education guidance this week.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Oklahoma
NACDS is closely monitoring several bills of interest to pharmacies, including SB 1541 that includes test and test for minor ailments and prescribing hormonal contraceptives, SB 1390 that would enhance the Attorney General’s enforcement powers over PBMs and SB 1670, legislation related to PBM audits and MAC pricing.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Oregon
HB 4149 (A-Engrossed), legislation related to PBM Reforms, was amended and passed the House Behavioral Health & Health Care this week. Given the amendments, Chair Rob Nosse (R) stated he will be convening a workgroup after this year's regular session and outlined issues to be addressed to advance additional PBM reforms in the state.
Also in Oregon, SB 1506 (A-Engrossed) passed the Senate and was assigned to the House Behavioral Health & Health Care Committee. It is scheduled for a Work Session on February 28. This bill would allow a pharmacist to test and prescribe, dispense and administer treatment for SAVS-CoV-2 consistent with protocols adopted by the State Board of Pharmacy by rule. It would also permit a pharmacist to delegate to a pharmacy technician or an intern under the pharmacist's supervision the administrative and technical tasks of performing a SARS-CoV-2 CLIA-waived test. Finally, the bill would require payment for these services effective October 1, 2024, with a sunset date of June 30, 2026.
Also in Oregon, HB 4113 (A-Engrossed), legislation requiring all amounts paid by an enrollee or paid by another person on behalf of the enrollee toward the cost of a covered prescription drug be included when calculating the enrollee's contribution to an out-of-pocket maximum, deductible, copayment, coinsurance or other cost-sharing requirements, passed the House Behavioral Health & Health Care Committee.
Also in Oregon, HB 4010 (A-Engrossed), legislation that includes language specifying that the flavoring of a prescription drug is not compounding, passed the House Behavioral Health & Health Care Committee.
Finally in Oregon, the Oregon Health Authority's Immunization Policy Advisory Team will meet on March 7 via Zoom. The final agenda will be available at the meeting or via email request three days before the meeting date by contacting imm.info@odhsoha.oregon.gov. Participation via Zoom requires advance registration using this link. Those who register will receive a confirmation email with additional information. Note: this information is necessary to join the meeting.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Pennsylvania
HB 2037, a bill to match the PREP Act’s immunization authority for pharmacists and technicians, has been introduced. It is cosponsored by a diverse group of bipartisan legislators that represent both rural and urban medically underserved areas of the state. Rep. Donna Bullock (D, Philadelphia), Majority Chair of the Children and Youth Committee, is the prime sponsor. Upon introduction, the bill was referred to her committee.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
South Dakota
HB 1147, legislation addressing discriminatory acts against entities participating in a 340B drug pricing program, unanimously passed the Senate Health and Human Services Committee and was deemed “certified uncontested” and placed on consent.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Tennessee
The Beacon Center of Tennessee’s newest report, “A Dose of Free Market Medicine,” compares Tennessee’s laws and regulations around pharmacists to recent reforms in other states, including Florida, Iowa, Kansas and Idaho. By enacting similar reforms, Tennessee policymakers can expand access to health care.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Utah
HB 132 (3rd Substitute), permitting pharmacists or pharmacy interns to engage in therapeutic substitution pursuant to a request or consent by a patient, passed the Senate and is eligible to be sent to Gov. Spencer Cox (R).
Also in Utah, HB 425 (1st Substitute), legislation related to PBM and health insurance reforms, passed the House Business and Labor Committee. The bill includes provisions related to pharmacy network requirements for health benefit plans, modified requirements for pharmacy audits and pharmaceutical manufacturer rebates applied at the point of sale.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Vermont
On February 28, the Board of Pharmacy will be holding its regularly scheduled meeting at 9:00 am. The agenda has been posted.
For more information, please contact NACDS’ Mike Sargent at 207-272-6435.
Washington
E2SSB 5213, PBM reform legislation pharmacy supports, continues to advance. The bill passed the Senate and was referred to the House Health and Wellness Committee where it passed on February 21 by a vote of 11-6.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Wyoming
HB 173, legislation related to the inclusion of retail pharmacies as in-network providers, failed a vote to be introduced. In an even-numbered year, bills in Wyoming must pass a vote in order to be formally introduced.
Also in Wyoming, SF 0100, legislation related to prompt payment of clean pharmacy claims, passed the Senate Committee of the Whole (COW) on February 21.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Arizona
NACDS submitted a letter to the Senate Finance and Commerce Committee in support of SB 1165, expanding PBM reforms in the state. The bill would prohibit PBMs from deploying discriminatory reimbursement practices that favor pharmacies affiliated with and under common control of the PBM over other, non-affiliated, network pharmacy providers. Additionally, the bill also includes provisions that would strengthen the state’s existing laws for audits conducted by PBMs, preventing PBMs from engaging in audit practices that penalize pharmacy providers for clerical or administrative issues on claims for covered medications that otherwise are payable.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
California
The Department of Health Care Services posted the following alerts:
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Colorado
Legislation pharmacies are supporting, HB 24-1045, which includes language in Sections 7 and 8 on pharmacy treatment and payment for substance use disorders (SUDs) is scheduled for a hearing on February 20 in the House Health and Human Services Committee.
Also in Colorado, the Colorado Pharmacists Society's (CPS) Pharmacy Day at the Capitol is February 28.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Indiana
The Family and Social Services Administration's (FSSA) Health Coverage Programs (IHCP) provided pharmacy updates approved by the Drug Utilization Board.
Also in Indiana, SB 192, legislation allowing a pharmacist to administer any immunization that is recommended by the Centers for Disease Control and Prevention Advisory Committee on Immunization Practices (ACIP) under a drug order, a prescription or a physician protocol, died in the House Appropriations Committee. Current law restricts the types of vaccines that can be administered under a physician protocol.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Kansas
HB 2747, legislation that would allow pharmacists to provide HIV post-exposure prophylaxis (PEP), was referred to the House Committee on Health and Human Services.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Kentucky
A bill that would apply many of the PBM reforms adopted in Medicaid to commercial and state employees’ plans has been introduced. SB 188 is sponsored by Sen. Max Wise (R), a longtime advocate of PBM reform. A few of the provisions included in this comprehensive bill include: a NADAC and Medicaid Dispensing Fee rate floor, anti-steering and anti-mandatory mail order language, a broad definition of specialty pharmacy and a formula to determine network adequacy.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Louisiana
The Department of Health's (LDH) Informational Bulletin 24-3 providing Medicaid immunization fee schedule updates has been posted.
Also in Louisiana, providers who bill for medically necessary services for specialized mental health and substance use services for dual eligibles for Medicaid enrollees should follow the process detailed in LDH's Informational Bulletin 15-17.
Also in Louisiana, LDH's Informational Bulletin 24-2 provides the American Society of Addiction Medicine (ASAM) criteria updates for adult substance use services.
Finally in Louisiana, the agenda for the February 21 Board of Pharmacy meeting should be available on the website soon.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Maine
On February 12, the Department of Health and Human Services updated its standing order regarding COVID-19 at home tests. The Standing Order authorizes licensed pharmacists to create a prescription for the over-the-counter (OTC) COVID-19 at home tests for eligible MaineCare members.
For more information, please contact NACDS’ Mike Sargent at 207-272-6435.
Nebraska
The Drug Utilization Review (DUR) Board posted the DUR Board Meeting Minutes from November 14, 2023. The next DUR Board Meeting will be held virtually on May 7.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
New Mexico
The Legislature adjourned its 30-day session on February 15.
Also in New Mexico, HB 165, legislation increasing the Medicaid Managed Care professional dispensing fee for independent pharmacies only, unanimously passed both houses and was sent to Gov. Michelle Lujan-Grisham (D) for signature. Members are urged to contact the Governor to urge her to veto the bill.
Also in New Mexico, HB 33, the Prescription Drug Transparency Act, was also sent to the Governor to sign into law.
Finally in New Mexico, the Governor has until March 6 to sign bills into law. Any legislation not acted upon by the governor is pocket vetoed.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
New York
NYRx, the New York State Medicaid Pharmacy Benefit Program, announced an update to its Brand Less Than Generic program (BLTG). Advair HFA® and Advair Diskus® are subject to the NYRx BLTG. In December 2023, due to market availability issues, NYRx temporarily allowed for generic Advair HFA® and Diskus® to adjudicate without prior authorization (PA) if the brand product was not available from the pharmacy’s wholesaler. The manufacturer has confirmed that Advair HFA and Diskus supply issues have resolved, and pharmacies will be able to obtain the supply needed for their NYRx members. Effective February 28, fluticasone/salmeterol HFA and Diskus (generic Advair) will once again require PA.
Also in New York, in conformance with State Education Law, a pharmacist shall dispense a less expensive, therapeutically equivalent drug containing the same active ingredients, dosage form and strength as the drug prescribed/ordered. This includes substituting the brand name drug when NYRx has determined it to be the less expensive alternative for the patient. Brand name drugs included in this program:
- Do not require “Dispense as Written” (DAW) or “Brand Medically Necessary” on the prescription.
- Have a generic copayment.
- Are paid at the Brand Name Drug reimbursement rate or usual and customary price, whichever is lower (SMAC/FUL are not applied).
- Do not require a new prescription if the drug is removed from this program.
Also in New York, Sen. Jeremy Cooney (D) introduced a bill, S8545, that authorizes registered pharmacy technicians to administer the same immunizations as licensed pharmacists under direct supervision of such licensed pharmacist. NACDS, in conjunction with the Community Pharmacy Association of New York State, will continue to support the bill and encourage passage this session.
Finally in New York, Gov. Kathy Hochul (D) signed S8096, a bill that relates to the effective date of the self-administered hormonal contraceptive prescribing authority for pharmacists. The new law changes the effective date of the 2023 law from eighteen months from enactment to January 1, 2024.
For more information, please contact NACDS’ Mike Sargent at 207-272-6435.
North Carolina
North Carolina Drug Control Unit issued an FAQ for dispensing professionals on reporting Gabapentin to the Controlled Substance Reporting System (CSRS) effective March 1. Pharmacists with additional questions should contact the Drug Control Unit. Note that based on a North Carolina Retail Merchants Association amendment, pharmacies are not required to report gabapentin to the CSRS when gabapentin is a component of a compounded prescription that is dispensed in dosages of 100 milligrams or less.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Oregon
The Board of Pharmacy posted a revised February 21 Public Health & Pharmacy Formulary Advisory Committee (PHPFAC) meeting agenda.
Also in Oregon, in advance of its February 21 meeting to review a pre-selected list of prescription drugs deemed eligible for affordability review, NACDS submitted comments to the Prescription Drug Affordability Board to express concern with the inclusion of vaccines. Additionally, NACDS expressed concern that there may be a significant impact on the availability and accessibility of certain prescription drugs at a patient's neighborhood pharmacy through the unintended consequences of inadequate and unfair pharmacy reimbursement by some payers resulting from the establishment of Upper Payment Limit (UPL) policies.
Also in Oregon, the Prescription Drug Affordability Board posted the agenda for its next meeting on February 21. Ozempic, Trulicity and Shingrix are listed on the agenda for affordability review. Please register in advance of the meeting.
Finally in Oregon, the Prescription Drug Affordability Board is seeking applicants with a background in clinical medicine or healthcare economics to fill vacancies. The board consists of eight members appointed by the governor and confirmed by the Senate. Members participate in monthly board meetings held virtually via Zoom. The purpose of the board is to protect Oregonians from the high cost of prescription drugs. Submit applications in Workday. Learn more in this information letter.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Pennsylvania
The Department of Human Services has released the much-anticipated Medical Assistance Bulletin for the new pharmacy payment for clinical services program which will launch on March 1.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.