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.
Illinois
The Department of Healthcare and Family Services is currently offering several new behavioral health courses through its Provider Assistance and Training Hub (PATH). All courses are open for registration in the Medicaid Technical Assistance Center (MTAC) Learning Center. Create or sign into your MTAC account at https://go.uillinois.edu/MTAC to access all available training courses. For training questions, please contact PATH-BH@illinois.edu. For questions about the MTAC Learning Management system, please reach out to omi.training@uillinois.edu.
Also in Illinois, the Illinois Legislative Black Caucus Foundation (ILBCF) is looking to host a statewide Veteran's Day Event November 10-12. Its goal is to give away 1,500-2,000 bags of groceries to Black Veterans throughout the state. To date, they have secured a donation of 500 bags of groceries and are trying to secure 1,000-1,500 additional. They say gift cards would be helpful as well. The groceries would be distributed throughout the state but particularly East St. Louis, Peoria, Champaign, Chicago (south and west sides) and the south suburbs of Chicago/Will County. If you are interested in supporting this event, please contact Tiffany Hightower, the Executive Director of the ILBCF at executivedirector@ilbcf.org or 773-896-6805.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Indiana
The Indiana Health Coverage Programs (IHCP) posted Bulletin # BT2023138 regarding reprocessing claims for certain glucose monitor procedure codes.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Massachusetts
On October 26, the Senate unanimously passed SB (Senate Bill) 2480 which will authorize pharmacists to prescribe, dispense and administer HIV (Human Immunodeficiency Virus) prevention drugs according to Department of Public Health and FDA (Food & Drug Administration) regulations and guidelines. The patient must prove they are HIV negative. The pharmacists may order an HIV test prior to prescribing and dispensing if the patient cannot provide proof of a negative HIV test. The pharmacist shall notify the patient that they will be required to be seen by a primary care provider to receive subsequent prescriptions for pre-exposure prophylaxis. A pharmacist shall not furnish a 60-day supply of pre-exposure prophylaxis to a single patient more than once every two years. The pharmacist shall notify the patient's primary care provider following the dispensing of the drug and provide the patient with a list of local providers if the patient is not under the care of a provider. This bill will now be referred to the House of Representative for its consideration. As was the case last session, this bill will be referred to the Joint Committee on Health Care Financing from where it can be considered as a stand-alone bill or as part of the debate on a comprehensive healthcare reform bill which we expect to begin in the Senate soon.
The Massachusetts Board of Pharmacy posted it's agenda for the November 2 meeting. Three policies are on the agenda as follows:
- Policy 14-02: Board Delegated Review (BDR): The "unknown loss protocol" was removed from the policy since the Board voted for a new "controlled substance loss protocol" at the October meeting. Also added was the ability for BDR to issue a reprimand for the loss of less than #100 units of a Schedule II controlled substance.
- Policy 2021-04: Continuing Education (CE) Requirements for Pharmacists: Details for the required pain management training for collaborative drug therapy management (CDTM) pharmacists were added to the CE policy. With this addition, we request that the advisory titled "Pain Management Training for CDTM Pharmacists" be rescinded.
- Policy 2023-01: Compliance Packaging and Reusable Dose Planners: The change to this policy allows Schedule II and III maintenance medications to be placed in multidrug-single-dose compliance packages.
MassHealth posted its October monthly bulletin that announced the start dates for enforcing the ordering, referring, and prescribing (ORP) requirements. Except the information in this bulletin, all information in APB 361 and APB 376 remains in effect. Due to necessary system updates, the start date to enforce the requirement that claims processed by the Pharmacy Online Processing System (POPS) must include a prescriber who is actively enrolled with MassHealth will be delayed. This requirement will be enforced for service dates on or after May 1, 2024. Pharmacies should continue reviewing informational messages related to this requirement to avoid ORP-related denials when enforcement takes effect.
For more information, please contact NACDS’ Mike Sargent at 207-272-6435.
Michigan
The Department of Health and Human Services issued a notice of proposed policy regarding Documenting Beneficiary Consent Authorizing Automatic Refills of Prescribed Pharmacy Products. Comments are due to MDHHS (Michigan, the Department of Health, and Human Services) (Michigan Department of Health and Human Services) on November 7, 2023.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Minnesota
The Department of Health (MDH) has posted updated information regarding the expansion of prescription drug transparency data under Chapter 70 passed in 2023. The law requires wholesalers, PBMs and pharmacies to report pricing data on drugs of significant public interest in 2024. MDH is developing an online reporting portal for the new stream. Pharmacies will be required to register. The department will release draft guidance in late 2023 for public comment, prior to finalizing the guidance in early 2024. The department is also preparing to release the first list of drugs requiring reporting by January 31, 2024. Pharmacies interested in receiving announcements on prescription drug price transparency may subscribe to Prescription Drug Price Transparency updates.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Nebraska
The Board of Pharmacy distributed its November 6 meeting agenda and the September 18 draft meeting minutes.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Nevada
The Legislative Commission appointed Interim Committee positions. Senator Fabian Donate (D), the co-Majority Whip as the Chair the Interim Committee on Health and Human Services, and Assemblyman David Orentlicher (D) to serve as Vice-Chair.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
New York
Medicaid posted a COVID-19 vaccine billing guidance for this season. The Medicaid “Pharmacists as Immunizers Fact Sheet” has information on how to bill for vaccines for over and under 19 years of age and a link to the Vaccine for Children (VFC) Program. Please be advised that Medicaid does reimburse for the COVID-19 vaccine and administration at Medicaid qualified pharmacies for adults 19 years of age and older. Children under the age of 19 years are vaccinated for COVID-19 and all other ACIP–recommended vaccines at VFC enrolled providers, including their practitioner’s office, public health clinics or, in most areas, their county health department. At this time, pharmacies dually enrolled in Medicaid and VFC may also immunize children between the ages of 3 to under 19 years of age for COVID-19, and ages of 2 to under 19 years for influenza, in accordance with the federal PREP (Public Readiness and Emergency Preparedness) Act and/or state law.
For more information, please contact NACDS’ Mike Sargent at 207-272-6435.
Oregon
The Board of Pharmacy issued a public notice of and agenda for its Strategic Planning Meeting scheduled to be held November 8-9, 2023. See agenda for details to participate in the meeting either in-person or virtually.
Also in Oregon, On August 11, 2023, the Oregon Board of Pharmacy voted to permanently adopt, effective March 1, 2024, OAR 855-115-0150(3) Pharmacist: Prohibited Practices. This rule says that pharmacists are not allowed to diagnose patients. The Board adopted this rule because there is no authority in ORS chapter 689 for pharmacists to diagnose and the Board wanted to make sure that pharmacists know this. On September 25, 2023, the Oregon Board of Pharmacy received a petition to repeal OAR 855-115-0150(3) pursuant to OAR 137-001-0070 Petition to Promulgate, Amend, or Repeal Rule; see below for details.
Proposed Amendments: OAR 855-115-0150(3) Pharmacist: Prohibited Practices
Petitioner's proposed amendment:
"Pharmacists must not:"
"(3) Diagnose."
Pursuant to OAR 137-001-0070(3), the Board of Pharmacy is inviting written public comment on the adopted rule, including
(a) Options for achieving the existing rule's substantive goals while reducing the negative economic impact on businesses;
(b) The continued need for the existing rule;
(c) The complexity of the existing rule;
(d) The extent to which the existing rule overlaps, duplicates, or conflicts with other state or federal rules and with local government regulations;
(e) The degree to which technology, economic conditions, or other factors have changed in the subject area affected by the existing rule, since the agency adopted the rule; and
Written public comments may be submitted to the Board of Pharmacy by email at pharmacy.rulemaking@bop.oregon.gov. The public comment period will close on November 15 at 4:30 pm. The board will review the public comments received at the December board meeting and will in writing, within 90 days after receipt of the petition, either deny the petition or initiate rulemaking proceedings pursuant to OAR 137-001-0070(4)(c). If you have any questions, please reach out to the Rules Coordinator, at pharmacy.rulemaking@bop.oregon.gov.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Texas
The third special session ends November 7, so lawmakers only have a short window of time to move forward on the Governor's priority legislation on school vouchers and funding, prohibiting private employer COVID mandates and border security. Gov. Greg Abbott (R) has hinted at the possibility of a fourth special session if his school vouchers proposal does not pass.
Also in Texas, HEB's Austin Pharmacy and Wellness teams toured NACDS Texas lobbyists through two HEB facilities, educating our team on the operations and healthcare services provided to the local community.
Also in Texas, Gov. Greg Abbott (R) appointed Raymond Charles Winter as Inspector General for Texas Health and Human Services, replacing Sylvia Hernandez Kauffman, who served for six years.
Also in Texas, the Health, and Human Services Commission's (HHSC) Department of State Health Services (DSHS) is hosting an Immunization Webinar on November 8. Topics include influenza programs, adult immunizations, current disease rates and strategies to improve immunization coverage.
Finally in Texas, HHSC's DSHS' announced a $4 million dollar grant to help implement policies and programs to prevent the use of dangerous drugs like fentanyl. The agency will create new tools to analyze the causes and effects of drug poisoning and then use that information to develop science-based strategies to prevent drug use and poisonings.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Virginia
The Department of Medical Assistance Services (DMAS) has invited pharmacy stakeholders to participate in a webinar on October 30 regarding the upcoming implementation of a system to reimburse pharmacies for clinical services as mandated by the passage of HB (House Bill) 1538 of 2023. DMAS also released the presentation from the previous workgroup meeting. DMAS intends to reimburse pharmacies for all the services added to pharmacy scope of practice over the last several legislative sessions, including immunizations and test & treat. DMAS is specifically interested in guidance from pharmacies as they build the claims system. NACDS suggests that members share the invite with staff with expertise in this area.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.