Georgia
The Legislature convened on January 8. Legislation regarding reimbursement and scope issues that carried over from the 2023 session are expected to be heard during the 2024 session.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Idaho
On April 6, 2023, Gov. Brad Little (R) signed HB 71, the Vulnerable Child Protective Act prohibiting puberty blockers, cross-sex hormones, and sex reassignment surgeries for children under the age of 18 when administered or performed for the purpose of changing the appearance of a child's sex with exemption for medically necessary uses of these drugs and procedures. On December 26, 2023, in a preliminary order, U.S. District Judge B. Lynn Winmill issued an order enjoining enforcement of HB 71 pending the outcome of litigation initiated by families filing a suit challenging the state law; Judge Winmill wrote that the 14th Amendment of the U.S. Constitution's guarantees of equal protection and due process give parents the right to get gender-affirming care for their children.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Illinois
The Department of Healthcare and Family Services (HFS) has issued a Provider Notice regarding Respiratory Syncytial Virus (RSV) vaccines for Medicaid customers. Additional information on other Provider Notices regarding these vaccines are available online.
Questions regarding this notice may be directed to a pharmacy consultant in the Bureau of Professional and Ancillary Services at 877-782-5565 for Medicaid Fee-for-Service claims, or the appropriate Medicaid Managed Care program.
Also in Illinois, the Department of Healthcare and Family Services (HFS) continues to prepare for the release of the new over-the-counter (OTC) birth control pill, Opill, which is anticipated in early 2024. Opill will be covered by HFS under both the Medicaid Fee-for-Service (FFS) and Managed Care programs without a prescription for women aged 18 years and older.
HFS requires pharmacies to submit all claims, including those for OTC medications, with a prescriber National Provider Identifier (NPI) in the Prescriber ID field (411-DB). For Opill, pharmacies may bill using the Department of Public Health standing order prescriber NPI for hormonal contraceptives.
Questions regarding this notice may be directed to a pharmacy consultant in the Bureau of Professional and Ancillary Services at 877-782-5565 for FFS claims, or the appropriate Medicaid Managed Care program.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Indiana
The legislature convened its 60-day short session on January 8.
Also in Indiana, the state Health Coverage programs (IHCP) issued two bulletins of interest to pharmacies:
- Coverage removed from Pfizer and Moderna COVID-19 vaccination replacement codes
- Pharmacy updates approved by Drug Utilization Review Board December 2023.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Iowa
The Department of Health and Human Services, Iowa Medicaid posted INFORMATIONAL LETTER NO. 2543-MC-FFS: Amerigroup Iowa, Inc. Rebranding to Wellpoint Iowa, Inc.
Also in Iowa, on January 3, 2024, Wellpoint released Clinical UM Guideline (Guideline #CG-DME-42) regarding the use of continuous glucose monitoring devices (CGMs). Also review the Iowa Administrative Code and Department of Human Services Medical Equipment and Supply Dealer Provider Manual for related information; see pages 39-40. Please contact the following for assistance: Angela Dillon or Joely Anderson.
Also in Iowa, in response to complaints by Iowa pharmacies, Andria Seip, Senior Health Policy Specialist, Iowa Insurance Division, sent a memo on January 4, 2024, to PBMs (Pharmacy Benefit Managers) licensed in the state that contracts requiring reimbursement models using "effective rates" are considered prohibited under Iowa Code section 510B.8C.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Kansas
The legislature convened on January 8.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Kentucky
The Medicaid Advisory Committee approved several motions suggested by the Pharmacy Technical Advisory Committee (PTAC), that NACDS serves on, to improve access to pharmacy vaccines in the Medicaid program:
- A written communication will be delivered to pharmacies clarifying that, per the rule passed last year, enrollment in VFC (Vaccines for Children) program is not required and claims will be reimbursed.
- They will work with PTAC to change policy to allow pharmacies to bill for vaccines in Medicaid FFS (Fee-for-Service).
- They will work with PTAC on a statewide protocol for pharmacists to administer HPV (HUMAN PAPILLOMA VIRUS) vaccines to increase adolescent vaccination rates.
Members are encouraged to share their thoughts and suggestions on these proposed policy changes with NACDS' Jill McCormack.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Louisiana
On January 7, Gov. Jeff Landry (R) was sworn into office, replacing former Gov. John Bel Edwards (D), who had reached his term limit. Ralph Abraham, MD, a physician, was appointed head of the Louisiana Department of Health. NACDS and our in-state partner, the Louisiana Alliance for Retail Pharmacies (LARP), have requested a meeting.
Also in Louisiana, the new Legislature elected last Fall was sworn in on January 8. Currently, Republicans hold a supermajority in both Houses.
Also in Louisiana, NACDS' in-state partner, the Louisiana Alliance of Retail Pharmacies (LARP), submitted a comment letter to the Board of Pharmacy at the December 28, 2023, public hearing raising concerns about a proposed rule on product integrity that implements temperature control measures for shipments of prescription drugs to patients. Specifically, the proposed rule change would require ALL home delivery medications, including room temperature medications, to be sent in temperature-controlled packaging from pharmacies to patients.
Also in Louisiana, the Department of Health (LDH) issued an Informational Bulletin 23-22 to Medicaid providers reminding them that RSV vaccines that have been covered since August 3, 2023, must have the correct CPT codes 90380 and 90381.
Finally in Louisiana, in late December 2023, the Centers for Medicare & Medicaid Services (CMS) approved the state plan amendment (SPA) to increase the dispensing fee for local pharmacies only from $10.99 to $11.81. The increased fee applies to Medicaid Fee-for-Service pharmacy claims and Medicaid Managed Care local pharmacy claims, retroactive to the date of service of October 1, 2023.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Maine
On January 4, the Maine Board of Pharmacy held its regular meeting. The agenda included the following:
- Access to HIV Prevention Medications (PL 2021 Ch 265), including PEP and PrEP Protocols
- Access to Birth Control by Making Certain Contraception Accessible from a Pharmacist (PL 2023 Ch 115)
- Authorize Vaccine Administration by Pharmacy Technicians and Reduce Vaccine Administration Training Requirements for Pharmacists (PL 2023 Ch 245)
- Board Rule Chapter Amend Limits on Medication in Vending Machines (PL 2023 Ch 160)
- Pharmacists Dispense an Emergency Supply of Chronic Maintenance Drugs (PL 2023 Ch 566) – Update
- Telehealth Rulemaking Status – Update
Also in Maine, on January 11, Gov. Janet Mills (D) issued a State of Emergency declaration. The State of the Civil Emergency will last one week, and the Governor will continue to evaluate its necessity daily. This declaration triggers the hazard pay provision for the City of Portland for those with operations within the city.
For more information, please contact NACDS’ Mike Sargent at 207-272-6435.
Maryland
The Board of Pharmacy final rule, COMAR 10.34.34, permitting Technician Product Verification (TPV) has been published and will be effective on January 28, 2024. You can find more details in the latest Board of Pharmacy newsletter. The rule allows TPV in both community and institution-based pharmacies.
Also in Maryland, the Department of Health announced that, in accordance with Senate Bill 678/House Bill 1151, they will permit Medicaid-enrolled pharmacist providers to bill Maryland Medicaid for professional services rendered within their lawful scope of practice, effective January 1, 2024. They released guidance for MTM (Medication Therapy Management) and Tobacco Cessation services on transmittal # PT 29-24 and transmittal # PT 49-24. Medicaid-enrolled pharmacists can bill Maryland Medicaid using billing and coding information according to the CMS 1500 Billing Instructions (Revised September 2023). For other ordinary questions, please email mdh.pharmacistsprofservices@maryland.gov or visit Pharmacists Professional Services.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Massachusetts
The Board of Pharmacy issued the following updates on January 11.
- Emergency Contraceptive (EC) Dispensing Report: Any EC dispensed pursuant to the standing order within a calendar year (January 1 – December 31) must be reported using the Annual Emergency Contraception Standing Order Report.
- Policy 2024-01 Naloxone Dispensing: Reviews the dispensing of over-the-counter (OTC) naloxone.
- Policy 2019-02 Automated Dispensing Device Use: Information for Hospice Inpatient Facility acute use was added.
- Policy 2018-01 Permitted Prescription Changes and Additions: Flavoring agent information was added.
- 247 CMR 22.00: Monetary Penalties: Draft Regulation.
The Board also sent a reminder to community pharmacies that the Board regulations require all community pharmacies to provide non-sterile compounding services to their customers. It has come to the Board’s attention that some pharmacies have discontinued their non-sterile compounding services. The Board cited the two regulations below that require this practice to be available; see below. The Board urged any pharmacy that has any questions about these regulations to contact them. The Board is discussing the need for further Board guidance on this issue, which they expect to discuss at a future meeting.
- 247 CMR 6.02: Conditions for Continuing Registration and Operation of a Pharmacy or Pharmacy Department
- (4) The pharmacy or pharmacy department shall maintain on the premises at all times a sufficient variety and supply of medicinal chemicals and preparations which are necessary to compound and dispense commonly prescribed medications in accordance with the usual needs of the community.
- 247 CMR 9.01: Code of Professional Conduct for Registered Pharmacists, Pharmacies and Pharmacy Departments
- (16) A pharmacist shall not refuse to compound customary pharmaceutical preparations except upon extenuating circumstances.
Also in Massachusetts, on January 10, the Public Health Council voted to make permanent the current emergency regulations at 105 CMR 700.004 (15) that authorize pharmacists to prescribe and dispense certain hormonal contraceptives. The Department of Public Health and the Council did not make any changes to the original emergency regulations. As a result, there will be no change to the current practice in this area.
For more information, please contact NACDS’ Mike Sargent at 207-272-6435.
Michigan
The Department of Health and Human Services announced that due to scheduled maintenance, the File Transfer Service (FTS) portal will be unavailable on January 14 from 10:00 am to 2:00 pm EST. They asked providers to refrain from submitting electronic files during this outage period. Billing agents or providers with additional questions can email AutomatedBilling@Michigan.gov for further assistance.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Missouri
Missouri became the final state in the country to implement a statewide prescription drug monitoring program (PDMP). Its new online system allows healthcare professionals to track patients' drug histories in an electronic database. As per the new law passed two years ago, dentists, doctors, pharmacists, and other professionals who dispense controlled substances will now be required to enter patient and prescription information into the database.
Also in Missouri, the Department of Social Services (DSS) MO HealthNet Provider Bulletin Volume 46 Number 34 confirmed that starting November 29, 2023, authorized pharmacy providers can bill for COVID-19 vaccines regardless of Vaccines for Children (VFC) enrollment or participant age. Retail pharmacies can only bill if the prescribing provider is an enrolled MO HealthNet pharmacist. Other VFC vaccines must still be administered by a VFC provider.
Finally in Missouri, MO HealthNet made changes to the Preferred Drug Listing for Insulin Agents effective January 9.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Montana
On December 22, 2023, the Board of Pharmacy published a final rule (MAR 24-124-80) and adopted New Rule I (ARM 24.174.505, Pharmacist Prescribing: General Requirements) implementing SB (Senate Bill) 112 (Statute: 37-7-106, MCA, Pharmacist Prescribing Authority – exceptions), that allows for independent prescribing authority for pharmacists in limited situations. The new rule was adopted as proposed and became effective December 23, 2023. Additional information will be available soon on the Board’s webpage.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Nebraska
Effective January 1, 2024, Nebraska Total Care transitioned to Express Scripts as its PBM (Pharmacy Benefit Manager). Members have been provided with new member ID cards. If a pharmacist needs a member’s specific prescription processing information or other help with a claim, visit the Express Scripts Pharmacist Resource Center. If a pharmacist needs assistance processing a claim, call the Express Scripts Pharmacy Help Desk at 1-833-750-4471
Also in Nebraska, the Department of Health and Human Services posted the Excel file of the fee schedule for Injectables January 1, 2024.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Nevada
The Board of Pharmacy is meeting on January 17-18 in Las Vegas and posted its agenda.
Also in Nevada, more than 80 new laws went into effect on January 1.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
New Mexico
The legislature will convene its 30-day short session on January 16.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
New York
NYRx, the New York Medicaid Pharmacy Benefit Program, issued this update regarding the NYRx BLTG (Brand Less Than Generic) Program for Flovent® and Advair®.
Also in New York, the Board of Pharmacy sent out two updates on January 2:
For more information, please contact NACDS’ Mike Sargent at 207-272-6435.
Oklahoma
The state filed a motion with the 10th Circuit Court of Appeals in PCMA v. Mulready asking the appellate court to stay the lower court’s enforcement of its original decision striking down the state’s PBM law, considering the state’s planned Supreme Court review of the appellate court’s refusal to overturn that lower court decision. While such a request is not often granted, a stay is needed to ensure the state can enforce its PBM laws while it petitions the Supreme Court for further review.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Oregon
The Prescription Drug Affordability Board posted a draft agenda for the January 17 meeting. Board calendar and materials from past meetings are also available online.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Rhode Island
Please see the most recent Medicaid Provider Update (January 2024). All provider updates dated back to 2019 are available online.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
South Carolina
The Legislature convened on January 9. Legislation regarding reimbursement and scope issues that carried over from the 2023 session are expected to be heard during the 2024 session.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Tennessee
The Tennessee Nonresidential Buprenorphine Treatment Guidelines, providing details about medication-assisted treatment (MAT) in Tennessee, were recently updated following review by the Commissioners of TDMHSAS (Department of Mental Health & Substance Abuse Services) and TDH (Department of Health).
Also in Tennessee, the Department of Health released an article, "Racial Disparities in Adolescent Flu Immunization Rates," highlighting public health concerns as factors such as socioeconomic status, limited access to health care, mistrust of medical systems and systemic barriers disproportionately affect minority communities and their immunization coverage rates.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Texas
Gov. Greg Abbott (R) appointed Mike McKinney, M.D., Golinda Erowele, PharmD, and Tony Schell to the Texas Pharmaceutical Initiative Governing Board. McKinney will serve as the Chair of the Board tasked with developing a business plan to provide cost effective drugs and other medical supplies for the public employee sector.
Also in Texas, the Governor reappointed two chain pharmacists, Rick Fernandez with Walgreens, and Julie Spier with Albertsons Companies to additional 6-year terms to the State Board of Pharmacy. Gov. Abbott also appointed two new members to the Board, Randy Martin, a pharmacist and clinical services manager at Texas Health Harris Methodist Hospital Fort Worth, and public member Garrett Marquis, chief communications officer for the Bank of New York Mellon.
Also in Texas, the Health and Human Services Commission (HHSC) alerted providers that beginning January 1, 2024, the managed care organization Amerigroup, began operating under a new name Wellpoint.
Finally in Texas, the State Board of Pharmacy updated licensing and renewal fees effective January 1, 2024. Fees for pharmacists and pharmacies have increased, but there was no change to pharmacy technician fees. The Board of Pharmacy also established new fees for remote pharmacies.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Vermont
On January 11, the Department of Health released the following notice regarding increased RSV cases and its strain on the health system. Reports have been sent to the Department that pregnant patients have been turned away from pharmacies. The Department asked that pharmacies are aware that:
- Pregnant individuals are eligible for Abrysvo.
- If a particular pharmacy does not have Abrysvo, please refer the pregnant individual to a location that does have it.
- We have Immunization Registry (IMR) data showing that pharmacies are administering Abrysvo to women of childbearing age. The IMR does not collect pregnancy status.
- Adults 60 years of age and older are eligible and encouraged to receive either Arexvy or Abrysvo vaccine.
- IMR data shows that pharmacies are giving doses to older adults.
For more information, please contact NACDS’ Mike Sargent at 207-272-6435.