Louisiana
The Board of Pharmacy's Regulation Review Committee has posted the agenda for the January 24 meeting in Baton Rouge.
Also in Louisiana, the Department of Health's (LDH's) vendor Magellan will approve overrides for non-preferred products when the preferred product has a manufacturer shortage. Contact the Magellan Medicaid Administration help desk at (800) 424-1664 to get the override. The prescriber does not need to fill out a prior authorization. The current list of drugs with known shortages are Sabril® 500mg powder for oral solution, generic Concerta®, generic Focalin XR®, Trileptal® suspension and generic Mydayis™.
Finally in Louisiana, LDH (Department of Health) issued Bulletin 24-1 informing providers that Medicaid is updating the Medicaid Fee-For-Service (FFS) files procedure codes.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
New Mexico
The Legislature convened its 30-day session on January 16.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
New York
On January 16, Gov. Kathy Hochul (D) announced her current year budget proposal. The impactful sections are below:
- Streamline Medicaid Drug Cap – to streamline and remove prior triggers to enable the state to get manufacturer rebates more quickly
- Discontinue Prescriber Prevails – to eliminate prescriber prevails in Medicaid where clinical standards for approval are not met
- Pharmacy Enhancements and Integration Specialty Drug Management – to create new benchmarks for physician administered drug reimbursement similar to pharmacy reimbursement under Medicaid Fee-for-Service (FFS); part of the goal is to bring drugs that do not have a NADAC up to WAC instead of current WAC-3%. Also, it includes requirement for all Medicaid enrolled pharmacies to submit annual cost reports in a form requested by the state Department of Health (DOH).
- Reduce Coverage for Over-The-Counter (OTC) Pharmaceuticals – to enable DOH to modify the list of OTCs covered in the Medicaid program
Also in New York, NYRx, the New York Medicaid Pharmacy Benefit Program, held its regular industry call on January 17. Updates are below; however, two other conversations occurred during the call, including Pharmacy Cost Reporting proposed in the budget and Inspector General (OMIG) audit protocols regularly updated to reflect Medicaid FFS pharmacy policies, e.g., change in signature on deliveries requirement. OMIG will be joining the February Pharmacy Sector call.
- Covid-19 Oral Antivirals: DOH discussed new guidance related to billing for antivirals (Paxlovid™ and Lagevrio™).
- Covid-19 Vaccine Billing for non-VFC (Vaccines for Children) Pharmacies: DOH discussed guidance for billing non VFC and admin code to use for VFC and non-VFC which can be found here.
- 1115 Waiver: 3-year waiver approved totaling $7.5 billion through March 31, 2027.
NYRx also revised its preferred drug list, effective January 18.
For more information, please contact NACDS’ Mike Sargent at 207-272-6435.
North Carolina
During the 2023 Legislative Session, the General Assembly passed, and the Governor signed into law, a statute making gabapentin a drug whose dispensing must be reported to the Controlled Substance Reporting System (CSRS). Gabapentin becomes reportable on March 1, 2024. The Drug Control Unit, which administers the CSRS, has created an FAQ guidance document for dispensers. Pharmacists with additional questions should contact the Drug Control Unit.
Note that based on an NC 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; see new G.S. 90-113.73(c)(1).
Also in North Carolina, on January 10, Medicaid released the following concerning pharmacy eligibility to serve as Medicaid providers. All questions should be directed to Medicaid.
Beginning in May 2021, NC Medicaid started taking additional steps, as outlined in the NCTracks Changes to Provider Verification Process bulletin, to ensure providers meet their contractual obligation to maintain their credentials on their NCTracks provider enrollment record. Multiple bulletin articles were published to notify providers of the change, and providers receive four targeted reminders prior to their suspension notification. Regardless of these efforts to inform and assist providers with this responsibility, we continue to see a fairly large number suspended, and subsequently terminated, from the NC Medicaid program due to their expired credential.
For this reason, and as part of an additional outreach effort, we are notifying NC associations when the number of provider taxonomy suspensions exceeds a defined threshold of unique providers on the report received at the end of each month.
On December 31, 2023, approximately 115 Pharmacist providers were suspended due to an expired credential. These providers have sixty days from the date of suspension to ensure that their license is renewed, and their NCTracks provider enrollment record is updated to avoid termination. Providers may update their NCTracks provider record through the Manage Change Request process. NCTracks User Guides and Fact Sheets offer basic instructions for making the necessary update and any additional questions may be referred to the NCTracks Call Center at 800-668-6696.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Oklahoma
Pharmacists working in multiple locations must have their small wallet card pharmacy license, a copy of their immunization certificate and a copy of their CPR certificate available to produce to the Board’s compliance officers for inspection.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Oregon
The Prescription Drug Affordability Board meeting has been rescheduled to January 26. The registration link and meeting agenda have been posted online.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Texas
The next quarterly meeting of the Board of Pharmacy is Tuesday, February 6, at the new Barbara Jordan State office building. The agenda will be posted here when it becomes available.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Washington
On January 24, pharmacy professionals and students will gather at the Capitol in Olympia for the first of two legislative days which NACDS is proud to sponsor. The advocacy event allows pharmacists, students and pharmacy technicians to educate legislators about the importance of pharmacies as a convenient, accessible community healthcare destination, as well as an opportunity to promote pharmacists and technicians as vital members of the healthcare team.
Also in Washington, Health Care Authority (HCA) created a new flyer that pharmacies can distribute to help reach Medicaid patients encouraging them to update their contact information and apply for or renew coverage. Pharmacies can order the free flyers in both English and Spanish.
Also in Washington, the Heath Care Authority's (HCA) first quarter Preferred Drug List (PDL) used by Uniform Medical Plan and the Department of Labor and Industry is available online.
Finally in Washington, legislation expanding prescriptive authority for pharmacists, HB 2116, will be heard in the House Committee on Health Care & Wellness on January 24. Take action today to register your support for the bill. If you reside in the state, register your support with your legislator by filling out this form. To share your support with all Committee members, use this link to submit a supporting statement or testimony.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Alabama
To streamline the provider enrollment process, Alabama Medicaid provider enrollment applicants should gather all needed materials before applying. READ MORE for some of the most common reasons why applications are denied. If you have any questions regarding your application, please contact Provider Enrollment at (888) 223-3630.
Also in Alabama, on January 17, at 2:00 pm CST, the Board of Pharmacy will hold a Practice of Pharmacy Workgroup Meeting, where they will delve into Alabama Administrative Code 680-X-2-.14. This code defines the pivotal roles and duties of pharmacy technicians within the healthcare system. For those who wish to attend in person, the meeting will be held at 111 Village Street, Birmingham, AL 35242. Virtual attendance is available here. Do not miss this chance to be a part of the conversation that shapes the future of pharmacy in Alabama.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Alaska
The Board of Pharmacy issued a reminder to pharmacists regarding Collaborative Practice Agreements (CPAs). CPAs are established between medical providers and pharmacists and are housed at the Medical Board, not the Board of Pharmacy. It is important to note that CPAs are established between a physician and a lead pharmacist, not a pharmacy. In the event of a change of pharmacist-in-charge (PIC) at a pharmacy that affects an established CPA, a new CPA must be submitted to the Medical Board for review.
Also in Alaska, pharmacists now have the authority to prescribe immunizations, epinephrine, and emergency drugs. As a result, a Collaborative Practice Agreement is not required to prescribe and administer these items.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Arkansas
The Board of Pharmacy met at the Board offices in Little Rock on January 9 and 10.
Also in Arkansas, the state pharmacist's association received a grant of $78,548. The funds will be utilized in 2024 to educate pharmacists and prescribers about the pharmaceutical supply chain regulatory guidance and oversight mandated by the federal government for drug wholesalers. The training aims to inform them about how this regulation affects patients, physicians, and the local pharmacists.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
California
The Department of Health Care Services posted the following alerts, bulletins, and weekly notices on the Medi-Cal Rx Web Portal.
- Planned User Administration Console (UAC) System Migration for January 13, 2024 (January 11)
- Medi-Cal Rx Weekly Wrap-up for December 29-January 4 (January 5)
- Prior Authorization Request Requirement for Reyvow® (Lasmiditan Succinate) (January 3)
- Medical Foods Are Not a Covered Benefit (January 2)
- Medi-Cal Rx Monthly Bulletin for January (January 2)
- Changes to the Medi-Cal Rx Contract Drugs List (January 2)
- Changes to the Medi-Cal Rx Contract Drugs List – Authorized Drug Manufacturer Labeler Codes (January 2)
- Updates to the Medi-Cal Rx Provider Manual (January 2)
- Medical Suppliers Reminder: Updates to Diabetic Testing Supplies 100-Count LifeScan, Inc.'s OneTouch Verio Test Strips Will No Longer Be Contracted, Effective January 1, 2024 (January 1)
- Medi-Cal Rx Weekly Wrap-up for December 15-28 (December 29)
- Reimbursement for Commercial Lagevrio (Molnupiravir) (December 19)
- Reject Code 16 – Implementation Date Postponed (December 18)
- Medical Suppliers Reminder: Updates to Diabetic Testing Supplies 100-Count LifeScan, Inc.'s OneTouch Verio Test Strips Will No Longer Be Contracted, Effective January 1, 2024 (December 15)
- Medi-Cal Rx Weekly Wrap-up for December 8-14 (December 15)
- Reinstatement Spotlight (December 15)
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Colorado
The legislature convened on January 10.
Also in Colorado, an interim committee bill drafted by the Opioid and Other Substance Use Disorders Study Committee addressing medications for opioid use disorder (MOUD) prescribing by pharmacists is expected to be filed soon.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Delaware
The Board of Pharmacy will be holding its regular meeting on January 17. The agenda includes Pharmacists Dispensing and Administering Contraceptives Regulation Draft Update, Pharmacists Well-Being Index, Board of Pharmacy Act Revisions and Review and Consideration of Pharmacy License Specialties.
For more information, please contact NACDS’ Mike Sargent at 207-272-6435.
Florida
Gov. Ron DeSantis (R) released his Focus on Florida's Future Budget recommendations for Fiscal Year 2024-25. The proposed budget comes in at $114.4 billion, which is a $4.6 billion decrease compared to the state's FY 2023-24 budget. Governor DeSantis' Focus on Florida's Future Budget supports more than $1.1 billion in tax relief and the renewal of four traditional sales tax holidays as well as more than $153 million from the nationwide Opioid Settlement Agreement to continue support for the Office of Opioid Recovery, an accredited Graduate Medical Education program to increase the number of psychiatric residents and for other initiatives that support education, treatment and prevention for individuals with substance use disorders. The full budget highlights are available online.
Also in Florida, the Agency for Health Care Administration (Agency) has filed six (6) new Durable Medical Equipment and Medical Supply Services Coverage Policies for adoption in the Florida Administrative Code (F.A.C.). These new policies took effect on January 10. Please visit the Agency's website at Adopted Rules – Main Page (myflorida.com) for details on the new Durable Medical Equipment and Medical Supply Services Coverage Policies.
Finally in Florida, the Agency for Health Care Administration (Agency) has been working on modifying the way diabetic supplies are provided to Floridians served through the State's Medicaid program by transitioning reimbursement for diabetic supplies from the durable medical equipment (DME) fee schedule to the pharmacy point of sale system. The Agency plans to release the Preferred Product List as referenced in proposed rule 59G-4.002, along with a resource toolkit to assist providers with billing for diabetic supplies through the pharmacy point of sale system. Until further direction is given, the Agency will continue to reimburse DME providers for all currently available diabetic supplies listed on the Durable Medical Equipment and Medical Supply Services Provider Fee Schedule using the existing reimbursement process.
All interested parties should continue to check the Agency's Pharmacy Policy webpage periodically and read all Agency alerts that are sent out regarding these changes. Interested Parties may also email the Agency at PharmacyPolicy@ahca.myflorida.com with any questions.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
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.