South Carolina
Effective October 1, 2023, the Medicaid State Plan will be updated to allow South Carolina pharmacists to bill for hormonal contraception services in accordance with the Pharmacy Access Act and as described in this bulletin.
To be eligible for reimbursement for these services, pharmacists must complete a Healthy Connections Medicaid provider enrollment application. Pharmacists may apply on or after September 18, 2023. Interested pharmacists are encouraged to apply on the providers page of the Department of Health and Human Services' (SCDHHS) website and enroll as an "individual pharmacist" under the provider type "other medical professional." In addition to the standard enrollment information, pharmacists must provide information on the pharmacy or pharmacies where they will be providing this service. Training on completing this application and enrollment process is available on the SCDHHS website.
Once enrolled, pharmacies will be able to bill dates of service on or after October 1, 2023, for Medicaid members. This includes members enrolled in the full-benefit Medicaid program and those enrolled in the Family Planning limited benefit program. Pharmacies will be reimbursed for the procedure and diagnosis codes listed below under the Healthy Connections Medicaid member's medical benefit utilizing the CMS form 1500. These services will be reimbursed in parity with nurse practitioners and physician assistants at 80% of physician rates. The reimbursement rates for these services are available in the Base Physician Fee Schedule available on SCDHHS website. Covered services and billing guidance will be added to the Physicians Services provider manual by October 1, 2023.
Also in South Carolina, the Joint Pharmacist Immunization Protocol has been updated to allow pharmacists to administer Respiratory Syncytial Virus (RSV) in certain populations without a patient-specific prescription.
Pharmacists who administer vaccines under this Protocol shall maintain a current copy of this Protocol at each location at which a pharmacist administers a vaccine and an appropriate area for administering vaccines with the supplies and equipment.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Tennessee
Please see the webinar invitation for TennCare Pharmacies, during which OptumRx will unveil the findings from the Pharmacy TennCare Cost of Dispensing Survey. During this event, OptumRx will also disclose the updated professional fees applicable to all pharmacies within the TennCare Pharmacy Network. Please do not hesitate to reach out to your Provider Liaison Pharmacist with questions or concerns at TNRxEducation@optum.com.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Utah
The Department of Health & Human Services released the results of its recent survey of the average cost of dispensing a Medicaid prescription in the state. The mean cost of dispensing, weighted by Medicaid prescription volume, was $11.57 per prescription for all pharmacies including specialty pharmacies. For non-specialty pharmacies only, the mean cost of dispensing, weighted by Medicaid prescription volume, was $11.24 per prescription.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Vermont
The Vermont Board of Pharmacy posted the agenda for the September 27th meeting. The agenda includes drafts for state pharmacists prescribing protocols for emergency contraception and ACIP-recommended vaccines which are included in the agenda posting.
On September 18th, the Department of Vermont Health Access (DVHA) made changes to the Pharmacy Manual regarding automatic refills for Medicaid members. Vermont Medicaid does not pay for prescriptions that are not medically necessary or for individuals who are no longer eligible for Vermont Medicaid. Providers may not use automatic refill systems to deliver or provide prescriptions to members. Members and providers may not agree to waive the requirements of this section. Providers may contact members to initiate a refill, but members must choose to fill each prescription, and providers must determine that the member remains eligible for Vermont Medicaid before providers deliver or dispense the prescription. Providers may not assume that, because a member's prescription authorizes refills, the member has implicitly requested that the provider refill the prescription. For questions, please contact the Change Healthcare Pharmacy Help Desk at 1-844-679-5362. Vermont providers can also send inquiries via email to PBA_VTHelpdesk@changehealthcare.com.
For more information, please contact NACDS’ Mike Sargent at 207-272-6435.
Alabama
The Medicaid Agency has published a PSA video to encourage Medicaid recipients to complete their eligibility renewal forms when their notices come in the mail. Medicaid providers and partners are encouraged to share this video in public locations and on websites.
Medicaid has taken extraordinary efforts to notify recipients when it is time to renew.
Renewal notices are sent through regular mail, and the Agency is contacting recipients by
email, text message and phone when it is time to renew (if they have provided contact
information to the Agency). Several outreach resources are available for Medicaid partners to
make it simple to share the key messaging.
Please share the following key messaging from Medicaid:
* Public Service Announcement – August 29, 2023
* How to Update Contact Information with the Agency (Medicaid Recipients)
* Video: Keep Your Coverage
* Video (Spanish): Keep Your Coverage
Medicaid regularly updates information for recipients on the COVID-19 Information for Providers webpage. Medicaid recipients who have questions should call Medicaid's Recipient Call Center at (800) 362-1504 or visit a Medicaid office in their area. Providers may contact the Provider Assistance Center at (800) 688-7989.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Arizona
Last week, the Governor’s Regulatory Review Council (GRRC) held a Study Session that included pharmacy technician rules to permanently authorize pharmacy technician to administer vaccines under the delegation and supervision of a pharmacist. This week, at its September 6 meeting, the GRRC approved the rules. The rules take immediate effect.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Arkansas
Gov. Sarah Huckabee Sanders (R) may call a special session in September to address property tax relief.
Also in Arkansas, the Governor appointed two new members to serve a six-year term on the Board of Pharmacy. Clint Boone from Little Rock replaces Rebecca Mitchell and Beth Ann Davenport from Bentonville will succeed Amy Fore.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
California
The Department of Health Care Services (DHCS) posted the following bulletins, notices, and alerts on the Medi-Cal Rx Web Portal. Please note the Updated FAQs (Frequently Asked Questions) for the Pharmacy Retroactive Claim Adjustments.
- Reinstatement of the Labeler Code Restriction for Brand Name Suboxone (September 5)
- Reinstatement Spotlight (September 1)
- Diabetic Supplies Update: Changes to Continuous Glucose Monitoring Systems Policy, Effective October 1, 2023 (September 1)
- Medical Supplies Update: Updates to Contracted Diabetic Test Strips and Lancets List, Effective October 1, 2023 (September 1)
- Maximum Allowable Ingredient Cost 30-Day Pharmacy Provider Notice (September 1)
- Medi-Cal Rx Monthly Bulletin for September (September 1)
- Changes to Medi-Cal Rx Contract Drugs List (September 1)
- Updates to the Medi-Cal Rx Provider Manual (September 1)
- Medi-Cal Rx Weekly Wrap-Up for August 18-24 (August 25)
- Reinstatement Spotlight (August 25)
- 30-Day Countdown: Reinstatement of Cost Ceiling and Prior Authorization for Enteral Nutrition and Specific Standard Therapeutic Classes (August 23)
- Lift of Labeler Code Restriction for Truvada (August 22)
- Recommencement of Pharmacy Retroactive Claim Adjustments: Publication of Updated Frequently Asked Questions (FAQs) (August 21)
- Medi-Cal Rx Weekly Wrap-Up for August 11-17 (August 18)
- Reinstatement Spotlight (August 18)
Also in California, Gov. Gavin Newsom (D) declared a state of emergency in Del Norte and Siskiyou Counties due to fires. During a declared state of emergency, the Board of Pharmacy reminds licensees of information and state laws intended to help pharmacists provide prescription drugs – including controlled substances – for residents displaced because of emergency evacuation.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Florida
Gov. Ron DeSantis (R) signed Executive Order 23-171, declaring a state of emergency in preparation for Tropical Storm/Hurricane Idalia. The Agency for Health Care Administration (AHCA) has contacted the Medicaid Managed Care Plans, to ensure they are making the necessary preparations pre- and post-storm, including allowing for early prescription refills. Fee-for-service recipients are also eligible for early refills. The Department of Health has also issued Emergency Order 23-002, which allows for mobile pharmacies and an extension of the PDMP (Prescription Drug Monitoring Program) reporting requirements.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Georgia
Gov. Brian Kemp (R) declared a State of Emergency ahead of the impact of Hurricane Idalia. The Board of Pharmacy has issued a statement seeking to remind pharmacy licensees in this time of emergency that the Board’s Policy #14 provides for the refill of certain medications for up to 30 days for persons in the areas covered by the State of Emergency.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Indiana
As a result of the passage of legislation earlier this year that NACDS supported, HB (House Bill) 1568 allowing pharmacists who meet certain requirements to prescribe and dispense hormonal contraceptive patches and self-administered hormonal contraceptives, CMS approved the SPA (State Plan Amendment) giving pharmacists the ability to bill Medicaid for services associated with the prescribing of hormonal contraceptives.
Also in Indiana, the Family and Social Services Administration (FSSA) recently issued several Indiana Health Coverage Program (IHCP) bulletins of interest to pharmacies, including pharmacy updates approved by the DUR (Drug Utilization Review) Board, enhancements to the fee-for-service prior authorization submissions process and changes to the submission requirements for the FFS (Fee for Service) claim administrative review process. IHPC also provided new portal links to providers webpage.
Also in Indiana, Cora Steinmetz, JD, is the new Medicaid Director, Family and Social Services Administration (FFSA). Previously, she was Senior Operations Director for health-related state agencies for Gov. Eric Holcomb (R).
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Iowa
The Department of Health and Human Services, Iowa Medicaid posted the following:
- INFORMATIONAL LETTER NO. 2501-MC-FFS – Iowa Medicaid Dashboard
- INFORMATIONAL LETTER NO. 2494-MC-FFS-D – Quarterly Code Update Communication Bulletin
- INFORMATIONAL LETTER NO. 2493-MC-FFS-D – Hope and Opportunity in Many Environments (HOME)
- INFORMATIONAL LETTER NO. 2491-MC-FFS – Avastin® (bevacizumab) Billing for Use in Ophthalmology
- INFORMATIONAL LETTER NO. 2489-MC-FFS – Billing for Medicaid Services
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
For more information, please contact NACDS’ Mike Sargent at 207-272-6435.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Kansas
The Board of Pharmacy published a guidance document for pharmacy technicians and pharmacy interns administering immunizations.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Louisiana
The new Single Pharmacy Benefits Manager (PBM) for Medicaid Managed Care will start on October 1, 2023. Magellan Medicaid Administration (MMA) will process all Medicaid managed care organization (MCO) pharmacy claims.
- A new Department of Health (LDH (Louisiana Department of Health)) Pharmacy portal still under construction website will go live on October 1, 2023.
- Pharmacy processing information for all six Medicaid MCOs (Managed Care Organizations) starting October 1, 2023:
- BIN Number: 025986
- NCPDP (National Council for Prescription Drug Programs) Version/Release #: D.0
- Processor Control #: 1214172240
- Group ID: LAMCOPBM
- Magellan Rx Management Pharmacy Call Center is available 24 hours a day, seven days a week, 365 days a year.
- The Member and Pharmacy Help Desk Phone Number is 1-800-424-1664
- Pharmacy Prior Authorizations (PA) phone number: 1-800-424-1664
- Fax Number: 1-800-424-7402
- Electronic: Enter prescriber PA at www.covermymeds.com
- MRx encourages pharmacies to submit test claims prior to the transition during the testing window from August 28, 2023, through September 15, 2023. To participate, you will need to e-mail MRxPharmacyTesting@magellanhealth.com with your name, phone number, pharmacy National Provider Identifier, and Switch information to receive the testing packet.
Also in Louisiana, state elections will be held this fall. The Primary will be held on October 14, and the General election will be on November 18. Tim Temple (R) is now running unopposed for Insurance Commissioner now that political newcomer Rich Weaver, dropped out of that race.
Also in Louisiana, starting on October 1, LDH will reimburse pharmacies for glucose monitors and diabetics supplies, and add diabetic supplies to the Medicaid Single Preferred Drug List to have one list of preferred/non-preferred products. As of December 1, 2023, diabetic supplies will be limited to pharmacy claims only.
Also in Louisiana, the next scheduled meeting of the Council on Medicaid Pharmacy Reimbursement is on September 13.
Also in Louisiana, Kimberly Sullivan is the new Interim Executive Medicaid Director for the Louisiana Department of Health (LDH), replacing Tara LeBlanc.
Finally in Louisiana, LDH provided several updates for pharmacies.
- 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
Secretary of Health Laura Ferrara Scott, MD, issued a standing order this week authorizing pharmacies to administer RSV vaccines.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Massachusetts
The Board of Pharmacy updated two policy positions. First regarding unfilled prescriptions, Policy 2023-10 responds to the DEA's new rules regarding the transfer of unfilled federally controlled substance prescriptions. Second regarding vaccine administration, Policy 2023-02 allows qualified pharmacy personnel to administer routine vaccines that are not yet on the Immunization Schedule (e.g., RSV vaccine), and Collaborative Drug Therapy Management (CDTM) pharmacists may now also administer travel vaccines and other non-routine vaccines in accordance with their CDTM agreement.
Also in Massachusetts, on September 12, the state legislature will be holding a hearing for the Joint Committee on Financial Services. This hearing will include HB 4066, an act relative to pharmacists as health care providers, making some of the test and treat language law.
For more information, please contact NACDS’ Mike Sargent at 207-272-6435.
Minnesota
The Department of Human Services released the 2023 Cost of Dispensing Survey Report that recommends a $0.78 increase in the Fee-for-Service professional dispensing fee for all retail pharmacies. I understand the General Assembly will have to pass legislation to implement it. NACDS intends to work with members and in-state partners on this in the next legislative session.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Missouri
The Board of Pharmacy released emergency rules regarding pharmacist vaccine administration, effective August 28, 2023. The rules establish guidelines for independent vaccination by pharmacists, for vaccines approved as of January 1, 2023, as well as provide guidance for vaccines administered under protocols. They also clarify that pharmacists may continue to administer vaccines that are periodically/annually reformulated or updated, such as seasonal influenza vaccines, if the FDA approved the original vaccine before January 1, 2023.
The Board issued a Supplemental Pharmacy Practice Guide summarizing the 2023 legislative changes.
Also in Missouri, the Department of Commerce and Insurance issued emergency rules on pharmacists' immunization procedures:
| 20 CSR 2150-5.025 Administration of Vaccines |
| 20 CSR 2220-6.050 Administration of Vaccines |
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Nebraska
The Department of Health and Human Services announced new income guidelines have increased the number of families who could qualify for the Women, Infants, and Children (WIC) nutrition assistance program. Some families who were not eligible for the program in the past may now qualify. Current Medicaid, SNAP (Supplemental Nutrition Assistance Program) or ADC (Aid to Dependent Children) recipients are income-eligible for the WIC program. All foster children under five years of age and pregnant teen moms in foster care are income-eligible for WIC.
Also in Nebraska, the Board of Pharmacy posted the agenda for the September 18 meeting and the draft minutes from the July 10 Board of Pharmacy meeting.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Nevada
The Board of Pharmacy met in Las Vegas on September 6 and 7. Use this link to access the agenda, minutes, and meeting materials.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
New York
On August 29, the New York Department of Health issued an updated policy regarding the Medicaid coverage and reimbursement of RSV vaccines.
Also in New York, NACDS joined a coalition letter against the proposed central fill pharmacy regulations that included a broad coalition including the Business Council of New York, Food Industry Alliance of New York and two FQHC (Federally Qualified Health Centers). NACDS and members have been actively advocating for a change and delay in the proposed regulations, that amongst its provisions would:
- Create a new central fill pharmacy registration class;
- Prohibit central fill pharmacies from being open to the public;
- Require that central fill pharmacies only prepare, and fill prescriptions sent from an originating pharmacy;
- Prohibit direct-to-patient central fill models;
- Require the originating pharmacy to obtain consent from the patient in writing before a prescription may be prepared by a central fill pharmacy;
- Requires an originating pharmacy to be able to prepare and dispense a prescription to a patient should the prescription not be received from the central fill pharmacy, or the patient seeks to pick-up the prescription from the originating pharmacy before it has been prepared by a central fill pharmacy; and
- Requires nonresident pharmacies engaged in central fill models to comply with select provisions of the rule.
For more information, please contact NACDS’ Mike Sargent at 207-272-6435.
North Carolina
Governor Roy Cooper (D) declared a State of Emergency ahead of the impact of Hurricane Idalia. Pharmacists are reminded that a state of emergency declaration triggers obligations for health benefit plans to cover emergency refills of prescriptions. More information from the NC Department of Insurance is here. Pharmacists and pharmacies are reminded that the Board of Pharmacy has exercised its authority under G.S. 90-85.25(a) to waive certain requirements of the North Carolina Pharmacy Practice Act to facilitate the provision of patient care during a declared emergency. With Hurricane Idalia’s approach, now is the time to review that policy and start implementing plans to ensure continuity of patient care.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Ohio
The Board of Pharmacy published a bulletin complying with the new regulations effective September 1 that authorize technicians to administer immunizations.
Also in Ohio, Medicaid (ODM) announced new Professional Dispensing Fee Rates in both the SPBM (Single PBM) and Fee-for-Service programs. The increases in the SPBM Managed Care program will be effective September 1, 2023. Since SPA approval is needed for the Fee-For-Service program, ODM projects that implementation would be effective on January 1, 2024.
Also in Ohio, the Board of Pharmacy has proposed the following rules for stakeholder feedback:
- 4729:5-3-21 – Continuous Quality Improvement Programs in Pharmacy Services. (NEW – Applies to Outpatient and Institutional Pharmacies)
- 4729:1-4-02 – Duty to report (Pharmacists). (AMEND)
- 4729:2-4-02 – Duty to report (Pharmacy Interns). (AMEND)
- 4729:3-4-02 – Duty to report (Pharmacy Technicians). (AMEND)
- 4729:5-4-02 – Duty to report (Pharmacies). (NEW)
Comments on the proposed rules will be accepted until close of business on September 8 and should be submitted here.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
For more information, please contact NACDS’ Mike Sargent at 207-272-6435.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Oklahoma
The Board of Pharmacy adopted Chapter 15 approved rule allowing pharmacy technicians to administer immunizations, effective September 1, 2023.
Also in Oklahoma, Gov. Kevin Stitt (R) appointed Ellen Buettner as the new CEO (Chief Executive Officer) of the Oklahoma Health Care Authority (OHCA) which oversees Oklahoma's Medicaid program. She had served as Chief of Staff since 2019.
Finally in Oklahoma, the Oklahoma Pharmacists Association's (OPhA) annual convention was held in Oklahoma City last weekend where the President of Osborn Drugs, Bill Osborn, was sworn in to serve as the President of OPhA.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Oregon
Gov. Tina Kotek (D) signed HB 2725 (Chapter 509), legislation prohibiting PBMs (Pharmacy Benefit Managers) from retroactively denying or reducing payment on a claim after adjudication unless the pharmacy and PBM agree that payment was incorrect due to clerical error. It also prohibits PBMs from imposing fees on pharmacies after point of sale. It also requires a PBM, if denying or reducing reimbursement on a claim, to provide notice to pharmacy of specific claim that is denied or reduced and detailed explanation for denial or reduction.
Also in Oregon, the Oregon Health Authority has posted new protocols for the following vaccines: RSV (Respiratory Syncytial Virus), Influenza (IIV 2023-24 – Interim), and Influenza (LAIV 2023-24 – Interim). An interim protocol will be replaced with a final protocol once the ACIP (Advisory Committee on Immunization Practice) recommendations are published in the MMWR (Morbidity and Mortality Weekly Report). Also, the following protocols have been updated: HPV (HUMAN PAPILLOMA VIRUS) vaccines (9vHPV) and Meningococcal A, C, W, T and B.
Also in Oregon, the Board of Pharmacy posted opportunities for interested persons to serve on the Board. The Board has the following member opportunities available:
- Two Pharmacy Technician member positions available for reappointment or appointment – Apply here by November 5, 2023
- One public member position available for reappointment or appointment – Apply here by November 5, 2023
Board members are appointed by Governor Tina Kotek and each Board member serves at the pleasure of the Governor. If you are interested in applying to serve on the Board, please visit the Board Member Opportunities webpage, review ORS 689.115, and apply through the governor's Boards and Commissions website.
Finally in Oregon, the Board of Pharmacy announced the next meeting of the Public Health & Pharmacy Formulary Advisory Committee and posted the meeting agenda. Of interest is "Concept #1 – Immunizations" under "Committee Protocol Development". A link to the meeting agenda is provided below.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.