Maryland
The Prescription Drug Affordability Board (PDAB) released the agenda for the July 24 meeting which will be held remotely at 2:00 p.m. Please register for the meeting in advance. The Board continues to welcome public comment and input on all its work. Please submit comments to comments.pdab@maryland.gov, and they will be provided to the Board prior to the upcoming Board Meeting. Please visit the Board's website for more information about the upcoming and previous board meetings, presentation materials, and to learn more about the PDAB's work.
Also in Maryland, The Department of Health (MDH (Maryland Department of Health)) is currently accepting applications and nominations for physicians and pharmacists to serve on the Medicaid Drug Use Review (DUR) Board in 2024. The DUR Board is comprised of up to twelve (12) licensed and actively practicing physicians and pharmacists in Maryland. Members are appointed by the Secretary of MDH and serve one term of three (3) years from the date of their appointment with the option to serve an additional three (3) year term. All interested applicants are required to submit a formal application by August 1, 2023.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Michigan
This week, Gov. Gretchen Whitmer (D) signed SB 219 effective July 19. The bill codifies PREP (Public Readiness and Emergency Preparedness) Act authority, allowing pharmacies to provide all ACIP (Advisory Committee on Immunization Practices) vaccines to patients aged 3 years and older. It also authorizes pharmacists to order and administer CLIA-waived tests for COVID, Flu and RSV and provide drugs that treat those conditions under CDC protocols. Many thanks to members, the Michigan Retailers Association, and the Michigan Pharmacists Association for their work with the Legislature on this critical patient access to care law.
Also in Michigan, the Bureau of Professional Licensing (BPL) within the Department of Licensing and Regulatory Affairs (LARA) sent a communication reminding pharmacy that the new Central Fill and Shared Pharmacy Services rules were effective as of May 19, 2023. The email asks that Licensee review the rules and statute for a complete understanding of all applicable requirements. Questions about the revised rules may be sent to BPLHELP@michigan.gov.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Minnesota
The Department of Health’s weekly COVID Vaccine Provider Update reminds immunizers that the COVID-19 Vaccine Provider Agreement is still in effect until the new vaccine formulations are available.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Missouri
On July 6, Gov. Mike Parson (R) signed into law three bills enacting the largest pharmacy scope of practice expansion (HB 115 / SB 157 / SB 45 & 90). The bills allow pharmacists to independently administer all vaccines approved by the FDA as of January 1, 2023. The law also expands the services pharmacists can provide through physician protocols, and it creates framework for statewide standing orders for the testing and treatment of COVID, Flu and Strep.
Also in Missouri, effective July 30, MO HealthNet will no longer allow automatic refills or automatic shipments of medications, devices, or supplies. MO HealthNet does not pay for any
prescription without an explicit request from a participant or the participant's responsible party, such as a caregiver, for each refilling event. Participants and providers cannot waive the explicit refill request requirement and enroll in an automatic refill program.
Also in Missouri, MO HealthNet also reported that due to the increase in the Missouri Pharmacy Reimbursement Allowance (Pharmacy Tax), the adjustment to account for the Professional Dispensing Fee for Medicaid-reimbursed prescriptions was increased effective July 1, 2023.
Also in Missouri, the Department of Commerce and Insurance's (DCI) Department of Health and Senior Services issued a revised naloxone HCL standing order that now lists the nasal spray generically, allowing pharmacists to dispense the brand name or generic product.
Also in Missouri, starting July 17, MO HealthNet announced that the Pharmacy Help desk's NEW hours for drug prior authorizations will be Monday through Friday, 8:00 a.m. to 7:00 p.m. Central; weekend hours will remain the same 8:00 a.m. to 6:00 p.m.
Finally in Missouri, the MO HealthNet Division recently moved all provider forms regarding MO HealthNet benefits to a new Provider Forms page.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Montana
Based on the annual survey conducted by the Department of Public Health, this year's survey results provide data to support a proposed minimum dispensing fee of $5.11. Also, the maximum dispensing fee, for each volume range, is proposed to increase to incorporate the legislatively approved provider rate increase.
The Department of Public Health and Human Services issued a Notice of Public Hearing on Proposed Amendment to ARM 37.85.105, updating effective dates of Medicaid fee schedules effective July 1, 2023. The public hearing via remote conferencing will be held on July 27 at 9:00 a.m. Below are the proposed changes to pharmacy reimbursement.
(f)The outpatient drugs reimbursement dispensing fees range, as provided in ARM 37.86.1105(3)(b) is effective July 1, 2022 July 1, 2023:
(i) for pharmacies with prescription volume between 0 and 39,999, the minimum is $4.32 $5.11 and the maximum is $15.73 $16.36;
(ii) for pharmacies with prescription volume between 40,000 and 69,999, the minimum is $4.32 $5.11 and the maximum is $13.62 $14.16; or
(iii) for pharmacies with prescription volume greater than or equal to 70,000, the minimum is $4.32 $5.11 and the maximum is $11.52 $11.98.
(g) remains the same.
(h) The outpatient drugs reimbursement vaccine administration fee, as provided in ARM 37.86.1105(6), will be $21.32 for the first vaccine and $15.65 $18.65 for each additional administered vaccine, effective July 1, 2022 July 1, 2023.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Nebraska
The Department of Health and Human Services (DHHS) posted the following:
- COVID-19 Provider Update Call on August 2 at noon (Central): Join using the link or dialing by phone:
https://sonvideo.webex.com/sonvideo/j.php?MTID=mc307e2dda218d1060adfed7f454cfc16 or 408-418-9388 (access code: 2480 661 3098)
- Durable Medical Equipment, Medical Supplies, Orthotics and Prosthetics effective July 1, 2023:
- COVID-19 Fee Schedule effective July 1, 2023
- Injectables Fee Schedule effective July 1, 2023
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
New Jersey
On July 10, Gov. Phil Murphy (D) signed a package of bills targeting prescription drug costs. Most relevant was A536, an Act Concerning Pharmacy Benefit Managers (PBMs). This new law establishes greater oversight of PBMs. The act requires rebates to be used to lower premiums and out-of-pocket costs for consumers and prevents the practice of spread pricing. It also requires PBMs to apply for a license from the NJ Department of Banking & Insurance to strengthen regulatory oversight.
For more information, please contact NACDS’ Ben Pearlman at 617-515-2603.
New York
On July 17, the State Department of Financial Services adopted an amendment to the final rule regarding the PBM regulations and entities filing by electronic submissions.
On July 13, the State Department of Health's NYRx, the Medicaid Pharmacy Benefit Program, posted a program update for providers and prescribers. On July 14, they also announced prior authorization program updates.
For more information, please contact NACDS’ Ben Pearlman at 617-515-2603.
Ohio
The Board of Pharmacy published the agenda for the August 22 public hearing.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Oklahoma
The Board of Pharmacy's COVID-19 Waiver Request form that helped pharmacies navigate through challenging times during the pandemic has been changed to a "Waiver Request" form.
Also in Oklahoma, the Bureau of Narcotics and Dangerous Drugs Control passed a law defining "Acceptable IDs for CDS Prescriptions," changing the definition of recipient's identification number and recipient's agent's identification number for acceptable forms of identification for obtaining a controlled dangerous substance (CDS) prescription. The definition now refers to a federal law, which is 8 Code of Federal Regulations (CFR) 274a.2(b) (1)(v)(A) and (B). Title 63 O.S. §2-309B. 7. "Recipient's identification number" and "recipient's agent's identification number" means the unique number contained on forms of identification listed in 8 CFR 274a.2(b) (1)(v)(A) and (B).
Also in Oklahoma, the Attorney General is staffing up in preparation to taking over enforcement of PBM laws.
Finally in Oklahoma, the Board of Pharmacy held a hearing on July 19.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Oregon
Gov. Tina Kotek (D) signed SB 608, requiring the Oregon Health Authority (Medicaid) to conduct a cost of dispensing study every three years and the first study is due January 2, 2024.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Rhode Island
Medicaid is preparing to implement the Real Time 270/271 Eligibility Verification Request and Response and Real Time 276/277 Claim Status Request and Response Transactions. For Real Time transactions, the sender remains connected while the receiver processes the transactions and returns a response to the sender and with an average response time within 20 seconds. Gainwell will utilize a Real Time Safe Harbor interface referred to as HDE (Health Direct EDI). This will allow for trading partners to transmit the Real Time transactions directly to the translator (EDIaaS).
HDE connectivity and requirements per CAQH Core Rules
- Trading Partner Software web service to process transaction
- Trading Partner transaction can be in SoapUI or MIME format for submission
- Trading Partner will receive a URL, HDE username and password to access the HDE connection.
What does this mean? If you are a provider, contact your software vendor, clearing house or billing agency. Medicaid does not offer software for these Real Time transactions.
To participate
- Do you have a trading partner number?
- Is your contact information on the Healthcare Portal current?
- If you have answered yes to the above questions and are interested in these Real Time transactions, please answer the questions below.
Testing will begin late July to mid-August.
To participate in testing, you must provide the information below.
Name, TPID, contact name, email, and telephone number. Identify format (SOAPUI or MIME) for submitting Real Time transactions.
Send your answers to riediservices@gainwelltechnologies.com. Please make sure to add a subject line of Real Time Transactions.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
South Carolina
The Department of Health and Human Services (SCDHHS) consistently offers free training to prospective and enrolled Healthy Connections Medicaid providers. Many of these courses are available virtually. Information about the upcoming Healthy Connections Medicaid eLearning trainings for summer 2023 is listed here. These recurring virtual workshops cover a variety of topics including training on Medicaid basics, how to submit claims using the web-based tool and third-party liability (TPL). To register for a workshop, please visit the Medicaid eLearning site, www.medicaidelearning.com, or call (888) 289-0709 and select option 1. Additional training resources for providers are also available online through the Medicaid eLearning site.
Also in South Carolina, on July 18, 2023, CVS Pharmacy reached out to the Medical University of South Carolina to authenticate a hardcopy prescription for Promethazine DM (in a 473 ml bottle) and Tessalon Perles. The medical provider listed on the prescription was Dr. Chitra Lal. During the verification process, concerns were raised regarding the signature on the prescription. It was observed that the signature was not a conventional 'wet' signature and appeared to deviate from Dr. Lal's usual signature style. This discrepancy prompted a deeper investigation into the matter. Upon further examination, it was established that the prescription in question was a forgery. Rx verification should be requested by calling 864.255.5638.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Tennessee
The new rule from Tennessee Department of Commerce and Insurance, 0780-01-95 – Pharmacy Benefits Managers, became effective June 27, 2023.
Also in Tennessee, beginning August 1, 2023, prior authorization requirements will be removed for the following preferred medications: Advair Diskus, Advair HFA, Dulera, Symbicort, aripiprazole, Diclegis, ezetimibe, fenofibrate and Xarelto. We encourage you to read this notice thoroughly and contact OptumRx's Pharmacy Support Center (866-434-5520) should you have additional questions.
Finally, TennCare is continuing the process of reviewing all covered drug classes. Changes to the PDL [Preferred Drug List] may occur as new classes are reviewed, and previously reviewed classes are revisited. As a result of these changes, some medications your patients are now taking may be considered non-preferred agents in the future. Please inform your patients who are on these medications that switching to preferred products will decrease delays in receiving their medications. We encourage you to read this notice thoroughly and contact OptumRx's Pharmacy Support Center (866-434-5520) or tnrxeducation@optum.com should you have additional questions. For more details on Clinical Criteria, please visit https://www.optumrx.com/oe_tenncare/landing.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Texas
The 88th Regular Legislative Session adjourned sine die May 29. Gov. Greg Abbott (R) immediately called the first 30-day special session to address property tax cuts, which ended with no bills advancing to the Governor's desk. The Governor called a second special session to address property tax cuts. Speaker Dade Phelan (R) and Lt. Gov. Dan Patrick (R) finally reached an agreement on a property tax relief package, it passed and was signed by the Governor.
Also in Texas, Gov. Abbott signed into law several bills of interest to pharmacies:
- SB 2173 creates a voluntary prescription drug safe disposal pilot program to be developed by the Board of Pharmacy;
- HB 1283, legislation that makes permanent the single statewide drug formulary and preferred drug list for Medicaid managed care organizations; and
- HB 999, the copay accumulator bill requiring health plans and PBMs, not pharmacies, to apply any coupon or other reduction in out-of-pocket expenses made by or on behalf of an enrollee to the enrollee's deductible copayment, cost sharing responsibility or out-of-pocket maximum applicable to prescription drug benefits.
Also in Texas, with Attorney General Ken Paxton (R) still suspended from office as he awaits his September impeachment trial in the Senate, Gov. Abbott appointed Angela Colmenero as the new Interim Attorney General, replacing the short-term Interim Attorney General John Scott.
Also in Texas, Vaccines for Children (TVFC) Program provider manual is now on-line. TVFC IQIP providers are responsible for understanding program policies and requirements for 2022-2023 TVFC re-enrollment. The 2023-2024 Texas Vaccines for Children (TVFC)/Adult Safety Net (ASN) Program re-enrollment will open in October 2023 and close November 2023.
Finally in Texas, the agenda for the Drug Utilization Board July 21 meeting was posted.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Vermont
Due to the current state of emergency in the state and to ensure that Medicaid beneficiaries have access to the medications they need, the Department of Vermont Health Access (DVHA) is temporarily re-activating SCC 13 as an allowable NCPDP submission clarification code in the adjudication of pharmacy claims. Changes to point-of-sale will be effective from July 13, 2023, to July 25, 2023. This code is utilized by the dispensing pharmacist when processing an early refill for the patient and indicates that an override is needed based on an emergency/disaster situation recognized by the payer. The use of SCC 13 will override a Reject 79 (Refill too soon). It will not override either Reject 75 (prior authorization required) or Reject 76 (Plan limits exceeded). DVHA will monitor claims using this submission clarification code to ensure it is used only when medically necessary. Improper use of SCC13 will subject the claim to recoupment. 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.
On July 20, Gov. Phil Scott (R) signed the 3rd addendum to his emergency declaration. This addendum added the following relevant to pharmacies: "The Secretary of State is hereby directed to waive such rules and requirements as may be necessary to allow a pharmacist to extend a previous prescription for up to a 30-day supply for a maintenance medication for which the patient has no refills remaining or for which the authorization for refills has recently expired if it is not feasible to obtain a new prescription or refill authorization from the prescriber. "Maintenance medication" means a prescription drug taken on a regular basis over an extended period to treat a chronic or long-term condition. The term does not include a regulated drug, as defined in 18 V.S.A. § 4201." Additionally, a pharmacist who extends a prescription for a maintenance medication pursuant to this authority shall take all reasonable measures to notify the prescriber of the prescription extension promptly.
For more information, please contact NACDS’ Ben Pearlman at 617-515-2603.
Virginia
The Board of Pharmacy announced that due to the expiration of the federal public health emergency (PHE) and pursuant to the third enactment clause of HB 1323, routine childhood vaccines may be administered under the Board of Pharmacy (BOP) Vaccine Statewide Protocol for Persons Ages Three (3) through Seventeen (17). HB 1323 of 2022 made pharmacists' authority to provide vaccines under the PREP Act permanent in the Commonwealth.
Also in Virginia, the Department of Health sent a communication to licensees to clarify that the CDC's COVID-19 Vaccination Program Provider Agreement is still in effect and requires that all organizations and providers participating in the CDC COVID-19 Vaccination Program continue to abide by its terms until the transition to commercialization is complete.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Washington
The State Health Care Authority (HCA) announced that the Centers for Medicare & Medicaid Services (CMS) renewed the Section 1115 Medicaid Transformation Project (MTP) waiver for five years effective July 1, 2023.
Also in Washington, the third quarter Preferred Drug List (PDL) has been posted.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
West Virginia
The Board of Pharmacy’s July Newsletter contains a comprehensive review of significant legislation passed by the Legislature in 2023 and an update on corresponding rules.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Alabama
Effective October 1, 2022, the Medicaid Agency removed the requirement of absence of alcohol and illicit drug use by recipients for the prior approval of antiviral drugs used in the treatment of hepatitis C. A copy of the patient's drug and alcohol screening lab report is no longer required. All other criteria remain, including the patient consent form with the patient's and physician's signature, which must be submitted with requests.
The updated Prior Authorization (PA) request form and criteria booklet should be utilized by the prescriber or the dispensing pharmacy when requesting a PA. Updated forms and criteria can be found here.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
California
The Department of Health Care Services (DHCS) posted the following weekly notices on the Medi-Cal Rx Web Portal:
- Reinstatement Spotlight (June 23)
- Medi-Cal Rx Weekly Wrap-up for June 16-23 (June 23)
- Drug Lookup Tool – Enhanced Functionality (June 20)
- Reinstatement Spotlight (June 16)
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Indiana
The Family and Social Services Administration's (FSSA) Office of Medicaid Policy and Planning's Medicaid Director Allison Taylor is retiring later this summer. FSSA Secretary Dr. Dan Rusyniak announced that Cora Steinmetz, Gov. Holcomb's senior operations director for health-related state agencies, will be the next director of Indiana Medicaid. Steinmetz and Taylor will work closely during the weeks ahead to ensure a smooth transition.
Also in Indiana, the Health Coverage Programs (IHCP) updated its member eligibility and benefit coverage manual.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Michigan
The House Health Policy Committee reported a substitute version of SB 219 (H-2). The bill allows pharmacists to order and administer immunizations to patients aged three years and older; order and administer tests for COVID, flu or respiratory illness and furnish medications to treat COVID and flu. The bill is scheduled for a vote by the full House and must be returned to the Senate for concurrence.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Minnesota
As result of the passage of 2023 Session Law Chapter 70 (Article 2, Sections 8-21, 43), pharmacies and wholesalers will be required to report on Drugs of Significant Public Interest beginning in 2024. The Minnesota Department of Health (MDH) is in the initial stages of developing the reporting initiative. As work progresses, they will provide updates on implementation, opportunities for public comment and resources to support reporting entities newly engaging in this reporting initiative. NACDS will pass on all information to members. If you are interested in directly receiving announcements on prescription drug price transparency from MDH, you may subscribe to Prescription Drug Price Transparency updates.
Also in Minnesota, the MIIC (Minnesota Immunization Information Connection) forecaster has been updated to ensure all people ages five years and older are recommended to receive one dose of COVID-19 vaccine and people under five years to receive two or three doses, depending on the product and appropriate intervals. The forecaster cannot recommend a specific COVID-19 vaccine schedule based on the date of an administered dose or recommend bivalent (updated) doses only. The forecaster's updates will now validate the first dose received by clients ages five years and older and the first two or three doses received by clients under the age of fvie. Doses will be validated regardless of when they were received. All other doses will be recorded in a client's immunization record but not evaluated. Unevaluated doses will display in MIIC but will not contain information in the series column.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Nebraska
The Department of Health and Human Services (DHHS) posted the COVID-19 Fee Schedule effective May 31, 2023.
Also in Nebraska, the Department of Health and Human Services Division of Children and Family Services Economic Assistance issued Pandemic Electronic Benefits Transfer (P-EBT) benefits to households for school-age children eligible for free or reduced-priced school meals during the 2022-2023 school year. Children with an eligible COVID-19 absence from school will receive monthly support ranging from $25 to $139.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.