Nebraska
The Department of Health and Human Services issued the following provider bulletins:
- Provider Bulletin 23-32: Summary of Member Reimbursement Opportunities
- Provider Bulletin 23-30A: Claims for Reinstated Medicaid Members (Updated December 11, 2023); this is an update to provider bulletin 23-30.
Also in Nebraska, the Department of Health and Human Services posted the Excel file of the fee schedule for Injectables October 1, 2023 (Revised).
Also in Nebraska, the Department of Health and Human Services received approval from CMS for State Plan Amendment 23-0015: Adult Vaccines related to coverage of vaccines and vaccine administration in accordance with current Advisory Committee on Immunization Practices (ACIP) recommendations.
Finally in Nebraska, the Department of Health and Human Services posted the meeting recording from the December 6 COVID-19 Provider Call. The next meeting will be held on January 3, 2024, at noon (Central). To participate, use either the meeting link or phone number and access code below.
Join from the meeting link:
https://sonvideo.webex.com/sonvideo/j.php?MTID=mc307e2dda218d1060adfed7f454cfc16
Join by phone:
408-418-9388 (access code: 2480 661 3098 )
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
New Mexico
The Legislative Health and Human Services Committee met on November 28 to discuss the Prescription Drug Purchasing Report and a presentation on reducing prescription drug prices to reduce healthcare costs.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
New York
NYRx, the State Department of Health Medicaid Pharmacy Benefit Program, released updates to the NYRx Prior Authorization Programs and updated preferred drug list, changes were effective December 14.
The State Department of Health also released a reminder regarding pharmacy providers and members out-of-pocket costs. This communication was sent to all pharmacies to remind them of their responsibility for continued enrollment, to adhere to the policies and procedures of the Medicaid Program. Specifically, it is inappropriate to allow an eligible member to pay out-of-pocket for services that are covered by NY Medicaid (NYRx) beyond copay. Please be advised that out-of-pocket expenses are only reimbursable by Medicaid for Medicaid covered services when one of these three situations applies:
- Reimbursement can be made for both participating and non-participating Medicaid Providers during the three-month retro period up until they submit the application.
- Reimbursement can be made for only Medicaid participating Providers from the date the application is submitted up until they receive the Common Benefit Identification Card (CBIC).
- Reimbursement can be made for both participating and non-participating Medicaid Providers due to agency error or delay.
If there is an eligibility issue that is corrected in a timely manner, pharmacists should resubmit the claim when the issue is resolved and reimburse the member directly if the member paid out of pocket. There is support available to pharmacists to assist with claim issues. Questions regarding this communication may be directed to NYRx@health.ny.gov.
On December 12, A6779, a bill NACDS and the Community Pharmacy Association of New York (CPANY) had been supporting to expand the 2022 law allowing pharmacists to administer long-acting injectables, was sent to the Governor's desk by the legislature. Gov. Kathy Hochul (D) has until December 22 to act on the legislation.
For more information, please contact NACDS’ Mike Sargent at 207-272-6435.
Ohio
The Board of Pharmacy published a series of proposed rule changes and rescissions they intend to work on this winter. Comments are due to the board on January 17, 2024.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Oklahoma
The Tenth Circuit Court of Appeals denied the State of Oklahoma’s petition for rehearing in PCMA v. Mulready. The state now has 90 days to petition the Supreme Court for further review.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Texas
The Health and Human Services Commission (HHSC) Vendor Drug Program (VDP) now covers the 2023-2024 Pfizer-BioNTech, Moderna and Novavax commercial COVID-19 vaccines as a pharmacy benefit for both Medicaid managed care and fee-for-service, as well as the Children's Health Insurance Program (CHIP).
Also in Texas, Medicaid will perform the semi-annual update of the Medicaid preferred drug list on January 25, 2024. The Health and Human Services Commission (HHSC) made the PDL changes based on recommendations made at the October 2023 Drug Utilization Review Board meeting. Drug list recommendations from the meeting are available. Drugs with preferred status drugs may include brand name medication which would not require a PDL prior authorization nor the value of "1" in the "Dispense as Written (DAW) Product Selection code" field (408-D8). Refer to the Dispense as Written section of the Formulary Coverage chapter of the Pharmacy Provider Procedure Manual for more information.
Also in Texas, the Health and Human Services Commission (HHSC) is soliciting comments on the prospective clinical prior authorization proposals likely to be presented at the Texas Drug Utilization Review (DUR) Board meeting on January 26, 2024. The board reviews and recommends clinical criteria and the preferred or non-preferred drug status on the Medicaid formulary.
Also in Texas, December 11 was the filing deadline for the March 5, 2024, primary election.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Vermont
The Board of Pharmacy is scheduled to hold its regular meeting on December 20; the agenda has been posted.
For more information, please contact NACDS’ Mike Sargent at 207-272-6435.
Washington
Gov. Jay Inslee (D) hosted a roundtable this week to discuss the fentanyl crisis and laid out his proposals for the upcoming legislative session. The governor’s budget adds over $50 million in new funding to take down opioids for the 2023–25 biennium, augmenting the investments from the state’s $82 million opioid settlements with drug manufacturers and pharmacies responsible in part for the opioid crisis and general fund investments within the 2023–25 biennial budget. The biennial budget allocated over $200 million for substance use disorder (SUD) treatment facility operations, rental subsidies for people with SUD, treatment subsidies, criminal diversion programs, peer support services, Tribal SUD grants and more.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Alabama
Please find the latest ALERT for pharmacy providers regarding coverage for adult vaccines, COVID vaccines and their administration. Also, an ALERT regarding coverage of adult vaccines for non-pharmacy providers has been released. Both versions have been released and will be sent to the respective provider lists. Medicaid shared both ALERTs so that individuals were aware there is a specific notice for pharmacy providers as the billing is unique to pharmacy. All ALERTs can be found here.
Also in Alabama, the Center for Medicaid and CHIP Services (CMCS) has approved a community-based mobile crisis state plan amendment (SPA) that allows Alabama to create mobile crisis intervention teams to provide Medicaid crisis services. Alabama will be able to provide these services by connecting eligible individuals in crisis to a behavioral health provider 24 hours per day, 365 days per year. For more information on this approval, please see the full Alabama SPA.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Alaska
The Board of Pharmacy scheduled a special meeting on December 7 to review public comments received for the most recent publicly noticed regulations project, continue the discussion on unexpected closures of pharmacies.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Arkansas
The Insurance Commissioner issued a Bulletin #20-2023 defining business days and hours in the Prior Authorization Transparency Act.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
California
The Department of Health Care Services (DHCS) posted the following alerts, weekly notices, and monthly bulletin on the Medi-Cal Rx Web Portal. Please note the “Maximum Allowable Ingredient Cost 30-Day Pharmacy Provider Notice”; rates will be effective January 1, 2024, and will be posted to the Mercer Med-Cal Rx website no later than December 1, 2023. Also note the “Commercial COVID-19 Vaccine Coverage for Children” alert providing an updated policy whereby COVID-19 vaccines are a Medi-Cal Rx pharmacy benefit for members three years of age and older.
- Medi-Cal Rx Weekly Wrap-up for November 17-30 (December 1)
- Reinstatement Spotlight (December 1)
- 30-day Countdown: Medi-Cal Managed Care Plan Transition (December 1)
- Maximum Allowable Ingredient Cost 30-day Pharmacy Provider Notice (December 1)
- Medical Supplies Updates: Updates to Contracted Pen Needles, Insulin Syringes, and Sterile Syringes with Needles (Non-Insulin), Effective January 1, 2024 (December 1)
- Medical Supplies Update: Updates to Diabetic Testing Supplies, Effective January 1, 2024 (December 1)
- Medical Supplies Update: Updates to List of Contracted Self-Monitoring Blood Glucose Systems (Glucometers), Control Solutions, and Lancing Devices, Effective January 1, 2024 (December 1)
- Updates to the List of Contracted Enteral Nutrition Products, Effective January 1, 2024 (December 1)
- Medi-Cal Rx Monthly Bulletin for December (December 1)
- Changes to the Medi-Cal Rx Contract Drugs List (December 1)
- Updates to the Medi-Cal Rx Provider Manual (December 1)
- Commercial COVID-19 Vaccine Coverage for Children (November 29)
- Paper Remittance Advice: Dollar Sign Placement Update (November 22)
- Reinstatement Spotlight (November 17)
Also in California, the Board of Pharmacy provided this important alert and reminder to licensees about the drug xylazine.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Colorado
Gov. Jared Polis (D) convened a special session in mid-November to address property taxes.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
District of Columbia
The Department of Health Care Finance (DHCF) Quarterly Pharmacy Stakeholders meeting will take place on December 19 and 20. A virtual meeting link is available by RSVP’ing to allison.williams@primetherapeutics.com no later than December 18.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Indiana
The Health Coverage Programs (IHCP) issued a bulletin reminding pharmacy providers to submit claims with the appropriate DAW codes.
Also in Indiana, after four interim legislative hearings, the Health Care Cost Oversight Task Force issued a report with seven recommendations for legislation, including increasing transparency and prohibiting spread pricing by PBMs, third parties and insurers.
Finally in Indiana, the IHCP Bulletin 2023168 provides informational updates on the November Drug Utilization Review (DUR) Board.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Louisiana
The Department of Health (LDH) issued a report detailing the results of key initiatives and policy goals for five major categories designed to make measurable improvements:
- Improve health and well-being across the lifespan of Louisianans
- Support vulnerable and underserved populations
- Invest in and empower #TeamLDH
- Improve performance, accountability, and compliance
- Strengthen customer service, partnerships, and community relations
Also in Louisiana, LDH issued a bulletin outlining the available options to providers for pursuing claims resolutions and appeals of issues with Medicaid managed care organizations (MCO) and the state’s fee-for-service claims processor, Gainwell Technologies.
Also in Louisiana, LDH issued a revised bulletin with added information on provider enrollment.
Also in Louisiana, LDH announced an 11% decline in new human immunodeficiency virus (HIV) diagnoses over the past five years. As of June 2023, the number of individuals living with HIV in Louisiana stands at 22,920.
Finally in Louisiana, LDH issued a memorandum announcing that diabetic supplies will be added to the Medicaid Single Preferred Drug List to be reimbursed as pharmacy claims only effective December 1, 2023.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Maryland
The Maryland Prescription Drug Affordability Board (PDAB) Stakeholder Council will be held remotely at 2:00 PM on Mon. December 18, 2023, and is open to all stakeholders. The agenda and meeting materials will be available on the Stakeholder Council page prior to the meeting. After registering, you will receive a confirmation email containing details about joining the meeting. To register for in-person comments, please refer to the Stakeholder Council page. You can find more information about upcoming and previous meetings of the Board and the Council, and presentation materials on the PDAB website.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Massachusetts
The Massachusetts Board of Pharmacy issued the following orders:
- Policy 2023-07: Non-Sterile Compounding: Several modifications regarding the addition of flavoring agents were added.
- Policy 2023-09: Action Level Environmental Monitoring Results: Clarified that highly pathogenic microorganisms will be those determined by a qualified microbiology professional.
- Policy 2020-15: Scope of Practice: Statement that the pharmacist is responsible for the accuracy of the final dispensed prescription was added.
- Compounded Ketamine: Edits to this document include the FDA cautions regarding the use of all compounded ketamine products, not just nasal spray.
- Sterile Injectable Dispensing (Including Testosterone): Reviews how to interpret the proper days’ supply of injectable vials.
For more information, please contact NACDS’ Mike Sargent at 207-272-6435.
Michigan
Medicaid issued a bulletin announcing prescription copay change for Healthy Michigan Plan enrollees.
Also in Michigan, The Department of Licensing and Regulatory Affairs (LARA) issued an email communication to pharmacies regarding the new Pharmacy Technician Administrative Rules that were effective on Oct. 2, 2023. They noted they are diligently working on updating relative information on their website to reflect the revision. Please send questions about the revised rules to BPLHELP@michigan.gov.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Minnesota
The Secretary of State announced open positions on the Prescription Drug Affordability Board (PDAB) and the PDAB Advisory Council. Applications may be submitted on the Open Positions page. If you are interested in applying, please contact NACDS’ Jill McCormack to coordinate.
Also in Minnesota, the Department of Health (MDH) has opened registration to all manufacturers, wholesalers, pharmacies, and pharmacy benefit managers required to submit prescription drug price transparency reports. Beginning in 2024, prescription drug manufacturers, pharmacies, wholesalers, and pharmacy benefit managers will be required to report quarterly on drugs of substantial public interest identified by MDH. All reporting entities are required to register with MDH’s online reporting system beginning January 1, 2024. MDH’s guide to registering provides more detail on the process.
Upcoming Implementation Steps:
- January 1, 2024: registration requirement goes into effect
- By January 31, 2024: MDH releases the first list of drugs of substantial public interest for reporting
- Thirty (30) or more days after the drug list is posted, MDH will notify reporting entities of their reporting obligations; reporting entities have 60 days after the notification is sent to report
- Early 2024: MDH will release finalized reporting guidance
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Missouri
The Board of Pharmacy hosted a webinar providing new information on the Prescription Drug Monitor Program (PDMP).
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Montana
The Board of Pharmacy and the Board of Veterinary Medicine posted the Joint Full Board Meeting Agenda for December 7. The meeting will be held by teleconference only; see agenda for details. Information is available on the Board meetings page.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Nebraska
The Department of Health and Human Services issued Provider Bulletin 23-31: Hepatitis C Virus (HCV) Antiviral Treatment to notify Medicaid providers of upcoming changes to HCV antiviral treatment requirements.
Also in Nebraska, the Department of Health and Human Services issued Provider Bulletin 32-30: Claims for Reinstated Medicaid Members to inform Medicaid providers of members whose coverage has been reinstated due to recent federal guidance. Additional information on Medicaid member reimbursement is also available online, including copays for prescription drugs paid to pharmacies.
Finally in Nebraska, the Department of Health and Human Services posted the draft minutes from the November 14 Drug Utilization Review Board meeting. The next meeting will be held on January 9, 2024.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Nevada
The next meeting of the Board of Pharmacy will be in Las Vegas on December 6 and 7.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
New York
Effective November 29, the New York Department of Health issued updated guidance regarding dispensing of COVID-19 over-the-counter tests at the pharmacy.
NYRx, the New York State Medicaid Pharmacy Benefit Program, sent a release to pharmacy providers on December 6th. The program continues to field questions and concerns from residency program coordinators about pharmacies not able to submit claims to NYRx written by their interns and residents. NYRx asked the following shared regarding submission of claims:
For more information, please contact NACDS’ Mike Sargent at 207-272-6435.