South Carolina
A phoned-in prescription for promethazine/dextromethorphan was called into CVS, Lancaster, SC by an unknown person stating their identity as Dr. Allen Glimerm with Prisma Health Urgent Care, Greer, SC. This physician is no longer with this clinic. Rx was not called by the physician or any other authorized representative. Rx verification should be requested by calling 864.255.5638.
Also in South Carolina, the South Carolina Department of Health and Human Services (SCDHHS) will operate on an updated schedule for Healthy Connections Medicaid claims submission and payments to accommodate the Fourth of July holiday. Friday, June 30 at 5 p.m. is the deadline to submit claims for payments scheduled for Friday, July 7. Payments will be made on Monday, July 3. Electronic remittance advice will be available Thursday, July 6. Payments will be dated Friday, July 7, as usual. The schedule will return to a normal payment cycle on Friday, July 7.
Any questions or concerns regarding this bulletin should be directed to the Provider Service Center (PSC) at (888) 289-0709. The PSC's hours of operation are 7:30 a.m.-5 p.m. Monday-Thursday and 8:30 a.m.-5 p.m. Friday. The PSC will be closed Tuesday, July 4, in observance of the Independence Day holiday.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Tennessee
The Division of TennCare and its Managed Care Contractors (MCCs) would like to inform you of changes to the buprenorphine prescription benefit for TennCare members. These system and procedural changes impact prior authorization requirements for providers who prescribe buprenorphine products to TennCare members and those providers who participate in the Buprenorphine Enhanced Supportive Medication Assisted Recovery and Treatment (BESMART) provider network. These coverage allowances and changes to prior authorization processes became effective on May 15, 2023.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Texas
The Senate impeachment trial of Attorney General Ken Paxton (R) is set to begin on September 5th.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Vermont
This week, the legislature returned to override the Governor’s veto of H. 305, a bill that will, among its provisions, clarifies the definition of pharmacy technician, allows technicians to perform tests and vaccinations for Covid and other immunizations, allows pharmacists and technicians to administer vaccines for flu and covid for children ages 5 and up, allows a pharmacist to prescribe, order, or administer self-administered hormonal contraceptives for patients 18 years of age or older, vaccinations recommended by the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices (ACIP) and administered consistently with the ACIP-approved immunization schedules, and finally exempts persons dispensing over-the-counter hearing aids from provisions for audiologists and hearing aid dispensers.
For more information, please contact NACDS’ Mike Sargent at 207-272-6435.
Washington
The Department of Health (DoH) and the Health Care Authority (HCA) are hosting a webinar on July 18th for pharmacy staff to discuss barriers in prescribing and dispensing contraception.
Also in Washington, starting on July 1st, the HCA will be publishing quarterly updates to the Apple Health billing guides and fee schedules.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Arizona
The Board of Pharmacy posted the new OTC Naloxone FAQ on its website.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
California
The Department of Health Care Services (DHCS) posted the following weekly notices on the Medi-Cal Rx Web Portal:
- Medi-Cal Rx Weekly Wrap-up for June 2-8 (June 9)
- Reinstatement Spotlight (June 9)
Also in California, on June 13, the Department of Health Care Services posted a Freeze on Processing Paper Electronic Health Care Claim Payment/Advice Receiver Agreement Form [DHCS 6246 form].
Finally in California, the Board of Pharmacy posted its agenda and meeting materials for the Full Board Meeting on June 21.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Connecticut
Gov. Ned Lamont (D) signed legislation (SB 1102) that allows pharmacists to order and administer COVID, flu and HIV (Human Immunodeficiency Virus) tests, pharmacists to prescribe and distribute HIV-related prophylaxis and pharmacists and technicians to administer vaccines. Governor Lamont signed another bill (HB 6768) that allows pharmacists to prescribe emergency and hormonal contraceptives.
For more information, please contact NACDS’ Mike Sargent at 207-272-6435.
Idaho
The Board of Pharmacy published its June 2023 newsletter including the following articles.
- 2023 Legislative Update
- 2023 Legislative Update for Statutes
- Guidance for Lifestyle Injectable Treatments
- Answers to Frequently Asked Expedited Partner Therapy Question
- Board of Pharmacy Launches New Website
- Health Professional Recovery Program
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Illinois
Gov. JB Pritzker (D) has signed SB 303. https://www.ilga.gov/legislation/billstatus.asp?DocNum=303&GAID=17&GA=103&DocTypeID=SB&LegID=144008&SessionID=112 Effective January 1, 2024, it will be the joint responsibility of a pharmacy and its pharmacist–in–charge to ensure that all new pharmacy technicians are educated and trained using a standard nationally accredited education and training program, such as those accredited by the Accreditation Council for Pharmacy Education (ACPE)/the American Society of Health-System Pharmacists (ASHP), or equivalent work experience of 500 hours as a pharmacy technician covering the practice areas as required by the Illinois Pharmacy Practice Act.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Iowa
The Department of Health and Human Services, Iowa Medicaid posted the following:
- INFORMATIONAL LETTER NO. 2473-MC-FFS: Billing Evaluation and Management (E/M) Code 99211 and Modifier 25, effective July 1, 2023
- INFORMATIONAL LETTER NO. 2476_MC-FFS: June 2023 Pharmacy Billing Reference, effective Upon Receipt (This replaces INFORMATIONAL LETTER NO. 2388-MC-FFS.)
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Maine
On June 15, the Maine legislature approved LD 899, a bill that would authorize certified pharmacy technicians to administer vaccines under the direct supervision of a pharmacist and complete a certification program. Said certification program must be approved by the board and have at least six (6) hours of vaccine-related training that includes, at a minimum, training on the safe and effective administration of vaccines, hands-on injection technique, clinical evaluation of indications and contraindications of vaccines and the recognition and treatment of emergency reactions to vaccines and cardiovascular life support training. Lastly, the bill also clarifies the timing of when vaccine administration training requirements must be completed by pharmacists. The measure was approved with an emergency preamble and will be effective upon signing by the Governor.
For more information, please contact NACDS’ Mike Sargent at 207-272-6435.
Maryland
Medicaid issued Advisory #248 from the Office of Pharmacy Services in reference to the Generic vs. Brand Status on Maryland’s Preferred Drug List effective July 1, 2023.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Michigan
NACDS filed comments with the Department of Insurance and Financial Services (DIFS) supporting its proposed rule pursuant to the PBM (Pharmacy Benefits Managers) Licensure and Regulation Act.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
New Hampshire
Gov. Chris Sununu (R) signed SB 35, a bill that authorizes pharmacists, pharmacy interns and licensed advanced pharmacy technicians to administer an RSV vaccine to adults.
For more information, please contact NACDS’ Mike Sargent at 207-272-6435.
Oregon
The Oregon Board of Pharmacy permanently adopted the following rules at the June 2023 Board Meeting:
- Divisions 006/041/043/045/080/139/141 related to Standards Adopted by Reference *Effective 6/13/2023
- Divisions 019/020 related to Pharmacist Prescriptive Authority *Effective 6/13/2023
- Continuation of Therapy including Emergency Refills of Insulin v. 6/2023
- Travel Medications v. 6/2023
- HIV Post-exposure Prophylaxis (PEP) v. 6/2023
- HIV Pre-exposure Prophylaxis (PrEP) v. 6/2023
- Contraception v. 6/2023
- Divisions 019/041/043/045/080/139/141/143 related to Annual Self-Inspection Form Completion Date *Effective 8/1/2023
Also in Oregon, the House passed the following bills this week:
- HB 2725 (A-Engrossed), legislation prohibiting PBMs from retroactively denying or reducing payment on a claim after adjudication unless the pharmacy and the PBM agree that payment was incorrect due to a clerical error and requiring PBMs, if denying or reducing reimbursement on a claim, to provide notice to the pharmacy of the specific claim that is denied or reduced and an explanation for the denial or reduction.
- HB 3013 (B-Engrossed), legislation requiring PBMs to be licensed by the Department of Consumer & Business Services, amending the definition of "pharmacy benefit manager", establishing a rate floor, permitting pharmacies to file a complaint with the Department of Consumer & Business Services, imposing new requirements to coverage of 340B drugs and various other provisions.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Pennsylvania
As a reminder, the state’s Naloxone Copay Assistance Program will reimburse pharmacies up to $75.00 for Naloxone claims for any patient who appears hesitant to fill, regardless of the type of insurance they have (public or commercial), and those without coverage. Developed jointly by NACDS/PACDS members and the Governor’s Opioid Task Force, claims are billed through the PACE (Pharmaceutical Assistance Contract for the Elderly) program’s platform to make it seamless for pharmacies, with little criteria for the patient to qualify. Due to underutilization, the state recently reissued a bulletin outlining NCPDP D.0 payer specifications/billing instructions for pharmacies. It is NACDS’ understanding the $75.00 may be billed for either a copay or to offset total cost.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Tennessee
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 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 the website.
Also in Tennessee, the Tennessee Pharmacists Research and Education Foundation is looking to partner with 10 additional pharmacies for the Community Outreach Immunization Initiative. This opportunity is open to pharmacies across Tennessee that are willing to engage patients that have not received their COVID-19 vaccination series, as well as any other patients who may have gaps in their vaccination history. This opportunity will be a nine (9) month commitment and could earn your pharmacy up to $31,500. If you are interested register at the link here. If you have further questions about this opportunity, reach out to Danielle McCoy.
Finally in Tennessee, this communiqué has been sent to provide further clarification on the buprenorphine update changes that became effective May 15, 2023. Additionally, you will find an updated memo that properly reflects the recent buprenorphine changes for your records.
We encourage you to review this information thoroughly and contact the OptumRx Pharmacy Supports Center at 866-434-5520 or tnrxeducation@optum.com should you have questions.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Texas
The Health and Human Services Executive Commissioner Cecile Erwin Young announced that Emily Zalkovsky will lead the Medicaid and CHIP Services division as the Medicaid Director, effective July 1, replacing Stephanie Stephens.
Also in Texas, the Health and Human Services Commission (HHSC) is aware of a drug shortage for the brand name Chantix in the Smoking Cessation drug class due to a manufacturing delay of this product by Pfizer. In response to the preferred brand name Chantix shortage, HHSC removed the non-preferred status from the generic product, varenicline, on the preferred drug list.
Also in Texas, the HHSC Vendor Drug Program's (VDP's) Medicaid-enrolled pharmacy providers must ensure their email address is on file and up to date within the Provider Enrollment and Management System (PEMS). You can access the PEMS-associated job aid, Verifying an Email in PEMS (PDF), on tmhp.com if you need help confirming your email address. Your correct email address in PEMS means you will receive timely enrollment-related notifications from TMHP (Texas Medicaid & Healthcare Partnership). If you have marked TMHP notifications as spam or have blocked TMHP notifications, you will no longer receive those notifications. Additional information related to email addresses in PEMS is available in the Preparing for PEMS Guide (PDF) on tmhp.com.
Finally in Texas, HHSC VDP has updated two manuals of interest to pharmacies:
- The VDP Website Handbook includes several resources and references for stakeholders. Many are updated regularly and can resolve issues or prevent the need for a phone call to the help desk or emailing HHSC. This manual provides guidance and instruction on viewing or downloading manuals, forms and delimited data files.
- Pharmacy Provider Procedural Manual (PPPM) is a comprehensive resource for pharmacy providers enrolled with HHSC. The VDP publishes this manual with information about benefits, policies and procedures for outpatient pharmacy claims and rebates.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Washington
The Pharmacy Quality Assurance Commission (PQAC) held a workshop on June 15 to review stakeholder comments on PQAC prepared draft rules on the accessible labeling issue.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Alabama
The Medicaid Agency implemented a Telemedicine Policy effective June 1, 2023. The Telemedicine Policy and detailed information are located in Chapter 112 of the July 2023 publication of the Provider Billing Manual.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
California
The Department of Health Care Services (DHCS) posted these resources to provide further resources to assist with Medi-Cal Rx Reinstatement.
- Medi-Cal Rx Reinstatement: Phases II-III: Easy access to resources and support
- FAQ: Frequently asked questions regarding Medi-Cal Rx Reinstatement
- DHCS Medi-Cal Rx Reinstatement slide deck
- Medi-Cal Rx Reinstatement information page: Select Medi-Cal Rx Reinstatement tab, located on the left
For further questions, email Medi-Cal Rx Education & Outreach. DHCS values your input. Please complete this short survey to provide feedback.
Also in California, this week, the Board of Pharmacy issued a notice to be “Beware of Scam Calls” as a result of licensees reporting being victimized by scam callers claiming to represent the “California State Board of Pharmacy” (Board) or another government agency.
Finally in California, the Department of Health Care Services (DHCS) posted the following alerts and weekly wrap-ups on the Medi-Cal Rx Web Portal:
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
District of Columbia
The Board of Pharmacy’s June newsletter has been published.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Florida
Consumers can purchase qualifying disaster preparedness supplies exempt from tax during the two 2023 Disaster Preparedness Sales Tax Holidays, May 27- June 9, 2023, and August 26-September 8, 2023.
Also in Florida, the Board of Pharmacy is developing amendments to Rule 64B16-27.650 regarding additional immunizations or vaccines which may be administered.
Finally in Florida, the Board of Pharmacy proposes amending Rule 64B16-28.108 regarding dispensing medication to a blind or visually impaired patient. More information can be found here.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Illinois
Due to the access to care issue for bronchodilation medications for customers with asthma and other respiratory issues, the Department of Healthcare and Family Services (HFS) will temporarily remove the prior authorization requirements for generic albuterol sulfate inhalers, effective immediately. Pharmacy providers with questions may contact the Bureau of Professional and Ancillary Services at 877-782-5565 for FFS claims, or the applicable MCO.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.