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.
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.
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’ Ben Pearlman at 617-515-2603.
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.
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.
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.
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.
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.
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.
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.