Louisiana
HB 471, by Rep. Barbara Freiberg (R) allowing pharmacists, pharmacy interns supervised by a pharmacist, and licensed technicians supervised by a pharmacist to administer immunizations to individuals seven years old or older, passed the Senate Health and Welfare Committee on May 31 without amendments by a 5-2 favorable vote, and is now pending Senate floor action for a final vote. Pharmacies need to contact state senators in their community and urge a YES vote on the Senate floor. The legislature is scheduled to adjourn on June 8.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Massachusetts
The Board of Pharmacy issued two notices after its May 31 board meeting. In regard to scope of practice, the first order pertains to immunizations and injections as well as from new policy 2023-08. The second order issues a new policy that consolidates previous stocking allowance orders.
For more information, please contact NACDS’ Ben Pearlman at 617-515-2603.
Michigan
The Board of Pharmacy published a final rule on Central Fill Pharmacies, effective May 19, 2023.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Minnesota
As the 2023 legislative session came to a close, Gov. Tim Walz (D) signed session law Chapter 70 (SF 2995). The legislation requires Medicaid to conduct a feasibility study and implementation plan for carving the prescription drug benefit out of managed care and into Fee-For-Service. The study is due to the General Assembly by January 15, 2026.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Nebraska
The Department of Health and Human Services is accepting applications for Pandemic Electronic Benefits Transfer (P-EBT) benefits for homeschooled and fully virtual school-age students (K-12); application deadline is June 22. Through P-EBT, eligible school children receive temporary emergency nutrition benefits loaded on EBT cards that are used to purchase food. All benefits for homeschooled students and fully virtual students will be issued on August 15, 2023, for the 2022-2023 school year.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
New York
The State Department of Financial Services posted its proposed rulemaking for Pharmacy Benefit Managers regulation on May 24, 2023. The purpose is to establish rules for PBMs regarding assessments, license requirements, reporting and record keeping and to clarify definitions. Public comments are due 60 days from when this was published.
The NYRx Medicaid Pharmacy Benefit transition announced this week a 30-day countdown for transition fills. As you know, as of April 1, 2023, Medicaid members enrolled in mainstream Managed Care (MC) plans, Health and Recovery Plans (HARPs) and HIV-Special Needs (SNPs) began receiving their pharmacy benefits through NYRx, the Medicaid Pharmacy Program.
To ensure a smooth transition for members, NYRx instituted a transition fill period from April 1, 2023, to June 30, 2023. During the transition period, members were provided a one-time transition fill for up to a 30-day supply of a drug that would normally require prior authorization (PA) under the NYRx Preferred Drug Program (PDP). The one-time transition fill does not mean that a PA will not be required for future fills. Beginning on July 1, 2023, all claims will be subject to NYRx pharmacy program criteria listed on the NYRx PDL.
PAs issued by Medicaid Managed Care plans prior to April 1, 2023 (that are active/valid after April 1, 2023) will continue to be honored by NYRx. This includes clinical PAs that may also require PA under NYRx. The state encourages members to continue to use the portal and call with any issues. The upcoming change of note is starting July 1, 2023; all claims will require a prior authorization via the IVR/Portal System (with some exceptions).
For more information, please contact NACDS’ Ben Pearlman at 617-515-2603.
Ohio
The Department of Medicaid (ODM) announced that on July 1, 2023, they will transition pharmacy benefits for Medicaid Fee-for-Service (FFS) enrollees to Gainwell, their single pharmacy benefits manager (SPBM). This transition consolidates oversight of Medicaid pharmacy benefits for managed care and FFS members, giving prescribers and providers one vendor to work with regardless of how their patients are enrolled in Medicaid. Beginning July 1, Medicaid FFS prescribers and pharmacies will route claims to Gainwell's new BIN 024251 and PCN OHRXPFFS. This information will be included on the new FFS member ID cards, but they will retain their current member ID numbers. The Pharmacy Reference Guide and Payer Sheet has been updated to reflect the changes. For questions about the transition, please email MedicaidSPBM@medicaid.ohio.gov
Also in Ohio, the Board of Pharmacy's final rule on pharmacists' immunizations authority was published, effective June 1. The rule reflects the passage of HB 6 of 2021 (134th GA). It updates the state's current practice to permit pharmacists to administer: Flu and COVID vaccines by protocol or vaccines for "any other disease" with a prescription to patients aged 7 years and older; and "any disease" under a protocol. Further regulations concerning technician and intern vaccines required under HB 6 are still in the rulemaking process. NACDS continues to work with our in-state partners and the Legislature to pass legislation to bring pharmacy immunization authority in line with the PREP (Public Readiness and Emergency Preparedness) Act.
Finally in Ohio, on May 24 the Board of Pharmacy posted numerous guidance documents regarding pharmacy technician and technician trainee registration, reciprocity and training programs. To view the documents please go to Pharmacy.Ohio.Gov.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Oklahoma
With two-thirds support in both houses, on May 17, lawmakers, not Gov. Kevin Stitt (R) called a special legislative session to get more time to finalize the state's $12.8 billion budget for the upcoming fiscal year and to ensure that they get the final say on any bills they pass. The special session ran concurrently with the regular legislative session that adjourned sine die on May 26. The special session gives lawmakers the ability to come back in June if they need to override any of Gov. Kevin Stitt's vetoes on budget bills or related pieces of legislation.
The legislature officially adjourned the regular session on May 26. Prior to adjournment, lawmakers overrode 13 bills that Gov. Kevin Stitt's (R) vetoed, including HB 1843, legislation that moves the enforcement authority over PBMs from the Insurance Commissioner to the Attorney General, effective November 1, 2023.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Oregon
The June 7-9, 2023 Board of Pharmacy Meeting agenda and meeting materials are now available. Additional meeting materials may be added to the agenda prior to the board meeting. Visit the board website for current meeting materials.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Pennsylvania
The Department of Human Services published the following bulletins:
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Rhode Island
The June 2023 provider update can be found here. Previous issues can be found on the EOHHS [Executive Office of Health & Human Services] website at the provided link above.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Tennessee
To assist prescribers and providers, prior authorization (PA) requirements can be bypassed for certain medications when specific medical conditions exist. Those specific medications and diagnoses can be found here. Prescribers are encouraged to include the applicable diagnosis code on written prescriptions for inclusion on the electronic pharmacy claim. The submitted claim should include a Diagnosis Code Qualifier (Field # 492-WE) of "02," indicating ICD-10, as well as the appropriate Diagnosis Code (Field # 424-DO). 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.
Also in Tennessee, TennCare is continuing the process of reviewing all covered drug classes. Changes to the PDL 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.
Finally in Tennessee, effective July 1, 2023, TennCare members will be able to obtain Continuous Glucose Monitors (CGMs) and supplies from their local in network retail pharmacy. This new coverage pathway will not affect coverage under the medical plan. This update allows TennCare members to access CGMs and related supplies through either their pharmacy OR medical program. Under this new coverage pathway, prescriptions for CGMs and maintenance supplies may be sent to your patient's in-network pharmacy of choice. 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 information, contact NACDS’ Leigh Knotts at 803-243-7207.
Texas
The legislature adjourned sine die at 6:00 p.m. on May 29. Prior to adjournment, the Senate and the House finalized the $321.3 billion state budget for the two-year cycle beginning on September 1, 2023. They also passed and sent Gov. Greg Abbott (R) several bills of interest to pharmacies, including:
- HB 25, creates the Canadian Wholesale Prescription Drug Importation Act to provide lower cost prescription drugs for consumers;
- HB 4990, establishes the Texas Pharmaceutical Initiative governing board and advisory council, a Texas State PBM;
- HB 1283, retains the single Medicaid managed care organizations formulary and preferred drug list;
- SB 2173 requires the Texas State Board of Pharmacy (TSBP) to develop and implement a prescription drug safe disposal pilot program.
Also in Texas, unfortunately on day 138 of the 140-day Texas legislative session, HB 1105, the PREP Act permanent immunization legislation that passed both houses with more than a 2/3's vote, died at midnight because Sen. Lois Kolkhorst (R) refused to appoint Senate conferees to negotiate with House conferees on the anti-COVID mandate amendments the Senator added to the bill before it passed the Senate on May 23.
Finally in Texas, on May 24, the House General Investigating Committee released information regarding its investigation of Attorney General Ken Paxton (R). Paxton had met with legislators early in session requesting $3.3 million of taxpayer's money in the state budget to settle a lawsuit between the Attorney General and former staff members. The lawsuit revealed the four former executives were fired in retaliation for reporting the Attorney General to authorities which violated the Texas Whistleblower Act. On May 27, the full House debated HR 2377, the 20 articles of impeachment. The resolution passed with a vote of 121 to 23 and was delivered to the Senate where the trial will begin by August 28. Gov. Greg Abbott (R) appointed John Scott to serve as the short-term interim Attorney General until a decision in the impeachment trial is reached.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Wyoming
The Board of Pharmacy adopted the following emergency rules effective April 14, 2023.
Also in Wyoming, the Board of Pharmacy announced a Notice of Intent to Adopt Rules impacting the following chapters. Comments may be submitted to bop@wyo.gov by June 21, 2023.
- Chapter 3: Pharmacy Internship Regulations
- Chapter 6: Continuing Professional Education Regulations
- Chapter 16: Immunization Regulations
- Chapter 18: Prescribing by Pharmacists
Finally in Wyoming, the Board of Pharmacy adopted the following rules effective May 24, 2023:
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Alaska
The Legislature adjourned on May 17. On the last day, legislation promoted by the Alaska Pharmacists Association (AKPhA), CS HB 112 by pharmacist Rep. Justin Ruffridge (R), passed. The bill streamlines the pharmacy practice statutes, including provisions to increase access to epinephrine auto-injectors and medication delivery devices for anaphylaxis emergencies.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
California
AB 317, legislation requiring a health care service plan or certain disability insurers that offer coverage for a service that is within a pharmacist's scope of practice to pay or reimburse the cost of the service provided by the pharmacist at an in-network pharmacy or by a pharmacist at an out-of-network pharmacy if the health care service plan or insurer has an out-of-network pharmacy benefit, passed the Assembly on April 27 and was referred to the Senate Committee on Health on May 10.
Also in California, AB 1341, legislation authorizing a pharmacist to furnish COVID-19 oral therapeutics following a positive CLIA-waived test, passed the Assembly on April 17 and was referred to the Senate Business, Professions and Economic Development Committee on May 10. Prior to passage in the Assembly, the bill was amended to include an urgency statute meaning it will be effective immediately upon enactment.
Also in California, the Department of Health Care Services (DHCS) posted the following alerts and weekly wrap-up on the Medi-Cal Rx Web Portal:
- Medi-Cal Rx Weekly Wrap-up for May 12-18 (May 19)
- Reinstatement Spotlight (May 19)
- Billing Tips: Non-Covered Medical Supplies (May 12)
Finally in California, Medi-Cal posted the following:
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Colorado
Prior to the end of Colorado's legislative session sine die on May 8, Gov. Jared Polis (D) signed into law the following two PBM reform bills.
- HB23- 1201, limits the amount that health insurance carriers or pharmacy benefit managers (PBMs) may charge beneficiaries of select employer-sponsored plans for prescription drugs to no more than the amount paid by the plan or PBM to a contracted pharmacy. The bill applies to select contracts issued or renewed on or after January 1, 2025. The bill grants audit authority to the Department of Health Care Policy and Financing (HCPF) for Medicaid contractors and the Department of Regulatory Agencies (DORA) for all other contracts. Failure to comply is a deceptive trade practice in the business of insurance.
- HB23-1227 enhances enforcement authority over PBMs by the Commissioner of Insurance in the Division of Insurance (DOI), Department of Regulatory Agencies (DORA). It also requires all PBMs to register with the Commissioner and pay a registration fee. These fees, credited to the DOI Cash Fund, must fund the division's costs to enforce PBM requirements and prohibitions.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Louisiana
HB 471, sponsored by Rep. Barbara Freiberg (R), authorizes pharmacists to order and administer, and pharmacy interns and pharmacy technicians to administer immunizations to children aged 7 years and older. The bill passed the House Health and Welfare Committee by a vote of 14-2 on May 16, and it was sent to the full House to be voted on next week. Thanks to Dwana Day with Brookshire Grocery Company, and Albertsons Companies’ pharmacists Ryan LaBarbera and Brittany Tucker for a fantastic job representing their profession by testifying at the House hearing. NACDS and the Louisiana Alliance for Pharmacies strongly urge immediate action contacting all legislators where you operate pharmacies in their district.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Michigan
An amended version of S-4 version SB 219 codifying PREP Act allowances overwhelmingly passed the Michigan Senate this week by a vote of 36-1. It now goes to the House Health Policy Committee for further consideration. NACDS will be supporting the efforts of members and partners to make appropriate changes to the language in the House.
Also in Michigan, the Department of Health and Human Services issued Numbered Letter L 23. It clarifies billing requirements for Medication Therapy Management. Medicaid letters and bulletins can be accessed on the provider webpage.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Missouri
Prior to the Legislature adjourning on May 12, the pharmacy practice act language pharmacies had promoted that allows pharmacists to administer all FDA authorized and approved vaccines to anyone 7years of age and older passed in two bills, SS/HCS/HBs 115 & 99 and HCS/SS/SCS/SBs 45 & 90. These bills also include language that allows pharmacists with a certificate of medication therapeutic plan authority to provide under a statewide standing order medications to treat flu, strep and COVID. Lastly, the omnibus bills included a provision amending the definition of “opioid antagonist” in a statute that is currently defined as naloxone hydrochloride; this act adds any other drug or device approved by the FDA that blocks the effect of an opioid overdose. (CCS HCS SS SCS SBs 45 & 90 and HBs 115 & 99)
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Nebraska
The Department of Health and Human Services (DHHS) announced plans to distribute Pandemic Electronic Benefits Transfer (P-EBT) benefits to households in the state with school-age children eligible for free or reduced-price school meals and children in childcare during the 2022-2023 school year period.
Also in Nebraska, the DHHS issued recent guidance regarding Executive Orders expiring on June 30, 2023. The following requirements are no longer waived or deferred as of July 1, 2023. Providers are encouraged to reacquaint themselves with the original, pre-Executive Order, specific requirements. For more information, contact DHHS.LicensureUnit@Nebraska.gov.
- Time-limited Provisional Licenses Pending Successful Examination Results
- Onside, Face-to-Face, or Direct Supervision to Complete Certain Work or Training Required to Obtain a Credential
- Practice Agreements
- Direct Client-contact Hours
Finally in Nebraska, the DHHS posted the following bulletins:
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Nevada
The Retail Association of Nevada, NACDS and the Nevada Pharmacy Alliance sponsored the Pharmacy Day at the Capitol on May 1. More than 50 pharmacists and pharmacy students met at the Capitol to advocate for patient care and the profession. Pharmacist State Senator Jeff Stone (R), the sponsor of SB 201, legislation that clarifies pharmacists can order CLIA tests and serve as lab director, as well as providing payment parity for Medicaid services provided by pharmacist, joined the group that evening at The Brewery in Carson City.
Also in Nevada, SB 57, legislation which will require PBMs to register the Division of Insurance and Department of Business and Industry passed the Senate and is pending in the Assembly Committee on Commerce and Labor.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
New Hampshire
The New Hampshire legislature has approved an NACDS supported bill SB 35, a bill that will authorizes pharmacists, pharmacy interns and licensed advanced pharmacy technicians to administer an RSV vaccine to adults. The bill now awaits signature from the Governor.
For more information, please contact NACDS’ Ben Pearlman at 617-515-2603.
New York
On May 16, the State Department of Health held a monthly NYRx Medicaid Pharmacy Benefit transition call for pharmacies. The state encourages members to continue to use the portal and call with any issues. The upcoming change of note is starting July 1, 2023; all claims will require a prior authorization via the IVR/Portal System (with some exceptions).
For more information, please contact NACDS’ Ben Pearlman at 617-515-2603.
Ohio
The Board of Pharmacy posted numerous guidance updates related to the expiration of the Public Health Emergency and the policies and waivers they adopted during the COVID pandemic, including:
- 2023-05-11 – Board Issues Updated Guidance Due to the End of Federal Public Health Emergency.pdf
- Administration of COVID-19 Vaccines during the COVID-19 Pandemic.pdf
- Board of Pharmacy – COVID-19 Response Efforts – Pharmacy Tech Vaccine Administration
- Board of Pharmacy – COVID-19 Response Efforts
To view the full list, go to Pharmacy.Ohio.Gov.
Also in Ohio, the Ohio Department of Medicaid and Gainwell Technologies are continuing the reimplementation of prior authorizations (PA) based on specific drug classes. Of note, the PA reimplementation only applies to new, initial authorizations. It does not apply to those patients who have previously taken the drug supported by recent claims history prior to May 23, 2023. Phase 6 of reimplementation will begin on May 23 and contain the following:
- Analgesic Agents: Gout
- Blood Formation, Coagulation, and Thrombosis Agents: Colony Stimulating Factors, Hematopoietic Agents, Hemophilia Factor, Heparin-Related Preparations, Oral Anticoagulants, Oral Antiplatelets
- Cardiovascular Agents: Angina, Hypertension and Heart Failure, Antiarrhythmics, Lipotropics
- CNS Agents: Alzheimer's Agents, Anticonvulsants Rescue, Fibromyalgia Agents, MAT of Opioid Addiction, Movement Disorders, Multiple Sclerosis, Narcolepsy, Neuropathic Pain, Smoking Deterrents
- Endocrine Agents: Diabetes- Hypoglycemia treatments, Endometriosis, Estrogenic Agents, Growth Hormone, Osteoporosis-Bone Ossification Enhancers, Progestin Agents, Uterine Fibroids
- GI Agents: Pancreatic Enzymes, Proton Pump Inhibitors
- Genitourinary Agents: Electrolyte Depleter Agents, Urinary Antispasmodics
- Infectious Disease: Antibiotics-Inhaled
- Ophthalmic Agents: Antibiotic and Antibiotic-Steroid Combination Drops and Ointment, Antihistamines and Mast-Cell Stabilizers, Dry Eye Treatments, Glaucoma Agents, NSAIDS, Ophthalmic Steroids
- Otic Agents: Antibacterial and Antibacterial/Steroid Combinations
- Respiratory Agents: Antihistamines-Second Generation, Cystic Fibrosis, Epinephrine Auto-Injectors, Hereditary Angioedema, Inhaled Agents, Leukotriene Receptor Modifiers & Inhibitors, Monoclonal Antibodies-Anti-IL/Anti-IgE, Nasal Preparations, Other Agents
- Topical Agents: Antifungals, Antiparasitics, Corticosteroids
Please reference the Unified Preferred Drug List (UPDL) posted on the SPBM portal to see products that require a PA. PAs may be submitted via phone, fax, mail and the SPBM portal. Please direct questions to the Gainwell Technologies Help Desk at 1-833-491-0344.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.