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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’ Mike Sargent at 207-272-6435.

July 21, 2023|Vermont|

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.

July 21, 2023|Virginia|

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.

June 23, 2023|Alabama|

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.

June 23, 2023|Indiana|

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.

June 23, 2023|Michigan|

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.

June 23, 2023|Minnesota|

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.

June 23, 2023|Nebraska|

New York

The New York Department of Health held a webinar  on the enacted Medicaid budget including NYRx, the Medicaid Fee-for-service pharmacy benefit transition.  The scorecard highlighted in the webinar shows additional savings for the state beyond what was projected by the transiition – $410 million to $547.8 million.

For more information, please contact NACDS’ Mike Sargent at 207-272-6435.

June 23, 2023|New York|

Ohio

NACDS reminds members that beginning July 1, Medicaid Fee-for-Service (FFS) pharmacy claims should be submitted to Gainwell with the BIN of 024251, a PCN of OHRXPFFS and the same 12-digit Medicaid ID number used to bill FFS today. All ODM-enrolled pharmacies will be able to submit FFS claims. No separate contracting with the SPBM is required. 

Additionally, prior authorization management will also transition to Gainwell beginning July 1. On this date, prescribers should begin submitting prior authorization requests to Gainwell, using the same forms and processes as used under the SPBM managed care program. All active prior authorizations on file with Change Healthcare will be transferred to Gainwell and will be honored through their original expiration date. 

Pharmacies and pharmacists can find the FFS Pharmacy Reference Guide and Payer Sheet at: Pharmacy Billing Information | pharmacy.medicaid.ohio.gov. 

Also in Ohio, The Common Sense Initiative (CSI) is reviewing the following Board of Pharmacy proposed rules to assess any adverse impact on the business community. To review the Board's Business Impact Analysis and provide comments to CSI, please click on the links below. 

  • 29:6-3-09 – Satellite Distribution Sites During a Public Health Emergency 
  • 4279:5-3-21 – Point of Dispensing Locations During a Public Health Emergency  
  • 4729:7-3-06 – Allows pharmacists to conduct medication validation (e.g., the final check) of a drug compounded in a prescriber clinic. 

The Board of Pharmacy is also seeking comments by July 28 on adding Nalmefene Nasal Spray under the definition of an overdose reversal drug to make it be available for widespread lay distribution in Ohio without a prescription, like naloxone. 

For more information, contact NACDS’ Jill McCormack at 717-592-8977.

June 23, 2023|Ohio|

Oregon

The Board of Pharmacy announced a rulemaking hearing on July 26 and is proposing to adopt the following rules. The rulemaking hearing will be held virtually and begins at 9:30 a.m. If you plan to testify, please complete the sign-up form on the website. Written comments may be submitted by 4:30 p.m. on July 26 via email. 

 Also in Oregon, the Board of Pharmacy announced it will receive public comments on the following proposed compounding rules at the July 26 rulemaking hearing beginning at 9:30 a.m. If you plan to testify or submit written comments, see the above section for guidance.  

For more information, contact NACDS’ Sandra Guckian at 703-774-4801.

June 23, 2023|Oregon|

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.

June 23, 2023|South Carolina|

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.

June 23, 2023|Tennessee|

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.

June 23, 2023|Vermont|

California

The Department of Health Care Services (DHCS) posted the following weekly notices on the Medi-Cal Rx Web Portal:   

 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.

June 16, 2023|California|

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.

June 16, 2023|Connecticut|

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.

June 16, 2023|Idaho|

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.

June 16, 2023|Illinois|
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