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Illinois

In 2022, the General Assembly passed Public Act (P.A.) 102-0700, which suspended the state’s 1 percent (1%) low rate of sales and use tax on retail sales of groceries from July 1, 2022, through June 30, 2023. The 1% grocery sales tax suspension ended on Friday, June 30. Retailers are now required to collect and remit the 1% sales tax on groceries. 

For more information, contact NACDS’ Leigh Knotts at 803-243-7207.

July 21, 2023|Illinois|

Indiana

The state's Health Coverage Programs (IHCP) provided updates on prior authorization (PA) criteria and Preferred Drug List (PDL) as approved by the Drug Utilization Review (DUR) Board at its June meeting. The provisions apply only to Medicaid fee-for-service.

Also in Indiana, a Medicaid state plan amendment (SPA) allowing pharmacists to be enrolled as providers was submitted to the Centers for Medicare & Medicaid Services (CMS). The SPA allows pharmacists to be enrolled as providers and includes provisions that would reimburse for all services pharmacists provide within their scope. Unfortunately, the state rulemaking process could take 18 months to two years to implement once approved by CMS. 

For more information, contact NACDS’ Mary Staples at 817-442-1155.

July 21, 2023|Indiana|

Iowa

The Department of Health and Human Services, Iowa Medicaid posted the following:

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

July 21, 2023|Iowa|

Kentucky

The Department of Human Services announced that due to the COVID-19 pandemic and the noticeable increase in vaccinations administered by pharmacy providers in recent years, they will be increasing the current pharmacy vaccine administration fee ($3.30) effective October 16, 2023. The new administration fee will be $27.49 for the first dose in the series. Each subsequent dose will receive an administration fee of $9.80 (if applicable). The effective date of this change is October 16, 2023. Members should expect to receive more information and billing instructions from MedImpact. NACDS reminds members that Medicaid no longer requires pharmacies to enroll in the Vaccine for Children Program (VFC) to be reimbursed for vaccines. 

Also in Kentucky, the Board of Pharmacy published a final rule permitting pharmacies to provide COVID treatment to patients. NACDS encourages members to review the rule because it also makes substantive changes to the process for providing test and treat services under ALL Board-approved protocols. 

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

July 21, 2023|Kentucky|

Louisiana

Effective October 1, 2023, Medicaid will reimburse continuous glucose monitors and other diabetic supplies as a pharmacy benefit.  

Also in Louisiana, the Department of Health (LDH) and its vendor Magellan Medicaid Administration (MMA) finally held an online seminar on July 17 detailing their plans to migrate to a Single MCO PBM on October 1, 2023. Pharmacy stakeholders were briefed on their plans to open a portal with on-line training videos and a testing window beginning on August 1. All pharmacies need to have a signed contract with MMA. New ID cards will be mailed by mid-September, but the Member's ID number will remain the same, so no crosswalk is needed. 

Also in Louisiana, by line-item vetoing certain sections in HB 1, the state's budget bill, Gov. John Bel Edwards (D) restored the $100 million reduction in funding to Louisiana Department of Health (LDH). Had the Governor not acted, the cuts would have caused loss of funding and federal matching funds, totaling between $400 million and $700 million. 

Also in Louisiana, Gov. John Bel Edwards (D) vetoed two school vaccine bills, HB 182 and HB 399, that the Governor feared could undermine public confidence in vaccines. The Legislature has an Override Veto Session scheduled to convene on July 18. 

Also in Louisiana, the Department of Health posted several provider notices of interest to pharmacies: 

Finally in Louisiana, the Board of Pharmacy published two rules in the Louisiana Register with immediate effective dates.  

  • Regulatory Project 2022-06 – Nonresident Pharmacies amended the rules for nonresident pharmacies to replace the term "out-of-state" with "nonresident," create parity between nonresident and resident pharmacy requirements, clarify intent and modify the responsibility on the pharmacist-in-charge (PIC) in the matter of policy and procedures. The rule was also amended to remove the requirement for nonresident pharmacies to designate a resident agent and registered office in Louisiana.  
  • Regulatory Project 2022-09 – Partial Fills of CDS (Controlled Substances) Prescriptions amended Sections 2735 and 2747 of rules relative to prescriptions for controlled dangerous substances (CDS). The change in Section 2735 places a requirement on pharmacies dispensing prescriptions for CDS to use a dispensing information system capable of accurately recording partial fills and refills of such prescriptions. The change in Section 2747 places a requirement on a pharmacist to dispense a partial fill of a prescription for a CDS when requested by the patient or prescriber, subject to the pharmacist's obligation relative to corresponding responsibility. 

For more information, contact NACDS’ Mary Staples at 817-442-1155.

July 21, 2023|Louisiana|

Maryland

The Prescription Drug Affordability Board (PDAB) released the agenda for the July 24 meeting which will be held remotely at 2:00 p.m. Please register for the meeting in advance. The Board continues to welcome public comment and input on all its work. Please submit comments to comments.pdab@maryland.gov, and they will be provided to the Board prior to the upcoming Board Meeting. Please visit the Board's website for more information about the upcoming and previous board meetings, presentation materials, and to learn more about the PDAB's work. 

Also in Maryland, The Department of Health (MDH (Maryland Department of Health)) is currently accepting applications and nominations for physicians and pharmacists to serve on the Medicaid Drug Use Review (DUR) Board in 2024. The DUR Board is comprised of up to twelve (12) licensed and actively practicing physicians and pharmacists in Maryland. Members are appointed by the Secretary of MDH and serve one term of three (3) years from the date of their appointment with the option to serve an additional three (3) year term. All interested applicants are required to submit a formal application by August 1, 2023. 

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

July 21, 2023|Maryland|

Michigan

This week, Gov. Gretchen Whitmer (D) signed SB 219 effective July 19. The bill codifies PREP (Public Readiness and Emergency Preparedness) Act authority, allowing pharmacies to provide all ACIP (Advisory Committee on Immunization Practices) vaccines to patients aged 3 years and older. It also authorizes pharmacists to order and administer CLIA-waived tests for COVID, Flu and RSV and provide drugs that treat those conditions under CDC protocols. Many thanks to members, the Michigan Retailers Association, and the Michigan Pharmacists Association for their work with the Legislature on this critical patient access to care law. 

Also in Michigan, the Bureau of Professional Licensing (BPL) within the Department of Licensing and Regulatory Affairs (LARA) sent a communication reminding pharmacy that the new Central Fill and Shared Pharmacy Services rules were effective as of May 19, 2023. The email asks that Licensee review the rules and statute for a complete understanding of all applicable requirements. Questions about the revised rules may be sent to BPLHELP@michigan.gov. 

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

July 21, 2023|Michigan|

Missouri

On July 6, Gov. Mike Parson (R) signed into law three bills enacting the largest pharmacy scope of practice expansion (HB 115 / SB 157 / SB 45 & 90). The bills allow pharmacists to independently administer all vaccines approved by the FDA as of January 1, 2023. The law also expands the services pharmacists can provide through physician protocols, and it creates framework for statewide standing orders for the testing and treatment of COVID, Flu and Strep.  

Also in Missouri, effective July 30, MO HealthNet will no longer allow automatic refills or automatic shipments of medications, devices, or supplies. MO HealthNet does not pay for any
prescription without an explicit request from a participant or the participant's responsible party, such as a caregiver, for each refilling event. Participants and providers cannot waive the explicit refill request requirement and enroll in an automatic refill program. 

Also in Missouri, MO HealthNet also reported that due to the increase in the Missouri Pharmacy Reimbursement Allowance (Pharmacy Tax), the adjustment to account for the Professional Dispensing Fee for Medicaid-reimbursed prescriptions was increased effective July 1, 2023.  

Also in Missouri, the Department of Commerce and Insurance's (DCI) Department of Health and Senior Services issued a revised naloxone HCL standing order that now lists the nasal spray generically, allowing pharmacists to dispense the brand name or generic product.  

Also in Missouri, starting July 17, MO HealthNet announced that the Pharmacy Help desk's NEW hours for drug prior authorizations will be Monday through Friday, 8:00 a.m. to 7:00 p.m. Central; weekend hours will remain the same 8:00 a.m. to 6:00 p.m. 

Finally in Missouri, the MO HealthNet Division recently moved all provider forms regarding MO HealthNet benefits to a new Provider Forms page.  

For more information, contact NACDS’ Mary Staples at 817-442-1155.

July 21, 2023|Missouri|

Montana

Based on the annual survey conducted by the Department of Public Health, this year's survey results provide data to support a proposed minimum dispensing fee of $5.11. Also, the maximum dispensing fee, for each volume range, is proposed to increase to incorporate the legislatively approved provider rate increase. 

The Department of Public Health and Human Services issued a Notice of Public Hearing on Proposed Amendment to ARM 37.85.105, updating effective dates of Medicaid fee schedules effective July 1, 2023. The public hearing via remote conferencing will be held on July 27 at 9:00 a.m. Below are the proposed changes to pharmacy reimbursement. 

(f)The outpatient drugs reimbursement dispensing fees range, as provided in ARM 37.86.1105(3)(b) is effective July 1, 2022 July 1, 2023: 

(i) for pharmacies with prescription volume between 0 and 39,999, the minimum is $4.32 $5.11 and the maximum is $15.73 $16.36;  

(ii) for pharmacies with prescription volume between 40,000 and 69,999, the minimum is $4.32 $5.11 and the maximum is $13.62 $14.16; or  

(iii) for pharmacies with prescription volume greater than or equal to 70,000, the minimum is $4.32 $5.11 and the maximum is $11.52 $11.98.  

(g) remains the same.  

(h) The outpatient drugs reimbursement vaccine administration fee, as provided in ARM 37.86.1105(6), will be $21.32 for the first vaccine and $15.65 $18.65 for each additional administered vaccine, effective July 1, 2022 July 1, 2023. 

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

July 21, 2023|Montana|

Nebraska

The Department of Health and Human Services (DHHS) posted the following: 

  • COVID-19 Provider Update Call on August 2 at noon (Central): Join using the link or dialing by phone:  

https://sonvideo.webex.com/sonvideo/j.php?MTID=mc307e2dda218d1060adfed7f454cfc16 or 408-418-9388 (access code: 2480 661 3098​)  

  • Durable Medical Equipment, Medical Supplies, Orthotics and Prosthetics effective July 1, 2023: 
  • Injectables Fee Schedule effective July 1, 2023 

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

July 21, 2023|Nebraska|

New Jersey

On July 10, Gov. Phil Murphy (D) signed a package of bills targeting prescription drug costs. Most relevant was A536, an Act Concerning Pharmacy Benefit Managers (PBMs). This new law establishes greater oversight of PBMs. The act requires rebates to be used to lower premiums and out-of-pocket costs for consumers and prevents the practice of spread pricing. It also requires PBMs to apply for a license from the NJ Department of Banking & Insurance to strengthen regulatory oversight. 

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

July 21, 2023|New Jersey|

New York

On July 17, the State Department of Financial Services adopted an amendment to the final rule regarding the PBM regulations and entities filing by electronic submissions.  

On July 13, the State Department of Health's NYRx, the Medicaid Pharmacy Benefit Program, posted a program update for providers and prescribers. On July 14, they also announced prior authorization program updates. 

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

July 21, 2023|New York|

Oklahoma

The Board of Pharmacy's COVID-19 Waiver Request form that helped pharmacies navigate through challenging times during the pandemic has been changed to a "Waiver Request" form. 

Also in Oklahoma, the Bureau of Narcotics and Dangerous Drugs Control passed a law defining "Acceptable IDs for CDS Prescriptions," changing the definition of recipient's identification number and recipient's agent's identification number for acceptable forms of identification for obtaining a controlled dangerous substance (CDS) prescription. The definition now refers to a federal law, which is 8 Code of Federal Regulations (CFR) 274a.2(b) (1)(v)(A) and (B). Title 63 O.S. §2-309B. 7. "Recipient's identification number" and "recipient's agent's identification number" means the unique number contained on forms of identification listed in 8 CFR 274a.2(b) (1)(v)(A) and (B). 

Also in Oklahoma, the Attorney General is staffing up in preparation to taking over enforcement of PBM laws. 

Finally in Oklahoma, the Board of Pharmacy held a hearing on July 19.  

For more information, contact NACDS’ Mary Staples at 817-442-1155.

July 21, 2023|Oklahoma|

Oregon

Gov. Tina Kotek (D) signed SB 608, requiring the Oregon Health Authority (Medicaid) to conduct a cost of dispensing study every three years and the first study is due January 2, 2024. 

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

July 21, 2023|Oregon|

Rhode Island

Medicaid is preparing to implement the Real Time 270/271 Eligibility Verification Request and Response and Real Time 276/277 Claim Status Request and Response Transactions. For Real Time transactions, the sender remains connected while the receiver processes the transactions and returns a response to the sender and with an average response time within 20 seconds. Gainwell will utilize a Real Time Safe Harbor interface referred to as HDE (Health Direct EDI). This will allow for trading partners to transmit the Real Time transactions directly to the translator (EDIaaS). 

 HDE connectivity and requirements per CAQH Core Rules 

  • Trading Partner Software web service to process transaction 
  • Trading Partner transaction can be in SoapUI or MIME format for submission
  • Trading Partner will receive a URL, HDE username and password to access the HDE connection. 

What does this mean? If you are a provider, contact your software vendor, clearing house or billing agency. Medicaid does not offer software for these Real Time transactions.  

To participate  

  • Do you have a trading partner number?  
  • Is your contact information on the Healthcare Portal current? 
  • If you have answered yes to the above questions and are interested in these Real Time transactions, please answer the questions below. 

Testing will begin late July to mid-August. 

To participate in testing, you must provide the information below. 

Name, TPID, contact name, email, and telephone number. Identify format (SOAPUI or MIME) for submitting Real Time transactions.  

Send your answers to riediservices@gainwelltechnologies.com. Please make sure to add a subject line of Real Time Transactions.  

For more information, contact NACDS’ Leigh Knotts at 803-243-7207.

July 21, 2023|Rhode Island|

South Carolina

The Department of Health and Human Services (SCDHHS) consistently offers free training to prospective and enrolled Healthy Connections Medicaid providers. Many of these courses are available virtually. Information about the upcoming Healthy Connections Medicaid eLearning trainings for summer 2023 is listed here. These recurring virtual workshops cover a variety of topics including training on Medicaid basics, how to submit claims using the web-based tool and third-party liability (TPL). To register for a workshop, please visit the Medicaid eLearning site, www.medicaidelearning.com, or call (888) 289-0709 and select option 1. Additional training resources for providers are also available online through the Medicaid eLearning site. 

Also in South Carolina, on July 18, 2023, CVS Pharmacy reached out to the Medical University of South Carolina to authenticate a hardcopy prescription for Promethazine DM (in a 473 ml bottle) and Tessalon Perles. The medical provider listed on the prescription was Dr. Chitra Lal. During the verification process, concerns were raised regarding the signature on the prescription. It was observed that the signature was not a conventional 'wet' signature and appeared to deviate from Dr. Lal's usual signature style. This discrepancy prompted a deeper investigation into the matter. Upon further examination, it was established that the prescription in question was a forgery. Rx verification should be requested by calling 864.255.5638. 

For more information, contact NACDS’ Leigh Knotts at 803-243-7207.

July 21, 2023|South Carolina|

Tennessee

The new rule from Tennessee Department of Commerce and Insurance, 0780-01-95 – Pharmacy Benefits Managers, became effective June 27, 2023. 

Also in Tennessee, beginning August 1, 2023, prior authorization requirements will be removed for the following preferred medications: Advair Diskus, Advair HFA, Dulera, Symbicort, aripiprazole, Diclegis, ezetimibe, fenofibrate and Xarelto. We encourage you to read this notice thoroughly and contact OptumRx's Pharmacy Support Center (866-434-5520) should you have additional questions. 

Finally, 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 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. 

For more information, contact NACDS’ Leigh Knotts at 803-243-7207.

July 21, 2023|Tennessee|

Texas

The 88th Regular Legislative Session adjourned sine die May 29. Gov. Greg Abbott (R) immediately called the first 30-day special session to address property tax cuts, which ended with no bills advancing to the Governor's desk. The Governor called a second special session to address property tax cuts. Speaker Dade Phelan (R) and Lt. Gov. Dan Patrick (R) finally reached an agreement on a property tax relief package, it passed and was signed by the Governor.  

Also in Texas, Gov. Abbott signed into law several bills of interest to pharmacies: 

  • SB 2173 creates a voluntary prescription drug safe disposal pilot program to be developed by the Board of Pharmacy;  
  • HB 1283, legislation that makes permanent the single statewide drug formulary and preferred drug list for Medicaid managed care organizations; and 
  • HB 999, the copay accumulator bill requiring health plans and PBMs, not pharmacies, to apply any coupon or other reduction in out-of-pocket expenses made by or on behalf of an enrollee to the enrollee's deductible copayment, cost sharing responsibility or out-of-pocket maximum applicable to prescription drug benefits. 

Also in Texas, with Attorney General Ken Paxton (R) still suspended from office as he awaits his September impeachment trial in the Senate, Gov. Abbott appointed Angela Colmenero as the new Interim Attorney General, replacing the short-term Interim Attorney General John Scott. 

Also in Texas, Vaccines for Children (TVFC) Program provider manual is now on-line. TVFC IQIP providers are responsible for understanding program policies and requirements for 2022-2023 TVFC re-enrollment. The 2023-2024 Texas Vaccines for Children (TVFC)/Adult Safety Net (ASN) Program re-enrollment will open in October 2023 and close November 2023. 

Finally in Texas, the agenda for the Drug Utilization Board July 21 meeting was posted.

For more information, contact NACDS’ Mary Staples at 817-442-1155.

July 21, 2023|Texas|

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|
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