New York
As you are aware, late in 2021 several PBM legislative packages were signed into law. Now as the NYS Department of Financial Services is developing regulations, the Department is seeking public comment on a series of issues. Those requests for comments can be found on the Department of Financial Services website: www.dfs.ny.gov/pbm.
The most recent Department request is for public comments about the applicability of the Pharmacy Benefit Manager (“PBM”) laws set forth in New York Insurance Law Article 29, as well as the need for rules to be promulgated thereunder, on PBM conduct while credentialing and re-credentialing pharmacies into a PBM network. View the Request for Public Comments (PDF)
Responses should be emailed to PBM@dfs.ny.gov, with “PBM2022-05” included in the subject line. Failure to include “PBM2022-05” in the subject line may result in your comment not being considered. The deadline for responses is September 9, 2022.
Also in New York, NYS Medicaid recently held a pharmacy sector meeting and discussed the work being done to ensure a smooth transition for pharmacy benefits from Medicaid Managed Care to Fee for Service (FFS). Here are the NYSDOH Pharmacy Benefit transition slides presented at the July 20th Medicaid meeting.
For more information, please contact NACDS’ Ben Pearlman at 617-515-2603.
North Carolina
All immunizing pharmacists who vaccinate NC Medicaid beneficiaries, NC Medicaid wants to hear from you on how you bill for vaccine and vaccine administration to NC Medicaid. Please take 1 minute to answer three simple questions to help us determine if we can help make claims processing an easier process for you. Please respond by August 1, 2022.
Also in North Carolina, the Board of Pharmacy has been made aware that a pharmacy has implemented a policy whereby its prescription processing system will not allow an NP- or PA-issued prescription to be processed without the supervising physician’s name and other information.
A supervising physician’s information is not required on NP (Nurse Practitioners)- or PA-issued prescriptions. On February 1, 2021, the NC Medical Board amended the prescribing authority rule for physicians’ assistants by removing the supervising physician information requirement for prescriptions written by physicians’ assistants.
On August 1, 2021, the NC Medical Board amended the prescribing authority rule for nurse practitioners by removing the supervising physician information requirement for prescriptions written by nurse practitioners.
Prior to the Medical Board’s 2021 rule amendments (as detailed in long-standing Board guidance, see Item 2403), the absence of a supervising physician’s name and telephone number did not render a PA- or NP-issued prescription “invalid,” “illegal,” or otherwise ineligible for dispensing under the North Carolina Food Drug and Cosmetic Act or the North Carolina Pharmacy Practice Act.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Pennsylvania
The Wolf Administration issued a press release announcing they have amended the Physician General’s Naloxone Standing Order to include ZIMHI. The announcement encouraged state residents to print the standing order and bring it to pharmacies to request the prescription. NACDS reminds members that PA has a program to reimburse pharmacies for Naloxone copays when the customer is reluctant to fill a script due to the copay cost. This federally funded program runs on the current PACE adjudication platform but is open to any Pennsylvanian regardless of whether they have state or private/commercial insurance.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Texas
The Board of Pharmacy quarterly meeting is Tuesday, August 2. Included on the agenda for possible ultimate action on the adopting of the pharmacy counseling waiver and non-sterile compound rules.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Utah
The Board of Pharmacy posted the following:
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Virginia
The Department of Health (VDH) has updated the COVID-19 Vaccine Standing Order to reflect the recent EUA (Emergency Use Authorization) of Novavax. For pharmacies enrolled in VaxMax, Novavax will become available for ordering beginning August 4th. You can view the COVID-19 Vaccine Standing Order on the VDH website. The Summary of Authorities for Pharmacists to Administer COVID Vaccines has also been updated.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Washington
The Health Care Authority announced that the University of Washington Pain and Opioid Provider Consultation Hotline is a free telephone consultation service for health care providers caring for patients with chronic pain issues. Any health care provider in Washington State can receive consultation and recommendations from a pharmacist or physician with specialized expertise in chronic pain care.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Alabama
All previously published expiration dates related to the COVID-19 public health emergency (PHE) are being extended by the Alabama Medicaid Agency (Medicaid). The new expiration date is the earlier of August 31, 2022, the conclusion of the COVID-19 national emergency, or any expiration date noticed by the Alabama Medicaid Agency through a subsequent ALERT.
Medicaid is preparing now for the end of the COVID-19 PHE. Medicaid partners can assist in relaying a consistent and simple message to the Medicaid recipients by sharing key messages from the Agency in your newsletters, social media posts, and other means of communication. To learn more about the “Yellow Postcard” campaign and the Communication Toolkit, please click here.
Also in Alabama, registration is open for the APhA Pharmacy-Based Immunization Delivery Certificate Training Program hosted by Alabama Pharmacy Association (APA). The program is scheduled for Saturday, August 13, from 8 a.m. – 6 p.m. at the APA office in Montgomery. The program is an innovative, intensive, and practice-based CPE activity, based on national educational standards for immunization training from the CDC (Centers for Disease Control). For more information and to register for the full certification course
Additionally, if it has been longer than three years since you were certified and you want a refresher course or if you need to satisfy the PREP Act’s 2-hour immunization CPE requirement, APA is offering six hours of continuing education in conjunction with the APhA program (minus the shots), which will include the most current immunization recommendations and guidelines. Also, the program has been approved by the Alabama Board of Pharmacy for six hours of consultant credit. For more information and to register for the refresher
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Alaska
Gov. Mike Dunleavy (R) signed into law HB (House Bill) 145 which recognizes pharmacists as prescribers and mandates payment parity reimbursement for pharmacy services. The bill also broadens collaborative practice agreements, allows pharmacists to independently prescribe and dispense vaccines, and allows pharmacy technicians to administer vaccines and emergency medications. It will go into effect on September 28, 2022.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Arizona
The Notice of Final Rulemaking related to Pharmacist Delegation/Technicians was published in the “Arizona Administrative Register” with an effective date of July 2, 2022. See PDF pages 994-998.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Arkansas
New rules on therapeutic substitutions were adopted by the Board of Pharmacy, effective May 10, 2022.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
California
The Department of Health Care Services (DHCS) posted the July 2022 Durable Medical Equipment and Medical Supplies Bulletin 562 including the following updates:
- Pfizer COVID-19 Vaccine Booster Dose Authorized for Individuals 5 to 11 Years of Age
- 2022 COVID-19 Vaccine Administration FAQs Available
- 2022 HCPCS Quarter 3 Update
- Tax Status Change for Select HCPCS Codes
- Guidance for Respiratory DME Codes E0482 and E0483 Updated
- September Virtual Claims Assistance Room Event
In addition, the Part 1 – Program and Eligibility bulletin was posted to the Medi-Cal website.
Also in California, the DHCS posted the July 2022 Pharmacy Bulletin 1019 on the Medi-Cal website with content similar to the bulletin above with the addition of O&P Services Recategorized as Surgery Supplies.
Also in California, the DHCS posted “Paper RADs [Remittance Advice Details] AND No Pay Documents Will No Longer Be Mailed Due to Supply Chain Issues.” Effective, July 18, 2022, RAD (Remittance Advice Details), EFT [Electronic Funds Transfer] and No Pay documents will only be available electronically. There is no impact on paper warrants or direct deposit payments. Additionally, the Medi-Cal Checkwrite Schedule will remain unchanged. Additionally, providers will be able to access them online PDF RADs and HIPAA 835 files as published. Providers who have not yet transitioned to the PDF RADs are encouraged to do so.
Also in California, the Department of Health Care Services posted the following alerts on the Medi-Cal Rx Web Portal.
- Inappropriate Treatment Delays and Denials for HIV PrEP and PEP (July 19)
- One-Week Countdown – Reinstatement of Reject Code 88 (July 15)
- Two-Week Reminder: Electronic Claims Agreement – Submission Deadline Extended to July 31, 2022 (July 15)
- Medi-Cal Weekly Wrap-Up for July 8-14 (July 15)
Finally in California, the Board of Pharmacy posted its meeting agenda and meeting materials for the July 27-28 Full Board Meeting.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Indiana
The state Medicaid Health Coverage Programs’ (IHCP) Drug Utilization Review (DUR) Board issued several updates in the IHCP Bulletin for pharmacies.
Also in Indiana, effective August 1, the IHCP will cover COIVD-19 Vaccine Counseling as part of Early and Periodic Screening, Diagnostic and Testing (EPSDT) benefit. Coverage applies to all IHCP programs for beneficiaries under the age of 21 who are eligible for EPSDT.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Louisiana
Walgreens pharmacist Troy Menard, a member of the Louisiana Board of Pharmacy, was chosen by his peers and honored by NACDS at the Louisiana Pharmacist Association Annual Convention’s award ceremony as the “2022 Chain Pharmacist of the Year.” {PHOTO Left to right: Walgreens pharmacists Jeff Gaude with Troy Menard}
Also in Louisiana, effective July 1st, the Medicaid Fee for Service Pharmacy Program and Managed Care Organizations will be reduced 30-cents from $37.08 to $36.78 to align with the Medicare rate and Louisiana Medicaid Professional Services. No dispensing fee shall be reimbursed, only an administration fee. At home, administration of the COVID-19 vaccine for any dose will be increased 38-cents from $32.60 to $32.98 for a total reimbursement of $69.76 ($32.98 + $36.78) or billed charges, whichever is the lesser amount.
Also in Louisiana, the Department of Health (LDH) Bureau of Health Services Financing sent a reminder memo that Medicaid will begin denying claims on December 31, 2022, for providers that have not completed the enrollment process through the Medicaid Provider Enrollment Portal by September 30.
Also In Louisiana, Gov. John Bel Edwards signed into law HB 673/Act 723 that establishes a new Pharmacy Benefit Manager Advisory Council. Both NACDS and our in-state partner, the Louisiana Alliance for Retail Pharmacies (LARP) have designated seats on the Council. The purpose of the Council is to provide monitoring of pharmacy benefit managers in Louisiana to advise the legislature, commissioner of insurance, and Board of Pharmacy on the most effective and efficient manner of regulation of pharmacy benefit managers to ensure the protection of the public.
Also in Louisiana, on July 13th both the Prescription Benefits Manager Monitoring Advisory Council (PBM-MAC) and the Pharmacy Benefit Manager Council (PMPAC) held in-person meetings in Baton Rouge. NACDS has designated seats on both Councils.
Finally in Louisiana, on July 1, Medicaid implemented a new preferred drug list (PDL). There were no new therapeutic classes added to the PDL at the spring 2022 Pharmaceutical & Therapeutics (P&T) Committee meeting.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Mississippi
As the Mississippi Division of Medicaid’s (DOM) transitions to a new Medicaid Management Information System (MMIS), the Department has announced a series of workshop webinars will be available in August and September to train providers in how to use the new system, MESA: Medicaid Enterprise System Assistance. Details about those webinars and instructions on how to register for them can be found on Gainwell Technology’s new Learning Management System (LMS), which is now available online.
Only current Medicaid-enrolled providers will be able to access the LMS and register for training (the webinars are not intended for CHIP-only providers). To verify your status as a Medicaid provider, you are asked to:
- Please only send us the current (Conduent/Envision) Medicaid Provider ID Number and email address for the individuals that would like to attend the training to the following: ms_provider.inquiry@mygainwell.onmicrosoft.com.
- Please include “LMS Registration” in the email subject line. We will use this information to validate your participation in the Mississippi Medicaid program.
- Once validated we will then send LMS registration instructions which will include the link and registration key for accessing the LMS.
- The instructions will also include how to sign up for the upcoming workshop webinars in August and September.
- Additionally, there will be Computer Based Trainings (CBTs) available beginning Aug. 1, 2022. We recommend you review these CBTs prior to the MESA go-live date of Oct. 3, 2022.
Providers can also learn more about MESA and find the latest updates and FAQs on the system implementation on DOM’s website.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Missouri
On July 14, the MO HealthNet Pharmacy Program transitioned the Preferred Drug Searchable Database to a new vendor. If the new database is unavailable, providers may use the Pharmacy Clinical Edits and Preferred Drug Lists webpage.
Also in Missouri, MO HealthNet Division (MHD) will begin desk audits of providers to ensure proper billing units are used for drugs billed to MO HealthNet. Providers are responsible for proper billing of claims as outlined in Section 15 of the Pharmacy Provider Manual. Providers must have adequate documentation and these records must be made available to MO HealthNet upon request.
Also in Missouri, announced provider rate increases contingent on CMS approving the State Plan amendment (SPA). Until then, current rates remain in effect.
Finally in Missouri, Gov. Mike Parsons (R) signed into law two opioid bills effective August 28, 2022. HB 2162 expands the definition of opioid antagonists that can be dispensed under a prescriber’s protocol or standing order to include addiction mitigation medications, and MO HB 2331 allows a pharmacist to dispense and opioid antagonist under a protocol or standing order.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
New Mexico
The Medical Assistance Division (MAD) of the New Mexico Human Services Department (HSD) is requiring all prescribers including pharmacists with prescriptive authority for Centennial Care members to enroll as a Medicaid Provider by November 12, 2022, to continue to receive payment for prescriptions. Failure to enroll as a Medicaid Provider will result in denial, rejection, or recoupment of payment for prescriptions when written for Centennial Care members.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
New York
As a result of PBM legislation enacted in 2021, the NYS Department of Financial Services is developing regulations, and the Department is seeking public comment on a series of issues.
Below are the three upcoming Public Notices with links for more details related to:
PBM Services to Medicare Part D Plans, Comments due August 1, 2022
View the Request for Public Comments (PDF) Responses should be emailed to PBM@dfs.ny.gov, with “PBM2022-02” included in the subject line. Failure to include “PBM2022-02” in the subject line may result in your comment not being considered. The deadline for responses is August 1, 2022.
Reporting Requirements for PBMs (Pharmacy Benefits Managers), Comments due August 5, 2022
View the Request for Public Comments (PDF) Responses should be emailed to PBM@dfs.ny.gov, with “PBM2022-03” included in the subject line. Failure to include “PBM2022-03” in the subject line may result in your comment(s) not being considered. The deadline for responses is August 5, 2022.
Practice of Patient Steering by PBMs due August 19, 2022
View the Request for Public Comments (PDF) Responses should be emailed to PBM@dfs.ny.gov, with “PBM2022-04” included in the subject line. Failure to include “PBM2022-04” in the subject line may result in your comment not being considered. The deadline for responses is August 19, 2022.
For more information about these Public Notices and DFS (Department of Financial Services) efforts to implement the law, please click here.
Also in New York, the Office of the Medicaid Inspector General (OMIG) published a Proposed Rule Making in the State Register related to Medicaid Program Fraud, Waste and Abuse Prevention with the stated purpose to establish requirements for providers to detect and prevent fraud, waste, and abuse in the Medicaid Program.
The full text of the proposed rule can be found here. Public comments are due within 60 days from when published on July 13, 2022. To read the new sections added to OMIG regulation through this rulemaking in their entirety, please click here.
In particular, the proposed rulemaking would repeal and add a new 18 NYCRR Part 521 to implement statutory changes resulting from the recommendations of the Medicaid Redesign Team II as adopted in the State Fiscal Year 2020-2021 Enacted Budget (Chapter 56 of the Laws of 2020, Part QQ) and to make other conforming changes related to:
(1) Provider Compliance Programs,
(2) Medicaid Managed Care Plan fraud, waste, and abuse prevention programs under the Medical Assistance (Medicaid) program, and
(3) The Obligation to report, return and explain Medicaid overpayments through OMIG’s Self-Disclosure Program.
For more information, please contact NACDS’ Ben Pearlman at 617-515-2603.
Ohio
The Ohio Department of Medicaid (ODM) announced that the enhanced COVID-19 administration reimbursement rate for pharmacies will end on Sept. 30, 2022, as the new Single Pharmacy Benefits Manager (SPBM) program takes effect.
Also in Ohio, the Board of Pharmacy issued guidance on the implementation of HB 193, which mandates electronic prescribing of Schedule II controlled substances. As the guidance notes, the law has a “safe harbor” provision which allows pharmacies to continue to fill paper prescriptions without verifying that the prescriber has an exemption. The law goes into effect on Sept. 23, 2022. Special thanks to the Ohio Council of Retail Merchants for working with NACDS and members during the legislative process to ensure that the “safe harbor” provision was included in the law.
Also in Ohio, the Board of Pharmacy posted a notice regarding license renewals for Certified Pharmacy Technicians. The renewal process opens on Aug. 1, 2022.
Finally in Ohio, the following are updates/reminders on the topic of the upcoming October implementation of the SPBM:
- To request a spreadsheet on the new dispensing fees by store location, please email medicaidspbm@medicaid.ohio.gov and include a list of your store NPI numbers.
- ODM sent a bulletin to pharmacies reminding them of important upcoming deadlines to participate in the SPBM program.
- On August 3, 2022, the Cost of Dispensing survey that will be used to set rates in both the Fee for Service and the SPBM Managed Care programs be sent out to all enrolled Medicaid pharmacies by both US Mail as well as email, if ODM has an email for the pharmacy on record. Surveys are due back on September 14, 2022. Here is a copy of the draft survey instrument.
- Myers & Stauffer will host two instructional cost of dispensing survey webinars on Aug. 11 at 3:00 PM and Aug. 16 at 8:30 AM. Information to register for the webinars will be included in the survey packet sent to pharmacies. A draft of the dispensing survey tool can be viewed here.
- For a list of specialty drugs and ingredient cost reimbursement by drug (OAAC (Ohio Average Acquisition Cost)) please visit the Myers & Stauffer Ohio Medicaid webpage.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Oklahoma
The State Board of Pharmacy (OSBP) is requesting that pharmacies email the following information within 24 hours of pharmacy closure during normal business hours, during the time when patients would expect the pharmacy to be open.
- License number of the pharmacy
- Name of the pharmacy
- Address of the pharmacy
- Name of the Pharmacist in charge (PIC)
- Dates that the pharmacy will be closed
- Hours the pharmacy will be closed
- Detailed explanation for closing
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Oregon
The Oregon State Newsletter – June 2022 has been posted to the NABP/Oregon website and includes the following information.
- No. 678 Safe Pharmacy Practice Conditions
- No. 679 Expedited Partner Therapy Updates
- No. 680 Rulemaking
- Rule Feedback
- Permanent Rules Adopted in April 2022
- Permanent Rules Adopted in June 2022
- No. 681 Compliance: Legal Advice vs Legal Information
- No. 682 Licensing: Technician Renewals Due June 30, 2022
- No. 683 REALD and Pharmacies
Also in Oregon, the Board of Pharmacy adopted the following temporary rules effective July 1, 2022, through December 27, 2022.
- OAR 855-019-0210 related to Duties of Pharmacist Receiving a Prescription
- OAR 855-139-0699 related to a Retail Drug Outlet RDSP (Remote Dispensing Site Pharmacy)
Also in Oregon, the Board of Pharmacy adopted the following permanent rules at the June 2022 Board Meeting.
- Divisions 006/041/043/045/080/139 – related to Standards Adopted by Reference & Definitions - Effective June 16, 2022
- Divisions 019/025/041 – related to Certified Oregon Pharmacy Technician/Pharmacy Technician Final Verification - Effective June 16, 2022
- Divisions 019/041/139 – related to Interpreters – Effective September 1, 2022
- Divisions 019/143 – related to Pharmacy Prescription Lockers - Effective June 16, 2022
- Division 020 – related to Pharmacist Prescriptive Authority – Tobacco Cessation & PrEP - Effective June 16, 2022
- Division 031 – related to Public Health Emergency Sunset – Effective June 16, 2022
- Division 041 – related to Telework – Effective June 16, 2022
- Divisions 041/139 – related to Permanent Pharmacy Closure Requirements – Effective June 16, 2022
- Division 080 – related to Pseudoephedrine/Ephedrine & Interns – Effective June 16, 2022
- Division 110 – related to Drug Outlet Categories – Effective June 16, 2022
- Division 139 – related to RDSP [Remote Dispensing Site Pharmacies] – Effective June 16, 2022
Finally in Oregon, effective July 1, 2022, through December 27, 2022, the Oregon Health Authority adopted a temporary rule amending OAR 410-121-0030 and 410-121-0040 in accordance with the Drug Use Review (DUR) Pharmacy & Therapeutics (P&T) Committee’s recommendations made during the June 2, 2022 meeting.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
South Carolina
The South Carolina Pharmacy Association (SCPhA) is seeking a new Chief Executive Officer. The selection process will begin in July 2022 and continue until the best candidate is identified. Questions may be directed to the Selection Committee c/o Jennifer Baker, SCPhA Immediate‐Past President & Search Committee Chair at scpharmacyjlb@gmail.com
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Texas
The Board of Pharmacy August 2nd meeting agenda includes proposed rules for final adoption on patient counseling, non-sterile compounding, and centralized prescription dispensing. If you are unable to attend the Board meeting, you can watch it on live stream.
Also in Texas, NACDS sponsored the Texas Pharmacy Association’s annual meeting keynote session with State Senator Charles Perry (R-Lubbock), the Vice-Chair of the powerful Senate Health and Human Services Committee. Last session, Sen. Perry, a vocal advocate for pharmacy benefit manager (PBM) reform, helped pass two important bills through the Senate that became law in 2021.
Also in Texas, NACDS and our in-state partner, the Texas Federation of Drug Stores, have arranged for Rep. Four Price (R) to tour a United Supermarket Pharmacy in Amarillo. (Left to Right: United pharmacist Tim Purser, pharmacy technician Danielle Coleman, pharmacist Viet Le Nguyen, NACDS’ TX lobbyist Nicole Kralj, State Rep. Four Price (R-Amarillo) and NACDS Mary Staples)
Finally in Texas, Gov. Greg Abbott (R) again extended the waiver for the requirement for pharmacists to have in-person contact for patient counseling to allow patient counseling to be performed by telephonic consultation until September 30, 2022, or until the March 13, 2020, disaster declaration is lifted or expires, whichever is earlier.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Utah
The Board of Pharmacy posted the following:
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Washington
The Health Care Authority (HCA) revised the Apple Health (Medicaid) COVID-19 vaccine clinical policy and the Emergency COVID-19 fee schedules.
For more information, contact NACDS’ Mary Staples at 817-442-1155.