California

On June 27, Gov. Gavin Newsom (D) signed SB (Senate Bill) 154 (Chapter 43) which includes language allocating $114.4 million to forgive the retroactive reduction of claims reimbursement for independent pharmacies in 2022-23. Another $28.4 million will be allocated in 2023-24. This was due to an error in the implementation of the actual acquisition cost reimbursement methodology for dates of service from April 1, 2017, to February 22, 2019, inclusive. On June 30, Gov. Newsom signed AB (Assembly Bill) 178 (Chapter 45) that directs the Department of Health Care Services to forego the recoupment of overpayments from independent pharmacies and defined “independent pharmacy” as a pharmacy owned by a person or entity who owns not more than 74 pharmacies in California. Also, on June 30, the Governor signed SB 184 (Chapter 47), the health trailer bill, that expands telehealth and exempts continuous glucose monitors and medication therapy management services from a 10 percent provider cut based on 2011 legislation.  

Also in California, the Department of Consumer Affairs issued this waiver extension on July 11: DCA Waiver DCA-22-217 Order Waiving Restrictions on Pharmacists Independently Initiating and Furnishing Paxlovid to Individual Patients. The full waiver and a list of current waivers is available on the DCA website. 

Also in California, the Board of Pharmacy recently communicated the following: 

Also in California, the Department of Health Care Services posted the following alerts on theMedi-Cal Rx Web Portal. Please note this week’s announcement about the postponement of implementation of NCPDP (National Council for Prescription Drug Programs) reject code 80 and the reminder about the July 31 deadline for all participating Medi-Cal Rx pharmacy providers and billers to submit a Medi-Cal Rx Telecommunications Provider and Biller Application/Agreement Form to continue submitting electronic claims without interruption. 

Finally in California, the Department of Health Care Services posted the “August 2022 Medi-Cal Provider Training Webinars”. 

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

July 15, 2022|California|

Delaware

Both Houses of the legislature passed SB 399 that authorizes a pharmacist to order, test, screen, and treat certain health conditions pursuant to a statewide written protocol for CLIA waived tests approved by the Division of Public Health. This legislation is pending Governor Carney’s (D) signature.

For more information, please contact NACDS’ Ben Pearlman at 617-515-2603.

July 15, 2022|Delaware|

Florida

Governor Ron DeSantis (R) issued an Executive Order to address the cost of prescription drugs in the state. The order directs all executive agencies to include provisions in all future contracts and solicitations with PBMs (Pharmacy Benefits Managers) (Pharmacy Benefit Manager), services that include the following:  

  • Prohibit spread pricing for all PBMs 
  • Prohibit reimbursement claw backs for all PBMs 
  • Directs agencies to include reporting requirements and data transparency, including a review of all rebates, payments, and relationships between pharmacies, insurers, and manufacturers 
  • Directs all impacted agencies to amend all contracts with these same provisions. 

Also in Florida, the Agency for Health Care Administration (Agency) has been implementing Referring, Ordering, Prescribing, and Attending (ROPA) requirements as directed by the 21st Century Cures Act (Cures Act) and by the Centers for Medicare and Medicaid Services (CMS). Previous provider alerts on National Provider Identifier (NPI) requirements for ROPA providers can be found on the Agency’s website in the Provider Message Archive. Providers must be enrolled with Florida Medicaid in accordance with Title 42, Code of Federal Regulations, Section 455.410(b). 

In accordance with CMS requirements, all Fee-For-Service claims submitted October 1, 2022, or after from a non-exempt provider type that do not have a ROPA provider listed on the claim will be denied. The exempted provider types that will not require a ROPA on the claim are listed below, all other provider type claims must have a ROPA provider identified by NPI on the claim for reimbursement by Florida Medicaid. 

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

July 15, 2022|Florida|

Iowa

The Iowa Medicaid Enterprise (IME) released the final July 2022 Cost of Dispensing (COD) Report with the following results:   

  • The report reflects the mean cost of dispensing, weighted by Medicaid volume, was $10.97 per prescription for all pharmacies, including specialty pharmacies. 
  • For non-specialty pharmacies only, the mean cost of dispensing, weighted by Medicaid volume, was $10.18 per prescription.    

IME stated the current dispensing fee of $10.38 will remain in place until additional state funding is appropriated by the Legislature next session to increase the dispensing fee to $10.97. A state plan amendment (SPA) would also be required, if funding is approved, and the increase would be prospective following CMS approval of the SPA. 

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

July 15, 2022|Iowa|

Massachusetts

The Massachusetts House of Representatives passed HB 4930 “Relative to Expanding Access to Reproductive Rights” by a vote of 136 – 17. This bill will now be considered by the State Senate. This legislation provides legal protections for Massachusetts health care providers, including pharmacists, from prosecution by out-of-state jurisdictions for legally protected health care and reproductive health care services and products provided in Massachusetts to out-of-state residents. This language is designed to protect these providers from criminal prosecution and associated civil lawsuits from states that prohibit access to legal health care and reproductive health services and products.  

Also in Massachusetts, the Commonwealth’s Senate today unanimously passed SB 2955 which will allow pharmacists to prescribe, dispense and administer HIV prevention drugs. This bill now goes to the House for their consideration.  

Finally in Massachusetts, the Board of Pharmacy has announced that additional guidance will be provided now that the FDA (Food and Drug Administration) (Food and Drug Administration) has updated the emergency use authorization (EUA) for Paxlovid to permit prescribing by pharmacists, subject to the terms of that EUA. Any prescribing must comply with the Emergency Use Authorization (EUA) and DPH’s prescribing guidance.  

For more information, please contact NACDS’ Ben Pearlman at 617-515-2603.

July 15, 2022|Massachusetts|

Mississippi

The Mississippi Division of Medicaid (DOM), on July 1, 2022, will reestablish payment methods for the ingredient costs of prescription drugs that existed prior to the July 1, 2021 rate freeze. This change will remove the freeze for dates of service on or after July 1, 2022. DOM has been in frequent communication with the Centers for Medicare and Medicaid Services (CMS) regarding State Plan Amendment 21-0018, which was submitted last year to freeze reimbursement for outpatient drugs in compliance with Senate Bill 2799 as passed during the 2021 Legislative Session. While CMS has not yet taken official action, DOM anticipates CMS will disapprove SPA 21-0018. Once this disapproval is received from CMS, DOM will reprocess fee-for-service claims for prescription drugs with dates of service between July 1, 2021, and June 30, 2022. 

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

July 15, 2022|Mississippi|

Nebraska

The Department of Health and Human Services (DHHS) announced the new fee schedule for injectables effective July 1, 2022. 

Also in Nebraska, the DHHS issued a notice of public hearing on August 8 for proposed changes to Title 471, Chapter 7 of the Nebraska Administrative Code (NAC) – Durable Medical Equipment, Prosthetics, Orthotics, and Medical Supplies (DMEPOS). 

Also in Nebraska, the DHHS posted the July 12 DUR (Drug Utilization Review) Board Meeting Agenda and the May 10 Draft Minutes. 

 Also in Nebraska, the DHHS published Provider Bulletin 22-12: Changes to Nebraska Medicaid Preferred Drug List (PDL) effective July 22. 

Finally in Nebraska, the DHHS posted the following: 

  • Medicaid’s next COVID update call will be held on Wednesday, August 3 at noon (Central). Call details will be added at this website one week before the call. 

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

July 15, 2022|Nebraska|

New Hampshire

Governor Sununu (R) signed NH SB 229 into law, expanding the authority of qualified pharmacy technicians to immunize. A pharmacist, pharmacy intern, [or] licensed advanced pharmacy technician, or certified pharmacy technician, under the supervision of an on-site immunizing pharmacist may administer influenza and a COVID-19 vaccine, if available, to the public. A pharmacist, pharmacy intern, or licensed advanced pharmacy technician, under the supervision of an on-site pharmacist may administer Hemophilus influenza, hepatitis A, hepatitis B, hepatitis A and B, human papillomavirus, meningococcal, pneumococcal, tetanus, and diphtheria, varicella, zoster, MMR (measles, mumps, and rubella), and Tdap (tetanus, diphtheria, and pertussis) vaccines, which have been approved by the Food and Drug Administration, to individuals 18 years of age or older as ordered by an immunizing pharmacist. This law goes into effect 90 days after July 27. 

Also in New Hampshire, Governor Sununu (R) vetoed NH HB (House Bill) 1022 which would have permitted Ivermectin to be dispensed via standing order.

For more information, please contact NACDS’ Ben Pearlman at 617-515-2603.

July 15, 2022|New Hampshire|

North Carolina

Governor Roy Cooper (D) has signed the 2022/2023 budget. Of importance to NACDS (National Association of Chain Drug Stores) members, language was added to extend from June 30, 2023, to June 30, 2026, pharmacy reimbursement being tied to the fee-for-service rate of NADAC (National Average Drug Acquisition Cost) plus a $10.24 dispensing fee. Language was also added to extend the State Health Director’s authority to issue statewide standing orders for COVID tests and vaccines until December 31, 2023 and maintains all the current statewide standing orders currently in place until rescinded by the State Health Director. This will ensure Pharmacies will continue to get reimbursed for the administration of the COVID vaccination and tests by North Carolina Medicaid. Finally, a provision was added to reauthorize the dispensing of biosimilars and the requirement for pharmacists to input patient information into a system that can be accessed by prescribers for biosimilar interchangeable. This can be achieved by processing the prescription through a PBM (Pharmacy Benefit Manager) or an electronic health record.  

Also in North Carolina, the Department of Health and Human Services is establishing Community Access Points in all 100 counties where North Carolinians can find free and easy at-home tests, to meet people where they are, with the tools they need to protect themselves from COVID-19.
Community organizations interested in becoming a Community Access Point can register online. Information on where to find at-home tests is available at: covid19.ncdhhs.gov/PickUpTests. Information on how and where to find all testing locations in North Carolina is available at: covid19.ncdhhs.gov/FindTests. 

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

July 15, 2022|North Carolina|

Ohio

On July 19 at 11am ET, the Department of Medicaid (ODM) will hold an online seminar with Myers & Stauffer to discuss the upcoming mandatory Pharmacy Cost of Dispensing Survey. NACDS emailed the information to join the online seminar to members on our Ohio list. However, if you need the call-in information, please contact Jill McCormack 

Also in Ohio, Myers & Stauffer has published the Specialty Drug list to be implemented in October concurrent with the new Single PBM program. 

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

July 15, 2022|Ohio|

Oregon

The Board of Pharmacy posted a public notice and agenda for the Safe Pharmacy Practice Conditions Workgroup meeting scheduled for July 18.

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

July 15, 2022|Oregon|

Pennsylvania

Gov. Wolf (D) has signed HB 2679 as Act 80 of 2022. The law, which was effective upon signing, allows pharmacists and pharmacy interns to administer COVID and flu vaccines to children down to the age of 5. The bill also makes a few COVID pharmacy waivers permanent related to pharmacist supervision of other vaccinators.

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

July 15, 2022|Pennsylvania|

Tennessee

Tennessee Pharmacy Association is looking for Champion Advocates to host legislators in their pharmacy or hospital, including members of Congress during the August recess. Please contact Anthony@TNPharm.org to express your interest. 

Also in Tennessee, please see the updates to the PDL, Clinical Criteria, and Interim Criteria for July 2022.  These changes went into effect on July 1st. 

Finally in Tennessee, the Tennessee Department of Health (TDH) is hosting an Alzheimer’s Disease and Related Dementias Healthcare Provider Conference on Friday, July 22, 2022, and will offer FREE Continuing Medical Education (CME) credits for participating providers (offered through TMA). Online sessions will be available one week after the conference concludes for providers that cannot attend the live event. Questions and to register Visit their website    

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

July 15, 2022|Tennessee|

California

This week, the State Health and Human Services Agency Secretary and the Director of the State Department of Public Health along with the State Public Health Officer issued a joint statement supporting the recommendation by the Western States Scientific Safety Review Workgroup, the U.S. Centers for Disease Control (CDC), the American Academy of Pediatrics and the Federal Food and Drug Administration (FDA) to grant emergency use authorization (EUA) of the Pfizer-BioNTech and Moderna COVID-19 vaccines for children as young as 6 months of age. 

Also in California, the Board of Pharmacy sent a notice about reissued pharmacy law waivers in response to Gov. Gavin Newsom’s (D) declaration of emergency and the nation declaration of emergency.  

These waivers and all Pharmacy Law waivers are posted under COVID-19 Updates and Resources on the Board’s website. 

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

June 24, 2022|California|

Florida

Florida Governor Ron DeSantis (R) signed into law on June 20, 2022, House Bill 357 which requires a health insurer or health maintenance organization providing pharmacy benefits through a group health insurance policy, including a pharmacy benefit manager, must comply with audit requirements. In addition, the legislation provides a penalty for failure to register as a pharmacy benefit manager. The law takes effect July 1, 2022.

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

June 24, 2022|Florida|

Illinois

The HFS (Healthcare and Family Services) Illinois Drugs and Therapeutics Advisory Board’s quarterly meeting will be held on Thursday, July 14, 2022. Call in information can be found here. Pre-registration is required

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

June 24, 2022|Illinois|

Iowa

On June 13, Gov. Kim Reynolds (R) signed HF 2384 related to PBMs (Pharmacy Benefit Managers) including MAC (Maximum Allowable Cost) lists, claw backs and enforcement.  

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

June 24, 2022|Iowa|

Minnesota

MDH (Minnesota Department of Health) has updated the Interim COVID-19 Vaccine Provider Guide, Template: COVID-19 Screening and Agreement and created the Pfizer-BioNTech COVID-19 Vaccine Protocol for 6 months through 4 years and Moderna COVID-19 Vaccine Protocol for 6 months through 5 years. Find these resources at COVID-19 Vaccine Providers.

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

June 24, 2022|Minnesota|

New Jersey

This week at the New Jersey Board of Pharmacy, the Board agreed to extend the remote processing pilot program for 6 months to allow time for the regulations to be finalized. The Board will be notifying New Jersey pharmacies of this extension. Today there are 124 pilot programs up and running. NACDS sent a letter last month requesting that the pilot be continued

For more information, please contact NACDS’ Ben Pearlman at 617-515-2603.

June 24, 2022|New Jersey|

Ohio

Last week, Medicaid (ODM (Ohio Department of Medicaid)) held a pharmacy stakeholders’ online seminar where they announced pharmacy reimbursement rates under the Single PBM, “Next Generation of Managed Care Program.” The slides and a recording of the online seminar can be found on the SBPM website.

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

June 24, 2022|Ohio|

Pennsylvania

Legislation that would allow pharmacists and pharmacy interns to administer COVID and flu vaccines to children down to the age of 5 advanced in both Chambers this week. HB (House Bill) 2679 was reported from the House Professional Licensure Committee and is poised for a vote by the full House next week. The Senate Professional Licensure Committee also amended SB (Senate Bill) 511 to match the language in HB 2679 and unanimously reported it to the full Senate for consideration. The intent is to deliver one of these bills to the Governor’s desk before adjournment for summer recess. However, if the General Assembly adjourns early, we are optimistic that the process can be completed in the fall, prior to sine die.

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

June 24, 2022|Pennsylvania|

Texas

In advance of the House and Senate health committee interim hearings this summer studying the pandemic response, NACDS and our in-state partner, the Texas Federation of Drug Stores (TFDS) provided joint letters to both the Senate Health and Human Services Committee and the House Select Committee on Health Care Reform highlighting how Texas pharmacies, empowered through federal authorizations to expand access to essential care services, were instrumental in providing millions of vaccinations, tests, and access points for antivirals. We urged lawmakers to take action to maintain critical access to care at pharmacies, allowing pharmacies/pharmacists to order and administer vaccinations approved by CDC/ACIP for ages 3 and older; initiate corresponding treatment pursuant to the result of a CLIA (Clinical Laboratory Improvement Amendments)– waived test; and permit pharmacy technicians’ to also administer the tests and vaccines. 

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

June 24, 2022|Texas|

Virginia

The Department of Health (VDH) has posted an updated COVID-19 Vaccine Standing Order to include COVID vaccines for children aged 5 and younger. You can also view the Summary of Legal Authorities for Pharmacists to Administer COVID Vaccines on their COVID-19 vaccine webpage for health professionals. 

Also in Virginia. The Department of Medical Assistance Services (DMAS) will hold the Pharmacy Liaison Committee Meeting on July 14 in Richmond. The agenda has been posted. If members have any questions or comments regarding the topics on the agenda, please send them to Jill McCormack by July 12. 

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

June 24, 2022|Virginia|

Alabama

All previously published expiration dates related to the COVID-19 emergency are once again extended by the Alabama Medicaid Agency. The new expiration date is the earlier of July 31, 2022, the conclusion of the COVID-19 national emergency, or any expiration date noticed by the Alabama Medicaid Agency through a subsequent ALERT. A listing of previous Provider ALERTs and notices related to the health emergency is available by selecting the Agency’s COVID-19 page

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

June 17, 2022|Alabama|
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