Arkansas
Rules allowing pharmacist therapeutic substitution went into effect as of May 10, 2022. Pharmacists whose practice is located within the State of Arkansas may substitute medications for therapeutically equivalent medications unless the prescriber indicates that no substitution is to be made or if the Arkansas State Board of Pharmacy has determined that a therapeutically equivalent product should not be substituted and has notified all pharmacists of that determination.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
California
The Department of Health Care Services posted the following alerts on the Medi-Cal Rx Web Portal.
- Enteral Nutrition Updates: Interchange of Equivalent Contracted Enteral Nutrition Product and Specialty Infant Authorization Term Limit (June 18)
- Medi-Cal Rx Weekly Wrap-Up for June 3-9 (June 10)
Also in California, Medi-Cal posted the following updates.
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- Respiratory Supplies: Updates to the List of Medical Supplies Billing Codes, Units and Quantity Limits
- National Correct Coding Initiative Quarterly Update for July 2022
- July 2022 Medi-Cal Provider “Coffee Break” Event
- August 2022 Medi-Cal Provider Training Webinars
- Get the Latest Medi-Cal News: Subscribe to MCSS (Medi-Cal Subscription Service) Today
- Provider Manual Revisions
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- Update: Second Booster Dose for Select COVID-19 Boosters Now a Benefit
- Age Eligibility and Availability Revised for Cabenuva
- New Medi-Cal Benefit for Hepatitis B Vaccine
- Respiratory Supplies: Updates to the List of Medical Supplies Billing Codes, Units and Quantity Limits
- One Time Injection Administration Fee Update
- National Correct Coding Initiative Quarterly Update for July 2022
- July 2022 Medi-Cal Provider “Coffee Break” Event
- August 2022 Medi-Cal Provider Training Webinars
Finally in California, the Board of Pharmacy has posted the following agendas for next week’s June 22 ad hoc committee meetings.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Colorado
The Board of Pharmacy is hosting a virtual Stakeholder Meeting on June 27 at 10 AM MDT to solicit feedback on multiple proposed revisions to the Board’s rules on newly passed legislation. Topics include Third Party Logistics Providers, Reporting Violations, and Collaborative Pharmacy Agreements and Appendix C (Statewide Protocol for Pre-Exposure and Post-Exposure Prophylaxis of HIV). Potential considerations to revise the rules to implement new legislation concern Colorado Senate Bills 22-116, 22-173, 22-027, 22-098; and Colorado House Bills 22-1235, 22-1246, 22-1115, and 22-1122. To participate, you must register for the online seminar. If you cannot attend the meeting or want to submit comments, send your comments to: dora_dpo_rulemaking@state.co.us by June 24, 2022.
Also in Colorado, HB (House Bill) 22-1370 will pass along drug manufacturer rebates to employers and consumers – valued at more than 16% of overall drug costs for those not sharing in rebates now. This bill represented one of the policy recommendations in the Department’s 2021 Reducing Prescription Drug Costs in Colorado Report.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Illinois
Governor JB Pritzker (D) signed HB4430, on June 10, 2022, effective January 1, 2023, this legislation expands the scope of practice for pharmacists to include the initiation, dispensing, or administration of drugs, laboratory tests, assessments, referrals, and consultations for HIV pre-exposure prophylaxis and HIV post-exposure prophylaxis. The measure also establishes a Medicaid reimbursement rate for all pharmacist-provided services.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Louisiana
The legislature adjourned its regular session on June 6.
Also in Louisiana, the Department of Health’s (LDH) deadline for Medicaid Provider Portal enrollment is June 30, 2022. All current providers must validate their information and sign the state’s provider participation agreement.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Mississippi
The Board of Pharmacy issued a proposed rule on pharmacy shared services as well as proposed amendments to the definitions found in Title 30 Part 3001, which will remove outdated definitions and add new ones to clarify the Board’s regulations. More information on these proposed rules can be found here.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Montana
This week, Gov. Greg Gianforte (R) declared a statewide disaster due to severe flooding in several counties with additional flood warnings in other areas of the state.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Nebraska
The Department of Health and Human Services posted an agenda for the Nebraska Medicaid DUR (Drug Utilization Review) Board Meeting to be held on July 12.
Also in Nebraska, a Technical Committee Meeting for the Credentialing Review (407) Pharmacy Technician is scheduled for June 28 and an agenda has been posted.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
New Mexico
Governor Michelle Lujan Grisham (D) signed an executive order creating a Prescription Drug Task Force directed to identify ways to expand access and affordable pricing for medications. The EO (Executive Order) directs its members to analyze and report solutions to manage and minimize the cost of prescriptions for New Mexicans. Membership will include a New Mexico licensed pharmacist engaged in practice at an independent pharmacy, the Superintendent of Insurance, a licensed physician in New Mexico, a patient advocate, and an individual whose profession is in the health insurance industry.
Also in New Mexico, the Medical Assistance Division (MAD) of the New Mexico Human Services Department (HSD) is now requiring ALL prescribers, including pharmacists with prescriptive authority for Centennial Care members to enroll as a Medicaid Provider to continue to receive payment for prescriptions. Failure to enroll will result in denial, rejection, or recoupment of payment for prescriptions when written for Centennial Care Members effective November 12, 2022.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
New York
On June 8, 2022, the New York State Department of Health in consultation with the Department of Environmental Conservation, announced the approval of two Drug Take-Back programs, proposed and operated by Inmar Rx Solutions, Inc. and MED-Project, LLC. Pursuant to Chapter 120 Laws of 2018, the New York State Drug Take Back Act (DTB) mandates that manufacturers establish, fund, and manage a New York State-approved drug take-back program(s) for the safe collection and disposal of unused covered drugs. Pharmacies of ten or more establishments within NYS and non-resident pharmacies that provide covered drugs to NYS residents by mail must implement such programs by providing consumers with a pre-approved method(s) of collection and disposal, free of charge to the consumer and pharmacy.
For more information on the Drug Take-Back programs to be operated by Inmar and MED-Project, visit their sites:
The press release can be found here: New York State Department of Health and Department of Environmental Conservation Announce Approval of Two Drug Take Back Programs
For more information, please contact NACDS’ Ben Pearlman at 617-515-2603.
Ohio
In response to questions posed to Medicaid (ODM) at the May Joint Medicaid Operations Committee (JMOC) meeting related to the implementation of the Single Pharmaceutical Benefits Manager, ODM issued a letter that contains further detail on the implementation timeline and other issues of import to members.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Oklahoma
The Department of Insurance issued Bulletin No. 5-2022 provides information to clarify what is required regarding a new law, SB (Senate Bill) 737 was codified into Title 36 § 6962 of the Oklahoma Statutes that includes new requirements which will have a significant impact on the Pharmacy Benefits Management industry. Because the law included a declaration of emergency, it took effect immediately on April 21st when signed by Governor Kevin Stitt (R).
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Pennsylvania
The House Professional Licensure Committee will consider HB 2679 on June 20. The bill, introduced by the Majority and Minority Chairs of the Committee, represents a compromise agreement that would expand pharmacists’ immunization authority by allowing the administration of influenza and COVID vaccines down to age 5. Currently, pharmacists can only vaccinate children for flu starting at the age of 9.
Also in Pennsylvania, the Board of Pharmacy has posted the agenda for the June 28 meeting. Members can access the meeting virtually and log-in instructions are included in the agenda.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Texas
The Senate Health and Human Services Committee will hold hearings on June 27 to examine the impact of state and federal pandemic policies-including agency guidance, licensing and regulatory actions, and health care industry policies-on patient care and treatment delivery.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Washington
The Care Authority (HCA) Director Sue Birch selected Dr. Charissa Fotinos, who has been the interim state Medicaid Director since August of 2021, as the new state Medicaid Director. Dr. Fotinos will also continue to serve as HCA behavioral health medical director.
Also in Washington, effective July 1, 2022, the Health Care Authority (HCA) is publishing quarterly updates to many of the Apple Health billing guides. Billing guides are located on HCA’s Provider billing guides and fee schedules webpage.
Finally in Washington, the State Health Care Authority (HCA) is beginning the first step of making its Medicaid Management Information System (MMIS), known as ProviderOne, more flexible and modifiable. First, HCA is working to replace the existing Pharmacy Point of Sale (POS) system. The new Pharmacy POS solution will offer the latest functionality, features, and technologies to better meet the needs of Washington’s Medicaid clients.
On the day of go‐live, fee‐for‐service pharmacy claims will no longer be billable using our current processor control number (PCN) and bank identification number (BIN). HCA will provide the new PCN/BIN as the project gets closer to go‐live. After the initial implementation, HCA will be adding functionality for pharmacies and prescribers to submit prior authorization requests through a new, secure online portal.
Sign up for the Health Care Authority’s email list to receive future updates on this project, including the go‐live date and PCN/BIN changes. If you have questions, contact pharmacyposproject@hca.wa.gov.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Alabama
Effective July 1, 2022, the Alabama Medicaid Agency will:
- Remove prior authorization (PA) from dexmethylphenidate ER (generic Focalin XR). Brand Focalin XR will now require PA.
- Update the PDL (Preferred Drug List) to reflect the quarterly updates listed below:
| PDL Additions | |
| Dexmethylphenidate ER (generic) | Cerebral Stimulants/Agents Used for ADHD (attention deficit hyperactivity disorder) (Long-Acting) |
| PDL Deletions | |
| Adhansia XR | Cerebral Stimulants/ Agents Used for ADHD (Long-Acting) |
| Focalin XR | Cerebral Stimulants/ Agents Used for ADHD (Long-Acting) |
For additional PDL and coverage information, visit the drug look-up site.
The Prior Authorization (PA) request form and criteria booklet should be utilized by the prescriber or the dispensing pharmacy when requesting a PA. The PA request form can be completed and submitted electronically on the Agency’s website.
Incomplete PA requests or those failing to meet Medicaid criteria will be denied. If the prescriber believes medical justification should be considered, the prescriber must document this on the form or submit a written letter of medical justification along with the PA form to Kepro. Additional information may be requested. Staff physicians will review this information.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
California
On June 1, Legislative Leaders announced a 2022-2023 Joint Budget Agreement that contains budget priorities from the Assembly and the Senate as well as elements of the Governor’s budget proposals. The agreement provides an overall plan to provide relief to families and small businesses, including $142.8 million over two years designated to forgive recoupment of pharmacy reimbursement rate reductions in Medi-Cal from prior years for independent pharmacies. NACDS and the California Retailers Association (CRA) have been advocating in recent months for forgiveness of the Medi-Cal Recoupments for all pharmacy providers. On June 3, NACDS and CRA submitted a joint letter to Gov. Gavin Newsom (D) urging him to allocate the $142.8 million for Medi-Cal pharmacy rate recoupment to all applicable pharmacies, including chains.
Also in California, the Department of Health Care Services posted the following alerts and notices on the Medi-Cal Rx Web Portal.
- Coordination of Benefits – Billing Medicare Part B and D Claims (June 6)
- Medi-Cal Rx Coordination of Benefits (COB) Reminder (June 6)
- Medi-Cal Rx Checkwrite Schedule – State Fiscal Year 2022-23 Available (June 3)
- Medi-Cal Rx PAVE Enrollment for ORP Providers (June 3)
- Medi-Cal Rx Newborn Claims (June 3)
- Medical Rx Weekly Wrap-Up for May 27-June 2 (June 3)
Finally in California, the Board of Pharmacy has posted the following documents for its Full Board Meeting to be held on June 16.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Maine
The Maine Board of Pharmacy has released its minutes from April and May meetings. The next Board meeting will be on August 4.
For more information, please contact NACDS’ Ben Pearlman at 617-515-2603.
Massachusetts
The Massachusetts Board of Pharmacy has updated its Policy 2022-03 which deals with unfilled Prescriptions. The Board decided to update the policy based on information from the DEA to allow pharmacies to send unfilled electronic prescriptions for federally controlled substances, including CII, to another pharmacy for initial fill. This can be done either by verbal transfer or election transmission, but methods must be pharmacist-to-pharmacist and follow the transfer requirements of 21 CFR section 1306.25. The next Board of Pharmacy meeting is scheduled for August 4.
For more information, please contact NACDS’ Ben Pearlman at 617-515-2603.
Minnesota
HF 4065, an omnibus health care bill was signed into law by Gov. Tim Walz (D). The bill includes a provision that allows pharmacists to administer intramuscular and subcutaneous drug injections and to place drug monitoring devices according to prescription, protocols, or collaborative practice agreements.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
New York
Before the New York State Legislature recently adjourned, both Houses passed legislation (A3040B-S4807B) which would authorize pharmacists to administer long-acting injectable medication for MH/SUD per a prescription or order. In addition, the legislature rejected efforts to delay or repeal the planned FFS (Fee for Service) transition of the pharmacy benefit set to take effect on April 1, 2023.
For more information, please contact NACDS’ Ben Pearlman at 617-515-2603.
Ohio
The Department of Medicaid (ODM (Ohio Department of Medicaid)) has published an important update regarding the implementation of the Single Pharmacy Benefit Manager (SPBM). The update clarifies that reimbursement rates for the new program will be announced later this month, that Gainwell has launched a new webpage that includes important program information and useful guides including the SPBM Pharmacy Reference Guide (Provider Manual). The website will continue to be updated with information for members, pharmacies, and prescribers. Lastly, they have also released an updated version of their SBPM FAQ (Frequently Asked Questions), which includes answers to many questions NACDS had previously submitted on behalf of members.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Rhode Island
The Department of Health has announced their endemic strategy for COVID-19 vaccination and testing.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Tennessee
Governor Bill Lee (R) has signed HB2228, effective July 1, 2022, under this measure, prescribers are required to include a prescription for naloxone hydrochloride or another opioid overdose reversal agent with any opioid prescription. This only applies for prescriptions of more than a 3-day supply of an opioid medication, when prescribed concurrently by the same provider with a benzodiazepine, when the patient presents an increased risk for overdose, or the patient at substantial risk of witnessing an opioid overdose event. Violations of this measure are considered a Class D felony.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
West Virginia
On June 2, the Insurance Commission filed the Pharmacy Auditing Entities and Pharmacy Benefit Managers Rule with an effective date of July 1, 2022. This rule is pursuant to passage of HB (House Bill) 2263 of 2021. The new rule amends the current rule relating to Pharmacy Audits that was effective on April 1, 2021 and remains in effect.
Also in West Virginia, The Insurance Commission has proposed a rule 114CSR99 to reflect changes to the WV Code because of the passage of Enrolled HB 4112 which was approved by Governor Justice on March 30, 2022. The rule will be considered by the Legislative Rule Making Review Committee during the 2022 legislative interims and put before the WV Legislature for approval in 2023. If you have comments, please email them to Jill McCormack before the close of business on June 23. Otherwise, you may email them to michael.n.malone@wv.gov of the Insurance Commission by 5pm on July 5, 2022.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.