California
AB 317, legislation requiring a health care service plan or certain disability insurers that offer coverage for a service that is within a pharmacist's scope of practice to pay or reimburse the cost of the service provided by the pharmacist at an in-network pharmacy or by a pharmacist at an out-of-network pharmacy if the health care service plan or insurer has an out-of-network pharmacy benefit, passed the Assembly on April 27 and was referred to the Senate Committee on Health on May 10.
Also in California, AB 1341, legislation authorizing a pharmacist to furnish COVID-19 oral therapeutics following a positive CLIA-waived test, passed the Assembly on April 17 and was referred to the Senate Business, Professions and Economic Development Committee on May 10. Prior to passage in the Assembly, the bill was amended to include an urgency statute meaning it will be effective immediately upon enactment.
Also in California, the Department of Health Care Services (DHCS) posted the following alerts and weekly wrap-up on the Medi-Cal Rx Web Portal:
- Medi-Cal Rx Weekly Wrap-up for May 12-18 (May 19)
- Reinstatement Spotlight (May 19)
- Billing Tips: Non-Covered Medical Supplies (May 12)
Finally in California, Medi-Cal posted the following:
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Colorado
Prior to the end of Colorado's legislative session sine die on May 8, Gov. Jared Polis (D) signed into law the following two PBM reform bills.
- HB23- 1201, limits the amount that health insurance carriers or pharmacy benefit managers (PBMs) may charge beneficiaries of select employer-sponsored plans for prescription drugs to no more than the amount paid by the plan or PBM to a contracted pharmacy. The bill applies to select contracts issued or renewed on or after January 1, 2025. The bill grants audit authority to the Department of Health Care Policy and Financing (HCPF) for Medicaid contractors and the Department of Regulatory Agencies (DORA) for all other contracts. Failure to comply is a deceptive trade practice in the business of insurance.
- HB23-1227 enhances enforcement authority over PBMs by the Commissioner of Insurance in the Division of Insurance (DOI), Department of Regulatory Agencies (DORA). It also requires all PBMs to register with the Commissioner and pay a registration fee. These fees, credited to the DOI Cash Fund, must fund the division's costs to enforce PBM requirements and prohibitions.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Louisiana
HB 471, sponsored by Rep. Barbara Freiberg (R), authorizes pharmacists to order and administer, and pharmacy interns and pharmacy technicians to administer immunizations to children aged 7 years and older. The bill passed the House Health and Welfare Committee by a vote of 14-2 on May 16, and it was sent to the full House to be voted on next week. Thanks to Dwana Day with Brookshire Grocery Company, and Albertsons Companies’ pharmacists Ryan LaBarbera and Brittany Tucker for a fantastic job representing their profession by testifying at the House hearing. NACDS and the Louisiana Alliance for Pharmacies strongly urge immediate action contacting all legislators where you operate pharmacies in their district.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Michigan
An amended version of S-4 version SB 219 codifying PREP Act allowances overwhelmingly passed the Michigan Senate this week by a vote of 36-1. It now goes to the House Health Policy Committee for further consideration. NACDS will be supporting the efforts of members and partners to make appropriate changes to the language in the House.
Also in Michigan, the Department of Health and Human Services issued Numbered Letter L 23. It clarifies billing requirements for Medication Therapy Management. Medicaid letters and bulletins can be accessed on the provider webpage.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Missouri
Prior to the Legislature adjourning on May 12, the pharmacy practice act language pharmacies had promoted that allows pharmacists to administer all FDA authorized and approved vaccines to anyone 7years of age and older passed in two bills, SS/HCS/HBs 115 & 99 and HCS/SS/SCS/SBs 45 & 90. These bills also include language that allows pharmacists with a certificate of medication therapeutic plan authority to provide under a statewide standing order medications to treat flu, strep and COVID. Lastly, the omnibus bills included a provision amending the definition of “opioid antagonist” in a statute that is currently defined as naloxone hydrochloride; this act adds any other drug or device approved by the FDA that blocks the effect of an opioid overdose. (CCS HCS SS SCS SBs 45 & 90 and HBs 115 & 99)
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Nebraska
The Department of Health and Human Services (DHHS) announced plans to distribute Pandemic Electronic Benefits Transfer (P-EBT) benefits to households in the state with school-age children eligible for free or reduced-price school meals and children in childcare during the 2022-2023 school year period.
Also in Nebraska, the DHHS issued recent guidance regarding Executive Orders expiring on June 30, 2023. The following requirements are no longer waived or deferred as of July 1, 2023. Providers are encouraged to reacquaint themselves with the original, pre-Executive Order, specific requirements. For more information, contact DHHS.LicensureUnit@Nebraska.gov.
- Time-limited Provisional Licenses Pending Successful Examination Results
- Onside, Face-to-Face, or Direct Supervision to Complete Certain Work or Training Required to Obtain a Credential
- Practice Agreements
- Direct Client-contact Hours
Finally in Nebraska, the DHHS posted the following bulletins:
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Nevada
The Retail Association of Nevada, NACDS and the Nevada Pharmacy Alliance sponsored the Pharmacy Day at the Capitol on May 1. More than 50 pharmacists and pharmacy students met at the Capitol to advocate for patient care and the profession. Pharmacist State Senator Jeff Stone (R), the sponsor of SB 201, legislation that clarifies pharmacists can order CLIA tests and serve as lab director, as well as providing payment parity for Medicaid services provided by pharmacist, joined the group that evening at The Brewery in Carson City.
Also in Nevada, SB 57, legislation which will require PBMs to register the Division of Insurance and Department of Business and Industry passed the Senate and is pending in the Assembly Committee on Commerce and Labor.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
New Hampshire
The New Hampshire legislature has approved an NACDS supported bill SB 35, a bill that will authorizes pharmacists, pharmacy interns and licensed advanced pharmacy technicians to administer an RSV vaccine to adults. The bill now awaits signature from the Governor.
For more information, please contact NACDS’ Mike Sargent at 207-272-6435.
New York
On May 16, the State Department of Health held a monthly NYRx Medicaid Pharmacy Benefit transition call for pharmacies. The state encourages members to continue to use the portal and call with any issues. The upcoming change of note is starting July 1, 2023; all claims will require a prior authorization via the IVR/Portal System (with some exceptions).
For more information, please contact NACDS’ Mike Sargent at 207-272-6435.
Ohio
The Board of Pharmacy posted numerous guidance updates related to the expiration of the Public Health Emergency and the policies and waivers they adopted during the COVID pandemic, including:
- 2023-05-11 – Board Issues Updated Guidance Due to the End of Federal Public Health Emergency.pdf
- Administration of COVID-19 Vaccines during the COVID-19 Pandemic.pdf
- Board of Pharmacy – COVID-19 Response Efforts – Pharmacy Tech Vaccine Administration
- Board of Pharmacy – COVID-19 Response Efforts
To view the full list, go to Pharmacy.Ohio.Gov.
Also in Ohio, the Ohio Department of Medicaid and Gainwell Technologies are continuing the reimplementation of prior authorizations (PA) based on specific drug classes. Of note, the PA reimplementation only applies to new, initial authorizations. It does not apply to those patients who have previously taken the drug supported by recent claims history prior to May 23, 2023. Phase 6 of reimplementation will begin on May 23 and contain the following:
- Analgesic Agents: Gout
- Blood Formation, Coagulation, and Thrombosis Agents: Colony Stimulating Factors, Hematopoietic Agents, Hemophilia Factor, Heparin-Related Preparations, Oral Anticoagulants, Oral Antiplatelets
- Cardiovascular Agents: Angina, Hypertension and Heart Failure, Antiarrhythmics, Lipotropics
- CNS Agents: Alzheimer's Agents, Anticonvulsants Rescue, Fibromyalgia Agents, MAT of Opioid Addiction, Movement Disorders, Multiple Sclerosis, Narcolepsy, Neuropathic Pain, Smoking Deterrents
- Endocrine Agents: Diabetes- Hypoglycemia treatments, Endometriosis, Estrogenic Agents, Growth Hormone, Osteoporosis-Bone Ossification Enhancers, Progestin Agents, Uterine Fibroids
- GI Agents: Pancreatic Enzymes, Proton Pump Inhibitors
- Genitourinary Agents: Electrolyte Depleter Agents, Urinary Antispasmodics
- Infectious Disease: Antibiotics-Inhaled
- Ophthalmic Agents: Antibiotic and Antibiotic-Steroid Combination Drops and Ointment, Antihistamines and Mast-Cell Stabilizers, Dry Eye Treatments, Glaucoma Agents, NSAIDS, Ophthalmic Steroids
- Otic Agents: Antibacterial and Antibacterial/Steroid Combinations
- Respiratory Agents: Antihistamines-Second Generation, Cystic Fibrosis, Epinephrine Auto-Injectors, Hereditary Angioedema, Inhaled Agents, Leukotriene Receptor Modifiers & Inhibitors, Monoclonal Antibodies-Anti-IL/Anti-IgE, Nasal Preparations, Other Agents
- Topical Agents: Antifungals, Antiparasitics, Corticosteroids
Please reference the Unified Preferred Drug List (UPDL) posted on the SPBM portal to see products that require a PA. PAs may be submitted via phone, fax, mail and the SPBM portal. Please direct questions to the Gainwell Technologies Help Desk at 1-833-491-0344.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Oregon
The Oregon Health Authority Public Health Division (OHA-PHD) announced a public hearing via Zoom on OHA-PHD’s proposal for the use of funds from the Preventive Health and Health Services Block Grant on May 31 from 1:00 p.m.-1:30 p.m. The draft proposal will be posted at www.healthoregon.org/lhd prior to the meeting. Program contact is Sara Beaudrault.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
South Carolina
On May 16, Gov. Henry McMaster (R) signed into law NACDS’ priority PBM reform legislation Senate Bill 520. The measure takes effect January 1, 2024; however, the Department of Insurance is prohibited from performing audits of PBMs before January 1, 2025. South Carolina’s regular legislative session has adjourned Sine Die; however, Governor McMaster has called the legislature back into special session to discuss abortion legislation.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Tennessee
The Department of Commerce and Insurance (TDCI) has launched a new, updated website. This website has direct links to the Standard Pharmacy Reimbursement Appeal Form and the formal Pharmacy Benefit Manager Complaint Form. The complaint form is fully electronic now to add ease of use on pharmacies and patients to submit complaints to TDCI.
Also in Tennessee, please see the provider notice regarding Sedative Hypnotic Benefit Limits. We encourage you to review this information and contact the OptumRx Provider Liaisons at tnrxeducation@optumrx.com with any further questions.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Texas
HB 1105, by Sen. Pete Flores (R) and Rep. Four Price (R), legislation that lowers the age to three years old and up for pharmacies to administer all vaccines and immunizations, is awaiting a hearing date in the Senate Health and Human Services Committee. NACDS and Texas Federation of Drug Stores’ (TFDS) chain pharmacists and independent pharmacists descended on the Capitol this week to educate all 31 Senate offices on the merits of the bill, sharing a Coalition letter signed by 13 Texas organizations, and passing out several pharmacy groups one-pagers explaining the bill. Late Thursday evening, the bill was posted for an 8:00 a.m. hearing on Friday morning in the Senate Health and Human Services Committee. Then an hour later, the Committee Chair, Senator Lois W. Kolkhorst (R), removed the bill from the agenda because of a disagreement with Sen. Flores.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Vermont
On May 12, the Vermont legislature approved HB 305, which would revise the definition of pharmacy technician to mean an individual who, only while assisting and under the supervision of a licensed pharmacist, performs tasks relative to dispensing prescription drugs, administering immunizations and performing tests for SARS-CoV. Pharmacy technicians may administer immunizations and perform tests for SARS-CoV. This measure also outlines requirements for pharmacy technicians in order to administer immunizations. They may only administer immunizations to individuals 18 years of age and older. Regarding patients five years old and older for flu and COVID-19 vaccines, a licensed pharmacist must be present to assist as needed. Pharmacy technicians may only administer immunizations that: (1) are recommended by the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices; and (2) licensed pharmacists are permitted to administer under the State clinical pharmacy protocol. This measure allows a pharmacist to prescribe, order or administer self-administered hormonal contraceptives, including subcutaneous depot medroxyprogesterone acetate as well as, 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, as may be amended from time to time. Lastly, this measure exempts persons dispensing over-the-counter hearing aids from provisions for audiologists and hearing aid dispensers. The bill now awaits signature from the Governor.
For more information, please contact NACDS’ Mike Sargent at 207-272-6435.
Virginia
The Board of Pharmacy has posted the agenda for the May 23 Regulation Committee. Note the agenda includes a chart of regulations in progress, including the “working environment” regulations that are currently in the Governor’s office.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Arizona
On May 3, Kristin K. Mayes, Attorney General, added her signature to the Board of Pharmacy’s emergency rules allowing a pharmacy technician to administer a vaccine when the technician has completed specified training and the authority to administer the vaccine is delegated by and under the supervision of the pharmacist on duty. The rule will be effective when filed with the Office of the Secretary of State.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
California
The Department of Health Care Services (DHCS) posted the following alerts and weekly notices on the Medi-Cal Rx Web Portal:
- List of Medications Eligible for an Extended Duration Prior Authorization (May 12)
- Reinstatement Spotlight (May 12)
- Medi-Cal Weekly Wrap-up for April 28-May 4 (May 5)
- Reinstatement Spotlight (May 5)
Also in California, the Board of Pharmacy posted the agenda and meeting materials for the May 17 meeting of the Full Board. Discussion topics include proposed regulations related to automated drug delivery system self-assessment form and the draft legislative report regarding assessment of Standard of Care Enforcement Model in the Practice of Pharmacy.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Colorado
Prior to the end of the regular session sine die on May 8, the legislature approved several bills pharmacies supported that have been signed into law by Gov. Jared Polis (D).
- SB23-162, will increase access to pharmacy services, including (1) pharmacy technicians administering vaccinations, point-of care testing and technical tasks delegated by the pharmacist, (2) increasing the Pharmacy Technician ratio for central fill facilities to 8:1 and (3) allowing Medicaid to reimburse pharmacies for administering vaccines to children under 19 years old.
- HB23- 1201, PBM reform legislation, eliminates spread pricing and provides for more transparency.
- HB23-1227 enhances the Commissioners enforcement authority over PBMs.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Georgia
On May 2, Gov. Brian Kemp (R) signed HB 416 which allows pharmacy technicians to administer all ACIP vaccinations to persons 18 years of age and older. The bill went into effect upon the Governor’s signature.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Iowa
The Department of Health and Human Services (HHS) issued INFORMATIONAL LETTER NO. 2459-MC-FFS RE: Molina Provider Contracting and Training. Molina Healthcare of Iowa will join Amerigroup and Iowa Total Care to provide benefits for IA Health Link and Hawki members on July 1, 2023. HHS will allocate up to one-third of Medicaid members to Molina effective July 1, 2023.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Kentucky
The Cabinet for Health and Family Services (CHFS) has published a COVID Vaccine and Testing FAQ to assist pharmacies specific to the Medicaid Unwinding. It clarifies CHFS' interpretation of pharmacist authority to provide COVID vaccines and testing post-May 11 and the expiration of the PREP Act. https://www.nacds.org/ceo/2023/0512/PHE-Unwinding-COVID-FAQ.pdf
Also in Kentucky, Gov. Andy Beshear (D) signed HB 349, sponsored by pharmacist Rep. Danny Bentley (R). The law expands expedited partner therapy for the treatment of sexually transmitted diseases (STDs) to include more diseases. The bill also permits the retail sale of HIV self-administered testing kits.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Louisiana
While HB 471, by Rep. Barbara Freiberg (R) authorizing pharmacists to order and administer, and pharmacy interns and pharmacy technicians to administer immunizations to children aged seven years and older was scheduled to be heard in the House Health and Welfare Committee on May 10, the sponsor asked that the bill be deferred until May 17. The additional time gives chain pharmacies an opportunity to take action and contact House Health and Welfare Committee members urging them to support HB 471 to preserve patient access for children and families to receive lifesaving vaccines at pharmacies.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Maryland
Beginning July 20, 2023, pharmacies will be required to report Naloxone dispensing to the PDMP (Prescription Drug Monitoring Program) because of passage of a 2022 law. Additionally, the PDMP is changing certain ASAP (American Society for Automation in Pharmacy) fields from “optional” to “required.” For more information, see the updated PDMP RxGov Data Submitter Reference Guide with changes dictated by the naloxone statute, changes to required fields and new guidance from ASAP for v4.2A & v4.2B.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Michigan
NACDS reminds members that the Department of Insurance has posted a draft rule pursuant to the PBM Licensure and Regulation Act. NACDS is currently reviewing the rule and intends to file comments by the June 9 deadline. If there are comments you would like us to include in the letter, please send them to Jill McCormack by close of business on May 26.
Also in Michigan, the Department of Health and Human Services (MDHHS) is soliciting comments from Medicaid Health Plan Common Formulary. The Common Formulary applies to pharmacy claims paid by Medicaid Managed Care Organizations. The public may submit comments on the drugs included or not included on the Common Formulary; new drug products; prior authorization criteria; step therapy criteria and other topics related to drug coverage. The comments will be reviewed by MDHHS and the Michigan Medicaid Health Plan Common Formulary Workgroup. The next drug classes to be reviewed by the Workgroup include Diabetes, GI, P & T Miscellaneous, Non-Drug Products and Endocrine & Metabolic. Changes may be made to the Common Formulary based on comments received. Comments are due June 16 and should be emailed to MDHHSCommonFormulary@michigan.gov .
For more information, contact NACDS’ Jill McCormack at 717-592-8977.