Nebraska
The Department of Health and Human Services posted information about the expiration of the federal COVID-19 public health emergency including fee-for-service providers are no longer allowed to extend prior authorizations that existed before the pandemic started through to the end of the pandemic without requiring follow-up visits and cost-sharing, including copayments/copays and premiums, will continue to be waived for members of Nebraska Medicaid until June 1, 2024.
Also in Nebraska, the Department of Health and Human Services announced Medicaid will hold weekly public webinars on the public health unwinding as part of the return to regular eligibility operations.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
North Carolina
Please see the May 2023 North Carolina Medicaid Pharmacy Newsletter.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Oregon
The Oregon Health Authority and the Oregon Department of Human Services announced lifting of COVID-19 response measures as federal health emergency ended. Some changes were effective May 11 while others will take effect in the coming weeks.
Also in Oregon, the Board of Pharmacy posted the agenda for the May 16 meeting of the Compounding Workgroup and the agenda for the May 17 meeting of the Public Health & Formulary Advisory Committee.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Tennessee
PBM Enforcement Update with TDCI (Tennessee Department of Commerce & Insurance). TPA welcomes Jud Jones, PharmD, Manager of PBM Compliance at TDCI on May 17 from 12:00 noon-12:30 p.m. CT and 7:00 p.m.-8:00 p.m. CT to hear the latest on PBM enforcement in the state.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Texas
for HB 1105, by Rep. Four Price (R), legislation that lowers the age to three years old and up for pharmacies to administer all vaccines and immunizations, was referred to the Senate Health and Human Services Committee for a hearing.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Virginia
The Board of Pharmacy issued a document outlining pharmacy’s authority to vaccine and perform COVID testing post the May 11 expiration of the PHE (public health emergency). Notably, the document includes a link to an updated statewide protocol to allow pharmacists and technicians to vaccinate children aged three years and older due to the passage of HB 1323 in 2022.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
West Virginia
The Board of Pharmacy’s April newsletter contains valuable information regarding legislation passed in the 2023 session and its impact on pharmacies, including HB 2754, which will make pharmacies PREP Act immunization authority permanent once rules have been promulgated. The Board’s goal is to do so by July 1, 2023. Of note, the newsletter provides information on an updated, online process to file Collaborative Practice Agreements.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Alabama
This ALERT, related to COVID-19 unwinding as it pertains to Pharmacy and DME [Durable Medical Equipment], has been released.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
California
The Department of Consumer Affairs' (DCA')s printing provider is currently experiencing technical difficulties. As a result, the printing of the Board of Pharmacy's renewals, certificates, licenses and letters is delayed. Printing interruption began on April 13. At this time, DCA does not have an estimated time of restoration. Updates will be provided as more information becomes available.
To verify your license status online: Go to the Board's website and click on License Search in the "Quick Hits" column to view and print your license record. California law allows the printout of a license record from the Board's website to serve as license verification.
Renewing your license: The Board reminds licensees of their responsibility to renew licenses before they expire. Renewal application forms and fees may be submitted up to 60 days before expiration.
- To renew online: Pharmacists, advance practice pharmacists, pharmacy technicians, designated representatives, pharmacies, hospitals and drug rooms may renew licenses online. Go to the Board's website and click on License Renewal Online in the "Quick Hits" column.
- To renew by mail: Go to the Board's website and click on License Renewal by Mail in the "Quick Hits" column.
Also in California, the Board of Pharmacy posted the following reflecting actions taken at the recent April Board Meeting:
- Pharmacist Remote Processing Waiver on Behalf of a Health Care Facility Licensed Pursuant to Health and Safety Code Section 1250
- April 2023 Board Meeting Action Items
Also in California, the Department of Health Care Services (DHCS) posted the following alerts, weekly notices and monthly bulletin on the Medi-Cal Rx Web Portal:
- Reminder: Prior Authorization Signature Requirements (May 4)
- Refill of Continuous Glucose Monitoring (CGM) Supplies (May 2)
- Discontinuation of the COVID-19 Uninsured Group Program (May 1)
- Reinstatement of the Medi-Cal Rx Controlled Substance Policy on Buprenorphine Products (May 1)
- Updates to the List of Covered Emergency Use of Authorization (EUA) COVID-19 Antigen Tests, Effective June 1, 2023 (May 1)
- Updated Appendix H – List of Physician Administered Drugs (PADs) with Reject Code 816 (May 1)
- Medi-Cal Rx Monthly Bulletin for May (May 1)
- Changes to Contract Drugs List (CDL) (May 1)
- Changes to Contract Drugs List (CDL) – Over-the-Counter Drugs (May 1)
- Changes to the Family PACT Pharmacy Formulary (May 1)
- Updates to the Medi-Cal Rx Provider Manual (May 1)
- Medi-Cal Rx Weekly Wrap-up for April 21-27 (April 28)
- Reinstatement Spotlight (April 28)
Finally in California, Medi-Cal posted the following:
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Florida
On May 3, Gov. Ron DeSantis (R) signed into law Senate Bill 1550. Effective July 1, 2023, The Prescription Drug Reform Act codifies the Governor’s actions from last year to require accountability among pharmaceutical middlemen, empower consumers through increased choice among pharmacies and create transparency in prescription drug price increases. More information from the Governor’s office can be found here.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Illinois
Gov. J.B. Pritzker (D) has signed HB 559 (Public Act 103-001), which codifies the COVID Executive Order that was in effect throughout the pandemic and governed the provision of healthcare services.
For Illinois pharmacy, this means the following:
- continuing to test and treat COVID and test for influenza and other health conditions identified by a statewide public health emergency.
- pharmacists may administer flu and COVID vaccinations to patients seven years of age and older under the pharmacists' own authority.
- pharmacists may delegate to technicians the administrative and technical act of performing tests. Technicians must complete an ACPE (Accreditation Council for Pharmacy Education) vaccination training course, basic CPR certificate and complete two (2) hours of immunization related continuing education per licensing period.
- Group or individual policy of accident and health insurance and managed care plans are required to provide coverage on or after January 1, 2025 for pharmacist-provided test and treatment services if the plan provides coverage for the same services provided by a licensed physician, and APRN, or a physician assistant, the pharmacist is included in the health benefit plan's network of participating providers, and reimbursement has been successfully negotiated in good faith between the pharmacist and the health plan.
Also in Illinois, this notice provides information regarding pharmacy billing policies that will resume at the end of the COVID-19 public health emergency (PHE). The PHE is scheduled to end on May 11, 2023. The requirements discussed in this notice apply to the Department of Healthcare and Family Services' (HFS) fee-for-service (FFS) program. The Medicaid managed care organizations (MCOs) do not have prescription limits as in the FFS program. The MCOs follow the Preferred Drug List (PDL) but set their own coverage policies and may have later implementation dates for the requirements below. Pharmacies may contact the applicable MCO with questions.
Effective with dates of service on and after May 12, 2023, the following pharmacy requirements that were in place prior to the PHE will resume:
Refill Too Soon
Pharmacies will no longer be able to override Refill Too Soon (RTS) claims by entering a Submission Clarification Code (420-DK) of 13, Payer, Recognized Emergency/Disaster Assistance Request. When a claim rejects for RTS, the pharmacy will need to request an override through pre-COVID processes. The RTS percentages will also be set back to the same tolerances in place prior to the PHE.
Preferred Drug List (PDL)
Changes made to the preferred drug list (PDL) due to potential drug shortages will be removed from the PDL. During the PHE, all albuterol HFA inhalers, levalbuterol inhalers and generic levalbuterol nebulizer solutions were changed to preferred status. These will revert to the pre-PHE classification.
Updates/changes will be maintained on the Department's website on the PDL webpage.
Quantity for supplies
Blood glucose/reagent test strips quantity will be decreased to a maximum of 200 per month. Lancet quantity will be decreased to a maximum of 200 per month. Providers are reminded to bill an accurate day supply even if it exceeds one month.
Quantity limits will be reinstated for Tamiflu, insulin and suboxone.
OTC (Over-the-Counter) Coverage
The temporary coverage granted during the PHE for acetaminophen and cough suppressants containing guaifenesin, dextromethorphan or their combinations will revert to the same status in place prior to the PHE.
3 Brand Limit
Edits that were removed to allow a customer to receive three brand name drugs during a 30-day period will be put back in place.
4 Prescription Policy
Edits that were removed to allow a customer to receive more than four prescriptions during a 30-day period will be put back in place.
Third Party Liability
Drugs will again be subject to prior approval in situations where the primary insurance did not pay due to a rejection or customer deductible requirement. These edits will resume, and claims will require an override in accordance with pre-PHE billing policy.
Questions regarding this notice may be directed to the Bureau of Professional and Ancillary Services at 877-782-5565.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Indiana
On May 1, Gov. Eric Holcomb (R) signed into law HB 1568, legislation allowing pharmacists to prescribe and dispense hormonal contraception.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Iowa
The Department of Health and Human Services published the following:
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Kansas
Prior to the legislature adjourning on April 28, SB 131, legislation that was amended to include extending the authority for pharmacy technicians to administer vaccines was sent to Gov. Laura Kelly (R). She signed it into law on May 1.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Kentucky
The Department for Public Health recently updated the Yellow Fever Vaccination Center Application to allow pharmacists to apply to participate. Further detail can be found on the Office of Epidemiology webpage.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Louisiana
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 is scheduled for a hearing in the House Health and Welfare Committee on May 10. The Louisiana Alliance for Retail Pharmacies is urging chain pharmacies to take action to preserve patient access to children and families for lifesaving vaccines at pharmacies.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Maryland
Gov. Wes Moore signed the following bills into law:
- HB 693– Allows pharmacist to delegate administration of certain vaccines to pharmacy technicians: – to adults 18 years of age and older: COVID, flu, pneumonia; and RSV or shingles to patients 50 years of age and older; allows techs to perform remote data entry under supervision. Effective upon signing, April 4, 2023.
- SB 678 – Requires Medicaid, CHIP and commercial insurers to reimburse pharmacies for services within their scope of practice if the plan would otherwise cover. Effective October 1, 2023; signed May 5, 2023.
- HB 374– Pharmacy audits – clarifies that the state's audit law applies to PBMs contracted with Managed Care Plans; adds new auditing thresholds and requirements that apply to all insurers and Managed Care; and requires PBMs to provide a secure electronic method of communication between the pharmacy and the PBM for sharing auditing information by October 2025. Provides that the Department of Insurance may promulgate rules. Effective January 1, 2024; signed May 5, 2023.
- HB 382 -Requires the State Department of Health and Prescription Drug Advisory Board to complete a study on MMC claims for calendar years 2021 and 2022 and on the costs of implementing a pharmacy reimbursement cost-based rate floor in MMC. The study is due to the General Assembly in October 2023. Effective upon signing, April 4, 2023.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Massachusetts
In advance of the May 11 Public Health Emergency ending, the Massachusetts Board of Pharmacy announced the following on May 4:
- In response to the continued public health need for vaccinations, the Board will not be enforcing the supervisory ratios set out in 247 CMR 8.06(3) at licensed pharmacies that are providing vaccination services provided that the following conditions are met:
- A maximum ratio of one pharmacist to six support staff is not exceeded; and
- at least three support staff are interns and / or certified, licensed pharmacy technicians.
- Due to continued staffing shortages, the Board does not intend to take enforcement action against pharmacies that perform and reconcile perpetual inventory counts at least every 15 days as long as back-counts are performed after each prescription is filled.
- Pharmacists, interns and pharmacy technicians may administer vaccines to individuals who are 5 years of age and older in accordance with Policy 2023-02: Vaccine Administration.
- COVID-19 Control Measures, including COVID-19 tests, may be dispensed or administered in accordance with Policy 2023-03: COVID-19 Control Measures.
For more information, please contact NACDS’ Mike Sargent at 207-272-6435.
Michigan
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'd like us to include in the letter, please send them to Jill McCormack by close of business on May 26,, 2023.
Also in Michigan, the Board of Pharmacy will hold a public hearing on Pharmacy – General Rules NOH 6.2.2023.pdf on June 2, 2023 at 9:00 a.m.. Written comments can be submitted to BPL-BoardSupport@michigan.gov. The open comment period ends June 2 at 5:00 p.m.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Minnesota
The Conference Committee on SF 2995, the Health Budget Bill, has been appointed and is currently meeting to produce a final bill. The Conferees include Senators Boldon, Kupec, Wiklund, Abeler and Morrison; and Representatives Keeler, Liebling, Pinto, Schomacker and Bierman. Several key pharmacy provisions are in the mix including:
- Pharmacy benefit carve-in to Fee-for-Service
- Pharmacy Technician immunization authority
- Payment for pharmacy services
- Requirement for on-going Cost of Dispensing surveys
NACDS has been working with the Minnesota Retailers Association, the Minnesota Pharmacy Association and members to help advance and support these provisions throughout the session. Once the conference committee report is finalized, the bill will go before the General Assembly for approval.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Montana
On May 1, Gov. Greg Gianforte (R) signed SB 112 (Chapter Number: 322), legislation allowing pharmacists to prescribe certain medications with limitations. In the coming months, the Board of Pharmacy will promulgate rules.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Nevada
SB 57, legislation that includes PBMs in the definition of administrators and creating licensing requirements, passed the Senate on April 25 was heard in the Assembly Commerce and Labor Committee on May 3.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
New York
On May 2, Gov. Kathy Hochul (D) signed A 1060: pharmacists administered contraceptives into law.
On the May 1 weekly NYRx Medicaid Pharmacy Benefit transition call, the State Department of Health reminded pharmacies that for the billing process for immunizations, there are different codes to use when billing for multiple vaccines and administration in the same day. Please see the following guidance.
For more information, please contact NACDS’ Mike Sargent at 207-272-6435.
North Dakota
The North Dakota Department of Health and Human Services Infectious Diseases and Epidemiology Unit and the North Dakota State University Department of Public Health are excited to announce an opportunity for approximately 15-18 North Dakota pharmacists to complete the Antimicrobial Stewardship Certification Program through the Society of Infectious Disease Pharmacists. Please see the document linked here for more information regarding the certification program curriculum and how to apply. Interested pharmacists must complete the application (PDF Form or Word document) and return it to Emily Perry by 5:00 p.m. on June 30. If you have any questions, please contact Emily Perry, Antimicrobial Stewardship Lead at NDSU's Center for Collaboration and Advancement of Pharmacy, at 701-552-2784 or by emailing Emily.Perry@ndsu.edu
Also in North Dakota, Gov. Doug Burgum (R) signed SB 2041, legislation that caps cost-sharing for insulin and medical supplies for insulin dosing and administration for enrollees in the public employee retirement system. It does not limit out-of-pocket costs on an insulin pump, an electronic insulin-administering smart pen or a continuous glucose monitor.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Ohio
The Board of Pharmacy is accepting comments for various rule sets up for the five-year rule review process. Comments are due to the Board on May 31 and should be posted here.
Also in Ohio, the state's SBPM, Gainwell, announced the launch of their call center's virtual agent, GABBYTM. GABBYTM is an interactive voice response system that offers several self-service functions, including checking claim statuses, member eligibility and prior authorizations. You can watch GABBYTM in action using this link.
Finally in Ohio, Gainwell will begin phase 5 of the re-implementation of Prior Authorization (PA) on May 9, 2023, on specific drug classes. Of note, the PA reimplementation only applies to new, initial authorizations, and it does not apply to those patients who have previously taken the drug supported by recent claims history prior to May 9. Phase 5 includes the following drug classes:
- Analgesic Agents: NSAIDS
- CNS Agents: Anti-Migraine Agents (Acute, Cluster Headache, Prophylaxis), Anticonvulsants, Antidepressants, ADHD Agents, Atypical Antipsychotics, Parkinson's Agents, Restless Legs Syndrome, Sedative-Hypnotics (Non-Barbiturates)
- Compounding Agents (Bulk Chemicals/Powders, Vehicles, Bases)
- Gastrointestinal Agents: Anti-Emetics, Crohn's Disease, Hepatic Encephalopathy, Irritable Bowel Syndrome (IBS) with Diarrhea, Ulcerative Colitis, Unspecified GI
- Infectious Disease Agents: Antibiotics – Cephalosporins, Macrolides, Quinolones, Tetracyclines
- Infectious Disease Agents: Antifungals
- Infectious Disease Agents: Antivirals – Herpes, HIV
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. Additional PAs are planned for reimplementation in a similar, incremental fashion during the second quarter of 2023. Please direct questions to the Gainwell Help Desk at 1-833-491-0344.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.