The Department of Health (MDH (Minnesota Department of Health)) shared the implementation timeline for expanded prescription drug price transparency reporting on drugs of significant public interest and ways to stay connected. Beginning in January 2024, pharmacies will be required to report pricing information.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Telligen to replace Alliant Health Solutions and Kepro as Medicaid UM/QIO Vendors:
Early in 2024, the Division of Medicaid (DOM) will transition to a new Utilization Management/Quality Improvement Organization (UM/QIO) vendor, Telligen.
Telligen will replace the following vendors:
To ensure a smooth transition, Telligen web portal registration instructions and educational materials will be shared in the upcoming weeks through a variety of communication avenues to ensure no provider lacks access to necessary resources and assistance. Updates will also be publicized on the DOM website and Late Breaking News.
Please note: Prior authorizations for members enrolled in MississippiCAN and CHIP will continue to be handled by the respective coordinated care organization.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
On November 28 at 1:00 pm, a public hearing will be held via remote conferencing to consider proposed adoption of New Rule I pertaining to pharmacist prescribing [MAR Notice No. 24-174-80]. The 2023 legislature passed SB 112, allowing for independent prescribing authority for pharmacists in limited situations; it is necessary to set standards for patient care, evaluation, recordkeeping, and provider notification required of pharmacists prescribing under SB 112’s authority. In addition to oral testimony at the hearing, written comments may be submitted at dli.mt.gov/rules or P.O. Box 1728; Helena, MT 59624-1728; comments must be received no later than 5:00 pm on December 1.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
On November 1st, the New York Department of Financial Services pulled back on regulations regarding PBMs (Pharmacy Benefit Manager). This was in response to an “overwhelming” number of comments submitted in opposition to the regulation from unions, employers, and health plans. The legislative objectives driving the regulations were ‘licensing standards for PBMs, including minimum standards related to market conduct practices, conflicts of interest, deceptive, anti-competitive, and unfair claims practices in connection with the performance of pharmacy benefit management services, predatory audit practices, and actions or procedures in the PBM industry that go against the best interests of the public.’ While the full regulations were pulled back, the Department did move part of the rule-making process and fully adopted the registration requirement for PBMs.
On November 8th, the New York State Board of Pharmacy will be holding their regular scheduled meeting in person in Albany. The agenda is as follows:
Executive Session 9:30 a.m.
Public Session 1:00 p.m.
o Discussion: Online Discontinuance Form
o Discussion: Drug Price List
o Upcoming 2024 Meeting Dates
For more information, please contact NACDS’ Ben Pearlman at 617-515-2603.
The Board of Pharmacy has completed its rulemaking on the authorization for, and regulation of, the use of direct-to-patient (DTP) dispensing systems. Board Rule .1821 provides that authorization and the standards that apply to the use of DTP systems. Board Rule .1616 authorizes limited service permits to be issued for operation of a DTP system when the system is not located on-site at the home pharmacy.
The board staff has completed programming to implement a limited-service permit application for an off-site DTP system and to allow an existing pharmacy to notify the Board that it will deploy an on-site DTP system.
Detailed guidance on the rules and standards governing DTP systems, as well as step-by-step instructions to add an on-site DTP system to an existing pharmacy’s services or to apply for an off-site DTP system limited-service permit are found here.
The general limited-service permit guidance document has also been updated to include information on DTP system permits.
Also in North Carolina, effective November 1, Medicaid waived the copay for antiretrovirals used to decrease viral load in members living with HIV (Human Immunodeficiency Virus).
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
The Board of Pharmacy announced that the November board meeting will be held on Monday, November 6th starting at 10:00 am; and Tuesday, November 7th and Wednesday, November 8th starting at 9:00 am. See the monthly agenda, which will be posted on Friday, November 3rd, for more specific information. The link to join the meeting will be available here Monday. The Board also posted the following items and updates on their webpage:
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
The Prescription Drug Affordability Board (PDAB) posted its November 15 meeting draft agenda. The PDAB will also review an updated working drug list during the November 15 meeting; the updated list has been posted on the PDAB data page. Below are links to information for the next meeting including current rules referenced in the draft agenda. The board calendar and minutes from past meetings are also available online.
Also in Oregon, the Oregon Health Authority proposed minor housekeeping edits to align with Federal requirements, clarify language, remove outdated references, and correct typos. Comments are due November 21 at 5:00 pm Pacific.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Medicaid plans to implement a system to reimburse pharmacies for a variety of services within their current scope of practice in 2024. We understand these would include immunizations, counseling, and diabetes management; and would apply to both the Fee-For- Service and Managed Care Program. We understand a Bulletin announcing the new program will be released the first week of December. NACDS will provide updates as we receive them, including instructions on enrollment. NACDS has been supporting member and in-state efforts to develop the program.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Please see the November 2023 provider update. Previous updates can also be found on the Executive Officer of Health and Human Services (EOHHS) Provider Updates web page.
Also in Rhode Island, Medicaid has noticed an increase in the number of Continuous Glucose Monitors (CGMs) submitted via pharmacy claims. Please note that Medicaid considers CGMs as DME products and requires prior authorization for all CGM-related items. All prior authorization requests must be submitted by the dispensing provider and must include a prescription and recent clinical notes. Requests submitted directly by ordering physicians will be returned.
In adherence with recent Medicare HCPCS code updates, Medicaid activated the following CGM codes:
Effective October 1, 2023, prior authorization requests submitted under codes K0553 and/or K0554 are being returned and must be resubmitted with the proper codes.
Claim submission for reimbursement must be done using either the 837 professional file format or via the CMS 1500 paper claim. Claims submitted otherwise will be denied.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.