Tennessee
TennCare has contracted with Mercer Government Human Services Consulting (Mercer) to conduct a professional cost of dispensing survey and a survey of acquisition cost data, also known as the Average Actual Acquisition Cost (AAAC) survey. Both surveys will begin on April 3, 2023, and must be submitted to Mercer no later than May 12, 2023.
All network pharmacies will be required to complete the professional cost of dispensing survey; however, only select pharmacies will also be required to complete the biannual AAAC survey.
Mercer will conduct a technical online seminar on March 20, 2023, at 10:00 AM CST to discuss both surveys and answer any provider questions. Please utilize the log in information below to join:
Link: https://mmc.zoom.us/s/92516957090?pwd=S0p3bm9JeHFGRTJ4R2NOeTZMNitnUT09
Passcode: 030511
Please feel free to direct any questions regarding the survey to (Lora.Underwood@tn.gov) or mercerrxpassage@mercer.com.
Also in Tennessee, please view the pharmacy provider notification regarding missing AAAC rates. You can contact the OptumRx Pharmacy Supports Center at 866-434-5520 or tnrxeducation@optum.com if you have any questions.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Texas
Legislation has been filed in both the House and Senate that would prohibit the Health and Human Services Commission’s Vendor Drug Program from including any discount price offered for the prescription drug, including a discount offered through a third-party discount card when defining the price of a prescription drug for purposes of determining the Usual and Customary (U&C) reimbursement rate for Medicaid. These bills include SB 1619 by Sen. Charles Perry (R) and HB 3214 by Rep. Donna Howard (D).
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Utah
HB 288 (1st Sub.), legislation requiring a pharmacist who dispenses opioids to offer to counsel the patient or the patient's representative on the use and availability of an opioid antagonist and offer to dispense an opioid antagonist with a prescription or under other defined criteria, passed both the House and the Senate and will be sent to Gov. Spencer Cox (R) for his consideration.
Also in Utah, SB 193, legislation that a health insurer may not require a pharmacy to dispense a clinician-administered drug directly to an enrollee with the intention that the enrollee will transport the drug to a healthcare provider for administering, passed the Senate and the House and will be sent to Gov. Cox for his consideration.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Washington
Broad reform legislation regulating PBMs, 2SSB 5213, that was supported by the Insurance Commissioner, the Washington State Pharmacy Association, and pharmacies, which would have prohibited requiring the use of mail-order pharmacies except for specialty drugs, reimbursing pharmacies below costs and excluding pharmacies from the network, died on the Senate floor on March 8.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Wyoming
The 2023 General Session of the 67th Wyoming Legislature adjourned on March 3.
The following bills were signed into law by Gov. Mark Gordon (R):
- SF 7 (Enrolled Act No. 36), legislation amending the definition of "opiate antagonist" to mean any device or medication approved by the U.S. FDA for the treatment of an opiate drug related overdose effective immediately upon completion of all acts necessary for a bill to become law.
- SF 9 (Enrolled Act No. 53), legislation authorizing payment for services rendered by a licensed pharmacist under the Medical Assistance and Services Act effective July 1, 2023.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Alabama
All previously published expiration dates related to the COVID-19 public health emergency (PHE) are once again extended by the Medicaid Agency (Medicaid). The new expiration date is the earlier of March 31, 2023, or any expiration date noticed by Medicaid through a subsequent ALERT.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Arizona
SB 1248, legislation repealing several components of the sunrise process for scope expansion, including pharmacy, passed the Senate (21-9) and the House (42-18) and was sent to the Gov. Katie Hobbs (D) for signature. The sunrise process will require material changes to certification, registration, or licensure.
Also in Arizona, on February 20, SB 1254 (Senate Engrossed), legislation repealing the requirement for a Schedule II opioid prescription that is directly dispensed by a pharmacist and that is not for the immediate administration to the ultimate user to have a red cap, passed the Senate and was transmitted to the House.
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.
- Policy Update of Remdesivir (Veklury) for the Outpatient Treatment of COVID-19 as a Pharmacy Benefit (March 1)
- Enteral Nutrition Update: Changes to the Published Enteral Nutrition Policy in the Medi-Cal Rx Provider Manual, Effective April 1, 2023 (March 1)
- Maximum Allowable Ingredient Cost 30-day Pharmacy Provider Notice (March 1)
- Pharmacy Provider Dispensing Fee Self-Attestation (March 1)
- Medi-Cal Rx Monthly Bulletin for March (March 1)
- Changes to Contract Drugs List (CDL) (March 1)
- Changes to Contract Drugs List (CDL) – Over-the-Counter Drugs (March 1)
- Updates to the Medi-Cal Rx Provider Manual (March 1)
- Medi-Cal Rx Weekly Wrap-Up for February 17-23 (February 24)
- Reinstatement Spotlight (February 24)
- 30-day Countdown – Phase III, Lift 1: Retirement of the Transition Policy for Beneficiaries 22 Years of Age and Older (February 23)
- New Resources for Providers: COVID-19 Testing and Treatment Support (February 21)
- Medi-Cal Rx Weekly Wrap-up for February 10-16 (February 17)
- Reinstatement Spotlight (February 17)
Also in California, Medi-Cal posted the following:
- CDPH Offers New Warmline for COVID-19 Testing and Treatment (March 2)
- Breast and Cervical Cancer Treatment Program: End of Medi-Cal Continuous Coverage (March 1)
- Medi-Cal Update – Pharmacy – February 2023 – Bulletin 1034 (
Also in California, on March 23, 2020, the DHCS published a regulatory provider bulletin (Requirements and Procedures for Emergency Medi-Cal Provider Enrollment) that established amended enrollment requirements and procedures for providers to temporarily and provisionally enroll in the Medi-Cal program during the COVID-19 public health emergency (PHE) as authorized by the Section 1135 waiver granted by the CMS. Effective March 29, 2023, DHCS is discontinuing the provider enrollment flexibilities authorized by the Section 1135 waiver. Providers will have 90 days from the end of the waiver period on March 29, to submit an application for enrollment via the Provider Application and Validation for Enrollment (PAVE) portal. Providers who have not submitted an application by June 27, will have their temporary enrollment deactivated, effective June 28.
Also in California, Magellan Rx Management posted the archived webinar for the Medi-Cal Rx Pharmacy Provider Dispensing Fee Self-Attestation that was held on February 23. This online seminar was hosted by Mercer and covered the attestation pharmacies must submit to determine the fee-for-service professional dispensing fee component of the pharmacy claim reimbursement for claims with dates of service within the state's following fiscal year. The DHCS also posted a current version of the Pharmacy Provider Dispensing Fee Self-Attestation FAQs.
Finally in California, the Board of Pharmacy posted the agenda and meeting materials for the Medication Error Reduction and Workforce Committee Meeting on March 8. The agenda includes a presentation by Peggy Binzer, Executive Director with the Alliance for Quality Improvements and Patient Safety and a discussion of the most recent report of the Well-Being Index.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Illinois
This notice relays information released from the Drug Enforcement Administration (DEA) regarding removal of the DATA Waiver (X-Waiver) requirement for practitioners prescribing buprenorphine. This information applies to customers covered under the Medicaid fee-for-service (FFS) program and by the managed care organizations (MCOs).
Previously, the federal government required practitioners with DEA licenses to also obtain a special waiver (known as an X-Waiver because the DEA Registration Number began with an X) to prescribe medications such as buprenorphine for the treatment of opioid use disorder (OUD) in office-based settings outside of federally registered opioid treatment programs. Health care providers were also restricted in the number of patients with OUD they could treat.
Section 1262 of the Consolidated Appropriations Act, 2023 (also known as the Omnibus bill), removes the federal requirement for practitioners to submit a Notice of Intent (have a waiver) to prescribe buprenorphine for the treatment of OUD. All practitioners who have a current DEA registration that includes Schedule III authority may now prescribe buprenorphine for OUD. There are no longer any annual limits on the number of patients that a prescriber may treat for OUD with buprenorphine. The January 12, 2023, letter from the DEA to waiver registrants identified these changes.
Pharmacies need to be aware of this change, as HFS [Department of Healthcare and Family Services] has received complaints that prescribers without a DEA X-Waiver are having trouble getting their prescriptions honored at local pharmacies.
Questions regarding this notice may be directed to the Bureau of Professional and Ancillary Services at 877-782-5565 for the FFS population or the applicable MCO.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Iowa
The Department of Health and Human Services published INFORMATIONAL LETTER NO. 2428-MC-FFS with April 2023 Iowa Medicaid Pharmacy Program Changes related to the following:
- New Drug Prior Authorization (PA) Criteria
- Changes to Existing PA Criteria
- Removal of PA Criteria
- Point-of-Sale Billing Updates
- DUR [Drug Utilization Review] Update
Also in Iowa, effective April 1, the Department of Health, and Human Services (Iowa HHS) will no longer require positive COVID-19 tests to be reported to the state Public Health Division. Since the development and widespread availability of rapid in-home tests – which are not required to be reported – the case and positive test counts in the state are no longer as meaningful as they once were. Iowa has no mandatory reporting order for any other respiratory viral illnesses such as influenza, RSV, and rhinovirus.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Montana
HB 710, legislation permitting pharmacy interns and technicians to administer immunizations, was introduced on February 21 and passed the Business and Labor Committee on February 24. After SB 239 failed to advance, the Montana Retail Association and the Montana Pharmacy Association found a new sponsor to pursue this legislation.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Nebraska
The Department of Health and Human Services (DHHS) published Provider Bulletin 23-06: Continuous Glucose Monitoring Updated Medicaid Reimbursement Policy that provides an update to Provider Bulletin 22-22 regarding coverage for eligible beneficiaries with diabetes effective January 1, 2023.
Also in Nebraska, the Board of Pharmacy posted a revised agenda for the March 6 meeting.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
New York
On February 21, the State Department of Health held an online seminar to update interested parties on the latest information regarding the Medicaid Pharmacy Benefit Transition from Managed Care to NYRx effective April 1. The next presentation and meeting will be March 21 at 1:00 p.m.
Also in New York, the Department of Financial Services (Department) Pharmacy Benefits Bureau ("PBB") announced a final request for public engagement as the Department looks to develop nation-leading regulatory standards for Pharmacy Benefit Managers (PBMs).
This request asks for information on PBM audits of pharmacies, which are meant to eliminate or reduce fraud, waste, and abuse, but often are overly burdensome and costly without meeting this intended goal. Instead, pharmacy owners are taken away from providing healthcare, requiring them to review and defend claims from years in the past at the sole direction of PBMs without justification. The information collected will inform the scope of regulations necessary to ensure audits follow a clear and transparent process and have guardrails in place to meet the goal of preventing fraud, misuse, and waste. The Department is in the process of developing a series of PBM regulations that together will form the most comprehensive regulatory framework in the country.
For more information, please contact NACDS’ Ben Pearlman at 617-515-2603.
North Dakota
Engrossed HB 1095,legislation to include comprehensive medication management services in health benefit plans, unanimously passed the House and was sent to the Senate where it was referred to the Human Services Committee. A hearing has been scheduled for March 7 at 9:00 a.m.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Oregon
Dana Hittle has been appointed as the permanent Medicaid director and will oversee Oregon’s Medicaid program, including the Oregon Health Plan. Hittle previously served as interim state Medicaid director for the last two years and, before that, was deputy Medicaid director.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
South Dakota
HB 1135, legislation related to PBMs, passed both the House and the Senate, and will be sent to the Gov. Kristi Noem (R) for her signature. This legislation includes requirements for PBM licensure, prohibits retroactive fees except in certain situations and the collection of renumeration fees and adds criteria for drugs to be placed on the MAC list.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Tennessee
TennCare is now in Phase II of its plan to unwind from the Public Health Emergency. They have created a communications toolkit and offered several other resources that healthcare providers, including pharmacies, can use to share more information with TennCare patients to ensure their coverage does not fall through.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Texas
Rep. Dr. Tom Oliverson (R), chair of the House Insurance Committee, filed HB 2021, legislation that applies existing law intended to protect patients and pharmacies to all PBMs operating in Texas. The PBMs and Health plans are orchestrating opposition leveraging the Texas Association of Business and the Texas State Chamber of Commerce, mounting an aggressive campaign saying that preempting ERISA hurts employer's ability to offer quality, affordable health care and prescription options that best fit the needs of their employees.
Also in Texas, NACDS and Texas Federation of Drug Stores (TFDS) pharmacists and interns from HEB and Walgreens spent time at the Capitol meeting with new members and staff to educate them on pharmacy's priority issues: Medicaid reimbursement rate floor and making the PREP Act flexibilities permanent by lowering the age to 3 years for pharmacists and pharmacy technicians to administer vaccinations without a prescription.
Finally, the House Public Health Committee convened an organizational meeting on February 27 to discuss an organizational meeting and will be taking invited testimony from the Texas State Board of Pharmacy (TSBP), the Texas Department of State Health Services, and the Texas Health and Human Services Commission.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Virginia
Pharmacy made tremendous advances in the Commonwealth in the 2023 Regular Legislative Session that will dramatically improve patient care and advance practice. HB 2274, allowing pharmacists to test and treat for flu, COVID, strep and UTIs (urinary tract infections) under a statewide Board of Pharmacy protocol, is on Governor’s desk for signing, along with its companion, SB 948. The bills are the final piece in updating Virginia’s law to match the PREP Act. Notably, the Legislature also passed SB 1538 to clarify that Medicaid must reimburse for all the pharmacy-based services currently authorized in the Commonwealth. The bill applies to both Fee-for–Service and Managed Care. NACDS thanks the Virginia Association of Chain Drug Stores (VACDS), the Virginia Pharmacists Association (VPhA) and members for their tremendous efforts on the ground during this short session. NACDS will continue to update members as the bill signing process unfolds.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Washington
NACDS sponsored the Washington State Pharmacy Association’s successful Pharmacy Days at the Capitol on January 25 and February 13. More than 120 students and pharmacists participated in 60 appointments with legislators advocating for PBM reform and, in general, for the profession of pharmacy, promoting convenient access to healthcare services. Pharmacist James Lin from Kroger-QFC met with Sen. Javier Valdez (D).
For more information, contact NACDS’ Mary Staples at 817-442-1155.
West Virginia
Our priority bills continue to advance in the Legislature. HB 2754, that would make the pharmacy immunization allowances from the federal PREP Act permanent in state law, was approved by the Senate Health and Human Resources Committee and is now on the Senate Floor for a final vote. The Senate passed an omnibus Rules package, SB 361, that authorizes the Board of Pharmacy to promulgate a rule increasing the pharmacy technician ratio from 1:4 to 1:6. The same bill also includes a final rule modernizing collaborative practice agreements to allow for population-based care. Notably, the collaborative practice rule is currently effective as an emergency rule. The package now awaits action in the House Judiciary Committee, as does Committee Substitute SB 345, a bill that would provide legislative approval of the PBM rule pursuant to the passage of HB 2263 of 2021.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Alaska
The Board of Pharmacy met on February 17 and 18.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Arizona
The Board of Pharmacy Task Force Committee-Rules Writing meeting will be held on February 22 at 9:00 a.m. An agenda has not been posted on the website.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
California
The Department of Health Care Services posted the following alerts and weekly notices on the Medi-Cal Rx Web Portal. Please note the reinstatement resources and information below.
- Evusheld® No Longer Authorized to Prevent COVID-19 (February 14)
- NCPDP Reject Code 83 – Duplicate Paid/Captured Claim (February 14)
- Reminder: Establishing Medical Necessity (February 14)
- Mpox Treatment Drug, Tecovirimat (TPOXX® or ST-246), as a Medi-Cal Pharmacy Benefit (February 13)
- Boostrix™ Claims System Issue (February 13)
- Medi-Cal Rx Weekly Wrap-up for February 3-9 (February 10)
- Reinstatement Spotlight (February 10)
Also in California, Medi-Cal posted the following:
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Colorado
The Department of Health Care Policy and Financing will be communicating to providers on rolling back certain flexibilities that will expire when the public health emergency.
For more information, contact NACDS’ Mary Staples at 817-442-1155.