New York

NYRx, the Medicaid Pharmacy Benefit Program, updated the preferred drug list, impacting Albuterol HFA formulations. The following are preferred in the NYRx Preferred Drug Program: 

  • albuterol HFA – generic ProAir® HFA (8.5 grams) 
  • albuterol HFA – generic Proventil® HFA (6.7 grams) 
  • Proventil® HFA 
  • Ventolin® HFA BLTG (Ventolin® HFA is subject to the Brand-Less-Than-Generic Program. The generic formulation of Ventolin® HFA, albuterol HFA (18 grams), is non-preferred and will require prior authorization.) 

Effective February 7, NYRx will make the following changes to the Brand Name Drug When Less Expensive Than the Generic Program: 

  • Alphagan P® 0.1%, Forteo® and Votrient® will be ADDED to the program. 
  • Flovent® HFA and Pennsaid® pump will be REMOVED from the program. 

For more information, please contact NACDS’ Ben Pearlman at 617-515-2603.

2024-01-26T10:15:21-05:00January 26, 2024|New York|

North Carolina

Medicaid has been informed that Wellcare and Carolina Complete have experienced an issue with their new PBM (Express Scripts), being set up to pay at 30 days instead of 14 days, resulting in pharmacies not being paid timely.  

Payments for the first week in January are going out in the coming week. Payments for the second and third weeks will be on a 30-day cycle and will come out in mid-February, payments for the fourth week in January will also come out by mid-February. Pharmacies should be “caught up” in mid-February.  

Penalties and interest will be paid in accordance with Section V. H.1.d of the NC PHP Contract. For more information, please see the Medicaid bulletin Prepaid Health Plan Interest and Penalties for Provider Claims.  

For more information, contact NACDS’ Leigh Knotts at 803-243-7207.

2024-01-26T10:10:38-05:00January 26, 2024|North Carolina|

Oregon

The Board of Pharmacy posted the agenda and meeting materials for its February 7-9 meeting. Please note the board will meet in Executive Session immediately after roll call for most of the day on February 7 and February 8 and anticipates resuming “Open Session” between 4:30 pm and 5:00 pm on both days.

For more information, contact NACDS’ Sandra Guckian at 703-774-4801.

2024-01-26T10:09:53-05:00January 26, 2024|Oregon|

Pennsylvania

The Department of Human Services (DHS) continues to work with pharmacy stakeholders on the launch of a new program that will allow pharmacists to bill for a wide variety of clinical services, including MTM (Medication Therapy Management), immunizations and patient counseling. On February 15 from 10:00 am – 12:00 noon, DHS is hosting a pharmacists enrollment training online seminar. You must register to attend. DHS will be requiring each individual pharmacist providing billable services to enroll as a provider, even those in a chain environment. They expect enrollment to open on March 1. We expect a final Bulletin to be published in the next few days with more details about the program, billing instructions and covered services. 

Also in Pennsylvania, a bill to reform PBM practices in Medicaid Managed Care and set a rate floor in the state employees’ benefit program has been introduced. SB 1000, cosponsored by Senators Judy Ward (R) and Tina Tartaglione (D), has been referred to the Health and Human Services Committee for consideration. NACDS assisted in-state partners in drafting the bill and will be actively involved in advocating for its passage. 

For more information, contact NACDS’ Jill McCormack at 717-592-8977.

2024-01-26T10:09:17-05:00January 26, 2024|Pennsylvania|

South Carolina

The Department of Health and Human Services (SCDHHS) consistently offers free Healthy Connections Medicaid training to enrolled Healthy Connections Medicaid providers and their billing agents. These recurring trainings are conducted by SCDHHS’ contracted vendors. Information about the upcoming February-April 2024 training is available online.  

Also in South Carolina, some Healthy Connections Medicaid-enrolled providers were mailed an IRS 1099-MISC form from the Department of Health and Human Services (SCDHHS). The IRS 1099-MISC form providers received in the mail in January 2024 from SCDHHS contains an error. While the dollar amount of “Medical and health care payments” listed in block six of the IRS 1099-MISC form is correct for calendar year 2023, the form indicates it is for calendar year 2022.

Corrected forms are currently being printed and will be mailed in the next two business days. Providers should receive the replacement IRS 1099-MISC forms for 2023 within the next three to seven business days.

The incorrect form showing the 2022 date should be disregarded and not used to file taxes for the 2022 or 2023 calendar years. The error occurred while printing the forms mailed to providers. The forms with the correct calendar year were submitted to the IRS.

If you have any questions, please contact the Provider Service Center at (888) 289-0709, extension four, option one. The Provider Service Center is open Monday through Thursday from 7:30 am to 5:00 pm and Friday from 8:30 am to 5:00 pm. 

For more information, contact NACDS’ Leigh Knotts at 803-243-7207.

2024-01-26T10:08:46-05:00January 26, 2024|South Carolina|

Texas

The Medicaid Vendor Drug Program (VDP) held a virtual quarterly pharmacy stakeholder meeting on January 17. 

For more information, contact NACDS’ Mary Staples at 817-442-1155.

2024-01-26T10:07:32-05:00January 26, 2024|Texas|

Vermont

On January 24, the Board of Pharmacy held its regularly scheduled meeting. The board welcomed new members, elected a new chair, and provided a legislative update. The next meeting is scheduled for February 28 at 9:00 am virtually via Teams.

For more information, please contact NACDS’ Ben Pearlman at 617-515-2603.

2024-01-26T10:07:02-05:00January 26, 2024|Vermont|

Washington

In advance of the January 24 House Health and Wellness Committee hearing, NACDS registered in support of HB 2116, legislation expanding prescriptive authority for pharmacists. We also submitted the attached support statement for the record.  

Also in Washington, the Pharmacy Quality Assurance Commission (PQAC) is scheduled to meet on February 1. The meeting materials will be available online soon. 

For more information, contact NACDS’ Mary Staples at 817-442-1155.

2024-01-26T10:06:29-05:00January 26, 2024|Washington|

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