California

Gov. Gavin Newsom (D) signed two bills, supported by NACDS, including AB (Assembly Bill) 1341 (Chapter 276, Statutes of 2023), legislation permitting pharmacists to provide COVID-19 medication as well as offer broader options for substance use disorder treatments as specified in the bill, and AB 317 (Chapter 322, Statutes of 2023), legislation helping to support patient access to essential healthcare services provided by pharmacists by requiring healthcare service plans that cover care that is otherwise within pharmacists’ scope of practice to reimbursement pharmacy providers for delivering those services. 

Also in California, Gov. Gavin Newsom (D) signed SB (Senate Bill) 786 (Chapter 414, Statues of 2023), legislation related to 340B, prohibiting PBMs from discriminating against a covered entity or its pharmacy in connection with dispensing a drug subject to federal pricing requirements or prevent a covered entity from retaining the benefit of discounted drug pricing for those drugs. 

Also in California, Gov. Gavin Newsom (D) signed AB 1286 (Chapter 470, Statutes of 2023), legislation sponsored by the Board of Pharmacy and opposed by NACDS and for which we urged him to veto because the legislation that would impose arbitrary staffing limits and impede pharmacies’ ability to optimize the use of pharmacy technicians to assist with technical duties that do not require a pharmacist’s professional judgement. This bill authorizes a pharmacy technician under the direct supervision and control of a pharmacist to prepare and administer influenza and COVID-19 vaccines, prepare, and administer epinephrine, perform specimen collection for specified tests, receive prescription transfers and accept clarification on prescriptions. The bill would prohibit a pharmacy with only one pharmacist from having more than one pharmacy technician performing these additionally authorized tasks unless the pharmacy has scheduled another pharmacy technician to assist the pharmacist with performing the nondiscretionary tasks currently authorized under existing law.  

Among the other provisions, the bill requires a pharmacist-in-charge or pharmacist on duty to immediately notify store management of any conditions that present an immediate risk of death, illness or irreparable harm to patients, personnel or pharmacy staff and requires store management to take immediate and reasonable steps to address and resolve those conditions. If those conditions are not resolved within 24 hours, it requires the pharmacist-in-charge or pharmacist on duty to notify the Board of Pharmacy. The board’s executive officer may choose to issue a cease-and-desist order, upon a reasonable belief that conditions within a pharmacy exist that present an immediate risk of death, illness or irreparable harm to patients, personnel, or pharmacy staff. Also in the bill, a chain community pharmacy, having 75 or more stores in California under the same ownership, must always be staffed with at least one clerk or pharmacy technician fully dedicated to performing pharmacy-related services with defined exceptions. Additionally, the bill requires a licensed community pharmacy to report all medication errors to an entity approved by the board.  

Also in California, Gov. Gavin Newsom (D) vetoed AB 782, legislation that would have excluded reconstitution of a drug pursuant to a manufacturer’s directions, tablet splitting or crushing, capsule opening or the addition of a flavoring agent from the Pharmacy Law’s definition of compounding. 

Also in California, on October 16, the Board of Pharmacy released the following message: 

Today this the start of National Pharmacy week, and the California State Board of Pharmacy would like to take this time to thank all pharmacy personnel for your hard work and professionalism to your patients. 

Each job plays an important part in providing the highest quality of care. According to recent statistics, more than 90% of Americans live within five miles of a community pharmacy, making your care accessible to millions of people. 

Thank you for your commitment to patient care and safety. 

Thank you! 

Also in California, the Department of Health Care Services (DHCS) posted the following alerts and weekly notices on the Medi-Cal Rx Web Portal. Please note the postponed implementation date for Reject Code 80; see alert for details. DHCS (Department of Health Care Services) anticipates Reject Code 80 will be reinstated before the end of 2023. They have initiated efforts to more precisely communicate the diagnosis requirements that will be reinstated and will provide a 30-day notice prior to this reinstatement. Also, as a reminder, on November 10, Medi-Cal Rx will proceed with the reinstatement of the Enteral Nutrition transition policy for members ages 22 years and older and the Brand Medically Necessary (BMN) PA (prior authorization) requirements will also be reinstated on November 10. 

Finally in California, Medi-Cal posted the following: 

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

2023-10-20T12:23:03-04:00October 20, 2023|California|

Florida

The Agency for Health Care Administration (Agency) announces that it is soliciting comments from providers which it will consider as part of the re-procurement of the Statewide Medicaid Managed Care (SMMC) program. (See Section 409.966(3)(a)(8), F.S.)  

The Invitations to Negotiate (ITNs) and information about the re-procurement, including anticipated timelines and instructions for submission of provider comments, can be found on the Department of Management Services’ Vendor Bid System at: MyFloridaMarket Place Vendor Information Portal.  

Key dates to note are: 

October 27, 2023: Anticipated Posting of ITN (invitation to negotiate) Respondent Names for Provider Comment 

November 9, 2023: Deadline for Receipt of Provider Comments, due by 5:00 PM 

The reference number for the SMMC program ITN is AHCA (Agency for Health Care Administration) ITN 010-22/23.  

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

2023-10-20T12:20:48-04:00October 20, 2023|Florida|

Illinois

Effective October 1, 2023, due to the increased prevalence of Respiratory Syncytial Virus (RSV), providers may submit prior approval requests for Synagis (palivizumab). This applies to customers covered under Medicaid fee-for-service or a managed care plan. Providers should contact the appropriate managed care plan for approval guidance. For fee-for-service customers, providers must complete the Drug Authorization Request Form for Synagis and fax it to the Pharmacy Unit at 217-524-7264. Approval for the early dosing will be provided for those customers who meet the Department’s Synagis Prior Approval Criteria.  

For both fee-for-service and managed care customers, the approval period for the dose will be effective through February 29, 2024. The Department will continue to monitor for necessary changes. This is a temporary deviation from the usual Synagis guidelines, and the Department will continue to monitor RSV prevalence and respond accordingly. 

Questions regarding this notice may be directed to a pharmacy consultant in the Bureau of Professional and Ancillary Services at 877-782-5565, or to the appropriate managed care plan.  

Also in Illinois, the Department of Healthcare and Family Services (HFS) is notifying all pharmacies of billing instructions for the new commercial COVID-19 vaccines now in circulation. These instructions apply to the fee-for-service program only.  

As HFS is still finalizing programming for the administration fee for the COVID vaccine, pharmacies cannot use “MA” in the Professional Service Code Field, nor add the administration fee until the new programming is complete. Pharmacies can still provide COVID-19 vaccinations and submit claims to HFS for reimbursement for the cost of the vaccination plus a dispensing fee as they would for other vaccinations that do not pay an administration fee.  

Once the programming is complete, pharmacies can then void and rebill for services rendered to receive the full payment including the applicable administration fee.  

A provider notice will be sent to pharmacies once programming is complete and pharmacies can bill for the administration fee. The void and rebill process to receive full payment for claims that were submitted without receiving the administration fee can commence at that time.  

Questions regarding this notice may be directed to a pharmacy consultant in the Bureau of Professional and Ancillary Services at 877-782-5565. 

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

2023-10-20T12:19:49-04:00October 20, 2023|Illinois|

Iowa

The Department of Health and Human Services, Iowa Medicaid posted the following: 

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

2023-10-20T12:18:37-04:00October 20, 2023|Iowa|

Kansas

The Board of Pharmacy is reminding pharmacy technicians to act on the following items: 

  • Technician Registrations – Technicians unable to take or pass the PTCB (Pharmacy Technician Certification Board) or ExCPT certification exam by October 31, 2023, may request a six-month extension at least 30 days before the technician’s registration expiration date by completing a Technician Certification Extension Request Form (LA-75).  
  • Continuing Education (CE) – Technician registrations expiring October 31, 2023, must complete 20 hours of ACPE/Board approved CE between November 1, 2021 – October 31, 2023, before their renewal. 
  • Renewal – Technician licenses expiring October 31, 2023, can be renewed online. Failing to renew on or before 11:59 PM CST October 31, 2023, will result in the registration being cancelled. 

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

2023-10-20T12:18:02-04:00October 20, 2023|Kansas|

Louisiana

The Department of Health (LDH (Louisiana Department of Health)) Medicaid posted several new provider notices. 

 Also in Louisiana, the Single Pharmacy Benefits Manager (PBM) for Managed Care Organizations (MCO) original implementation of October 1 was postponed until October 28, 2023. Magellan Medicaid Administration Inc. will serve as the processor for all Medicaid MCO pharmacy for all six MCOs (Aetna, AmeriHealth Caritas, Healthy Blue, Humana Healthy Horizons, Louisiana Healthcare Connections and United Healthcare). Currently Magellan is only processing test claims. If you would like to submit test claims, please e-mail RxPharmacyTesting@magellanhealth.com your contact’s name, phone number, pharmacy National Provider Identifier and Switch information to receive the testing packet. 

Finally in Louisiana, two-term Attorney General Jeff Landry (R) triumphed in the Louisiana governor’s race in a crowded field with more than a dozen candidates. Landry flipped the seat to the GOP, receiving over 51% of the vote last Saturday in the state’s so-called “jungle primary” election where all the candidates in both parties are on the same ballot. Gov. John Bel Edwards (D) was termed limited and could not seek election to a third term. For those state legislative and statewide office races where no one received more 50% of the vote, the top two contenders will face off in the November 18 general election. 

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

2023-10-20T12:17:06-04:00October 20, 2023|Louisiana|

Maine

The Board of Pharmacy updated its rulemaking for pharmacists to administer vaccines, consistent with Public Law 2023 Chapter 170. On October 6, 2023, the Board issued Written Statement #01-2023 indicating that the Board does not believe rulemaking is necessary before an appropriately licensed and ADV-certified pharmacist is permitted to administer vaccines consistent with the above-stated authorizations.

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

2023-10-20T12:16:28-04:00October 20, 2023|Maine|

Massachusetts

On October 19, MassHealth updated a previous notice that outlined the upcoming discontinuation of brand Flovent products and several associated changes to MassHealth’s coverage of inhaled respiratory agents. To facilitate transition from Flovent products to alternative inhalers, MassHealth has removed the PA (prior authorization) requirement from Arnuity Ellipta (fluticasone furoate inhalation powder) earlier than anticipated. Claims for Arnuity Ellipta processed through the Pharmacy Online Processing System (POPS) will be paid without PA beginning October 19, 2023. The MassHealth Drug List will be updated to reflect this change in PA status on December 4, 2023. 

The previously approved emergency regulations for pharmacists prescribing hormonal contraceptives were not published in the Friday, October 13 register by the Massachusetts Secretary of State. The next publishing date will be October 27, at which time they are expected to be published and will become effective upon publication. In the meantime, the Board of Pharmacy is developing a circular letter which will deal with all the operations issues regarding these regulations, including training and the screening risk assessment tools. These regulations come straight from the law that was signed as part of the Fiscal Year 23 Annual State Budget.  

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

2023-10-20T12:15:49-04:00October 20, 2023|Massachusetts|

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