Maryland
The Senate Finance Committee will hold a hearing on SB 64, legislation that would allow pharmacists to prescribe post-exposure prophylaxis (PEP) for HIV prevention, on January 31. If any members wish to submit written testimony, please contact NACDS’ Jill McCormack.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Massachusetts
The Board of Pharmacy has approved draft sterile compounding regulations to conform with the new USP standards. These regulations will require a public hearing and comments and review by the Governor before they are finalized.
Also in Massachusetts, an APS (Automated Pharmacy Systems) that meets all the requirements of the policy, and having been approved by the Board, is considered an extension of the pharmacy's licensed area whether its location is contiguous or non-contiguous to the pharmacy. As a reminder, one of the policy's requirements is that the APS must be at the same physical address as the pharmacy. Please see the updated policy 2022-07 relative to Automated Pharmacy Systems.
For more information, please contact NACDS’ Ben Pearlman at 617-515-2603.
Montana
The Department of Public Health and Human Services posted the 2023 Naloxone Standing Order on its Opioids and Overdose website.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Nebraska
The Nebraska Department of Health and Human Services (DHHS) will launch a new iServe Nebraska portal on January 27 that will serve as an easy-to-use system for individuals to apply to get help with food, heat, electricity, healthcare, childcare, and other essential needs. Individuals may apply for a single benefit or more at the same time. Also, starting March 1, DHHS will review each Medicaid member’s current eligibility. Members who are no longer eligible for Medicaid will have their information forwarded to the federal marketplace for follow-up about other coverage options.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Ohio
The next payment for the Supplemental (managed care) dispensing fee (as pharmacy commonly refer to it) is scheduled to be paid to pharmacies between February 1-15. This is the first payment of the fee for 2023 and since the October 1 implementation of the SPBM. Under the SPBM, the payments will run as a special financial cycle and will appear on the non-Claim 835. You can identify these payments on your Remittance Advice by the reason code of 9638 – "QtrSuppDispFee." For more information, please see the FAQ ODM was issued this week. The supplemental fee expires in June 2023, as it was meant to be a stopgap to assist pharmacies while the SPBM system was being developed.
Also in Ohio, NACDS submitted a comment letter to the Common Sense Initiative (CSI) regarding the Board of Pharmacy's proposed rule that would allow pharmacy technicians to administer vaccines. The letter expresses pharmacy's strong support for the bill but asks that the CSI recommend that the Board remove the ratio for technician vaccinators and align the training requirement hours with the PREP Act.
Finally in Ohio, the Department of Medicaid posted Myers & Stauffer's 2022 Pharmacy Cost of Dispensing Survey report. NACDS is currently analyzing the report that found that the cost to dispense increased since 2022. They reported a weighted mean of $9.46 and a weighted median of $8.44 as the cost to dispense for non-specialty providers.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Pennsylvania
The General Assembly's joint Legislative Budget and Finance Committee (LBFC) finally released its study of Pharmaceutical Pricing in the Commonwealth's Medicaid managed care program this week. The study was mandated by the passage of HB 941 of 2021, legislation that required key reforms to PBM practices in the program. These included prohibiting clawbacks, increasing transparency and eliminating spread pricing. Though LBFC cited they had difficulty accessing key data, the report makes several recommendations to the General Assembly to tighten up current law, increase pricing transparency and enforce the requirement for the release of data. NACDS is working with the Pennsylvania Association of Chain Drug Stores (PACDS), the Pennsylvania Pharmacists Association and other allies to advocate for legislation to address these issues.
Also in Pennsylvania, the Board of Pharmacy released its January 31 meeting agenda. Please note they will be discussing the proposed Pharmacy Technician Rules.
Finally in Pennsylvania, Medicaid issued a Bulletin with updated billing instructions for the COVID-19 bivalent booster, and Magellan announced updates and enhancements to PACE/PACENET web portal, including its embedded software applications and tools.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
South Carolina
After evaluating utilization data and consulting with the state’s managed care organizations (MCOs), the provider community and other stakeholders, SCDHHS (South Carolina Department of Health and Human Services) is announcing updates to the policy changes it previously issued. The updates announced in this bulletin are specific to the temporary flexibilities that were created during the COVID-19 PHE (Public Health Emergency) and do not impact other agency policies that existed prior to the PHE unless specifically indicated. The changes announced today will take effect once the current federal PHE has expired. While the exact end-date is not yet known, providers are advised that the Secretary of the U.S. Department of Health and Human Services previously announced that the federal PHE will remain in effect until at least April 11.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Tennessee
The Division of TennCare invites you to our virtual Annual Feedback Session for the Episodes of Care Program on March 23. This Session is open to all stakeholders to share successes, ask questions and give feedback to improve program design. The entire session is anticipated to take approximately one hour; however, the session will conclude when all feedback is given. This is a free event, although registration is required. Click HERE to register.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Texas
Lt. Governor Dan Patrick announced the Senate Committee assignments this week.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Virginia
Two companion bills that would allow pharmacists to test and treat under a statewide Board of Pharmacy protocol have advanced in their respective chambers. HB 2274 is poised for a vote on the House floor and SB 948 passed the Senate unanimously. The bills add the authority for pharmacists to test and treat for Flu, Strep, COVID and UTIs to the existing ten conditions/therapies that pharmacist can currently treat. However, opposition from the medical community to the UTI provision drove 10 negative votes in the House Health, Welfare and Institutions Committee, with the bill just squeaking out of committee with 11 favorable votes. NACDS has been working closely with in-state partners and members to advance these practice advancements over the last several sessions and issued an RxImpact Alert this week encouraging outreach to House members prior to the upcoming floor vote.
Also in Virginia, the Board of Pharmacy published a reminder that pharmacists must obtain at least two (2) hours of continuing education (CE) in 2023 on the following subjects related to opioids: medications for opioid use disorder (OUD), including methadone, buprenorphine, naltrexone, naloxone or any other drug indicated for OUD. The CE must be obtained between January 1 and December 31. Inquiries may be directed to pharmbd@dhp.virginia.gov
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
West Virginia
HB 2754, legislation that would codify pharmacy immunization authority to match that of the PREP Act has advanced. HB 2754 deletes the prescription requirement for children’s vaccines and allows pharmacy technicians to immunize. The bill received swift committee approval, overwhelmingly passed the House (90-5) and has been referred to the Senate Health and Human Resources.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Wisconsin
The Department of Health Services announced February 2023 will be the last month families will receive extra benefits in the state’s FoodShare program as a result of enactment of Consolidated Appropriations Act, 2023, passed by the U.S. Congress in late December. This act ends a federal program that has been providing additional benefits to households enrolled in the FoodShare program.
For more information, please contact NACDS’ Ben Pearlman at 617-515-2603.
Alabama
The Alabama Medicaid Agency has removed the requirement of absence of alcohol and illicit drug use by recipients for the prior approval of antiviral drugs used in the treatment of hepatitis C. A copy of the patient's drug and alcohol screening lab report is no longer required. All other criteria remain, including the patient consent form with the patient's and physician's signature, which must be submitted with requests.
The updated Prior Authorization (PA) request form and criteria booklet should be utilized by the prescriber or the dispensing pharmacy when requesting a PA. Updated forms and criteria can be found here.
Also in Alabama, the Alabama Department of Public Health (ADPH) Pharmacy Division is asking that you complete the following ReadyOp survey if you are unable to obtain oseltamivir (Tamiflu) for your patients due to drug shortages or supply issues. The information provided through this survey will enable ADPH to assess potential oseltamivir shortages quickly and respond appropriately.
The link will remain open until June 1, 2023. Questions should be directed to pharmacy@adph.state.al.us.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Arizona
NACDS, along with the Arizona Independent Pharmacy Coalition and American Pharmacies, sponsored “Putting Patients Before Profits in Healthcare.” The breakfast briefing for state legislators and staff provided information about how PBMs currently operate in the marketplace and the adverse impacts these practices are having on patients, prescribers, and pharmacies.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Arkansas
The legislature convened on January 9, 2023. HB (House Bill) 1007 was a prefile. The bill would expand a pharmacist's authority to prescribe HIV pre- and post-exposure prophylaxis (PrEP/PEP) under a statewide protocol.
Also in Arkansas, the Department of Human Services posted pharmacy billing Medicaid copay changes and exemptions effective January 1, 2023.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
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.
- How to Prepare for Retirement of the Transition Policy (January 12)
- Drug Use Review (DUR) Alert System Issue: Additive Toxicity (AT) (January 9)
- Medi-Cal Rx Weekly Wrap-Up for December 29-January 5 (January 6)
- Reminder: Drugs Supplied to Nursing Facilities (January 6)
- Reinstatement Spotlight (January 6)
- Medical Supplies: Updates to the List of Covered Disposable Insulin Delivery Devices (January 4)
- Now Active – Cal MediConnect Transition to Medicare MediCal Plans (January 1)
- Medi-Cal Rx Monthly Bulletin for January (January 1)
- Changes to the Contract Drugs List (CDL) (January 1)
- Changes to the Contract Drugs List (CDL) – Authorized Drug Manufacturer Labeler Codes (January 1)
- Changes to the Contract Drugs List (CDL) – Over-the-Counter Drugs (January 1)
- Changes to the Pharmacy Reimbursable Physician Administered Drugs (January 1)
- Updates to the Medi-Cal Rx Provider Manual (January 1)
- Bebtelovimab No Longer Authorized to Treat COVID-19 (December 30)
- Reinstatement Spotlight (December 30)
- Reinstatement Spotlight (December 23)
- Medical Rx Weekly Wrap-Up for December 16-22 (December 23)
- Monkeypox Vaccine as a Family PACT Pharmacy Benefit (December 21)
- 90-Day Countdown – Phase III: Retirement of the Transition Policy for Beneficiaries 22 Years of Age and Older (December 20)
- 30-Day Countdown – Reinstatement of Prior Authorization Requirements for 39 Drug Classes (December 20)
- Medi-Cal Rx IVR Enhancement to Enable Additional Self-Service Option! (December 20)
- Reinstatement Spotlight (December 16)
- Two-Week Countdown – Cal MediConnect Transition to Medicare MediCal Plans (December 16)
- Medi-Cal Rx Weekly Wrap-Up for December 9-15 (December 16)
Also in California, Medi-Cal posted the following:
- Telehealth Flexibilities and Revisions to the Telehealth Provider Manual (January 6)
- 2023 HCPCS Quarter 1 Update (December 30)
- Bebtelovimab No Longer Authorized to Treat COVID-19 (December 27)
- TAR [Treatment Authorization Request] Requirement Removal and FDA Approvals for Veklury ® (December 23)
- Coming Soon: Expanded Use of Bivalent Dosages Approved for Children 6 Months and Up (December 20)
- Medi-Cal News: National Correct Coding Initiative Quarterly Update for January 2023 (December 16)
- December 2022 Durable Medical Equipment and Medical Supplies Medi-Cal Update Bulletin (December 16)
- December 2022 Pharmacy Medi-Cal Update Bulletin (December 16)
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Colorado
The legislature convened on January 9, 2023.
Also in Colorado, the Department of Health Care Policy and Financing (HCPF) is hosting an informational session on preparing for the end of the Public Health Emergency. This online seminar is geared toward community partners such as advocacy organizations, providers and community organizations that may provide other assistance to Health First Colorado (Medicaid) or CHP+ members. Register in advance for the January 25 online seminar scheduled from 1:00 pm to 2:30 pm MST.
Finally in Colorado, Prescription Drug Affordability Board established under SB21-175 is currently evaluating draft rules for the Upper Payment Limits.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Florida
This week, Governor Ron DeSantis held a press conference at the Villages to outline proposed legislation that would target pharmacy benefit managers to try to lower prescription-drug costs in the state. NACDS President and CEO Steven C. Anderson released the following statement after the press conference.
Finally in Florida, all Medicaid Fee-For-Service claims submitted January 1, 2023, or after from a non-exempt provider type that does not have a ROPA [Referring, Ordering, Prescribing, and Attending] provider listed on the claim will be denied. The exempted provider types that will not require a ROPA on the claim are listed here, all other provider type claims must have a ROPA provider identified by NPI (National Provider Identifier) on the claim for reimbursement by Medicaid.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Illinois
The Illinois Department of Labor ("IDOL") recently issued the new 2023 "Your Rights Under Illinois Employment Laws" poster that ALL ILLINOIS EMPLOYERS are required to post in a conspicuous place in the workplace, where notices are customarily posted. See the links here. The poster includes information related to the Wage Payment and Collection Act, Child Labor Law, Minimum Wage Law, Equal Pay Act, Victims' Economic Security and Safety Act and the One Day Rest in Seven Act ("ODRISA").
Importantly, the ODRISA amendments that went into effect on January 1, 2023, require not only posting in the workplace, but also, for employees who do not regularly report to a physical workplace, and instead work remotely or travel for work, the poster must be provided to them via email or uploaded onto the employer's website. The ODRISA amendments also now include civil penalties for failure to comply with the ODRISA, including the posting requirements. Employers who fail to comply with the posting requirements will be subject to a civil penalty not to exceed $250, payable to the IDOL.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Indiana
The legislature convened on January 10, 2023. Several bills of interest to pharmacies have been filed, including several different bills that will allow pharmacists to prescribe hormonal contraceptives – SB (Senate Bill) 153 & SB 206, and HB 1224. Test and Treat, HB 1182, requires the state health commissioner to issue a standing order for pharmacists to treat or screen, test, administer or dispense for respiratory illness including influenza, severe SARS-CoV-2, and RSV (Respiratory Syncytial Virus); group A strep; lice; minor skin conditions; and emerging or existing public health threats identified by the state health commissioner. Also filed was SB 214, legislation that would establish a standing order for pharmacists to prescribe naloxone.
Also in Indiana, all are welcome to participate at the Indiana Pharmacists Association's (IPA) annual Legislative Day at the Indiana State House starting at 9:30 am on January 24. This event will allow all pharmacists, pharmacy students and pharmacy technicians from all practice settings to connect with legislators and colleagues across the state. Register here before January 19.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Iowa
The Iowa Insurance Division adopted and filed emergency rules (ARC 6739C), effective January 1, 2023, to implement changes made in 2022 Iowa Acts, House File 2384, regarding pharmacy benefits managers.
Also in Iowa, NACDS submitted a letter to the Iowa Insurance Division expressing appreciation for proposed rule changes (ARC 6740C) to Chapter 59, "Pharmacy Benefit Managers" ("PBMs") in accordance with 2022 Iowa Acts, House File 2384, and urging the necessary enforcement of included provisions to further the state's efforts on PBM reform and transparency. In particular, NACDS stated its support for language preventing PBMs from retroactively adjusting reimbursement of a clean claim paid to a pharmacy. Lastly, NACDS urged legislators and regulators to take additional action to help ensure pharmacies are fairly and adequately reimbursed with the ability to appeal below-cost reimbursement through the establishment of a maximum allowable cost appeals process.
Finally in Iowa, the Board of Pharmacy published its December 2022 newsletter including the following articles/updates: discontinuation of printed license and registration certificates, reminder for licensees to maintain current contact information, compounding records rule update, pharmacy's social media presence, electronic perpetual inventory logs, care facility documentation of immunizations, licensure of outsourcing facilities update, Narcan® and disposal programs, hard copy prescriptions during prescriber technical difficulties, Schedule II prescription annotations and 2023 board meeting schedule.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Kentucky
The Board of Pharmacy held a "special called" meeting on January 4 where they withdrew a new regulation and proposed rule amendments regarding out-of-state pharmacies. The rules would have created a new non-resident pharmacist license requirement for out-of-state pharmacists and stricter requirements for an out-of-state pharmacy to acquire a non-resident pharmacy permit. At the meeting, it was stated that the withdrawal was due to the voluminous number of public comments they received.
Following this, two Senate bills were introduced last week:
- SB 36 would reorganize the Board of Pharmacy to assign seats to different practice settings and make appointments subject to Senate confirmation.
- SB 37 would prohibit an out-of-state pharmacy permit holder from being required to have their pharmacists licensed, except for the Pharmacist in Charge (PIC).
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Louisiana
Effective January 1, 2023, the Louisiana Medicaid Pharmacy Program expanded to include a sixth managed care organization (MCO), Humana Healthy Horizons. For more information on verifying eligibility and processing claims, go to Pharmacy Facts.
Also in Louisiana, effective January 1, 2023, Medicaid Fee-for-Service (FFS) Pharmacy Program and Managed Care Organizations (MCOs), will implement a point of sale dispensing of contraceptives allowing a 6-month supply when the recipient has a previous history of contraceptive agents. The allowance applies to pharmacy claims submitted to FFS and MCOs (Aetna, AmeriHealth Caritas, Healthy Blue, Humana Healthy Horizons, Louisiana Healthcare Connections and UnitedHealthcare).
Finally in Louisiana, the 2023 Naloxone standing order was updated effective January 1, 2023
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Massachusetts
Please see these updated Provider Bulletins here (2022) and here (2023) regarding Coverage and Reimbursement Policy for Coronavirus Disease 2019 (COVID-19) Bivalent Vaccine Doses and Pre-exposure Prophylaxis, Extension of Flexibilities for Prior Authorization of Formula, Pediatric Immunization Vaccine / Administration SL Modifier Change and Managed Care Entity Bulletin 95: Access to Health Services through Telehealth Options for Members Enrolled in Managed Care Entities. To view and download other MassHealth publications visit Provider Publications.
Also in Massachusetts, on January 11, 2023, the Massachusetts Public Health Council approved redrafted regulations at 105 CMR 700.00 which will authorize pharmacy technicians to administer influenza and other immunizations as designated by the Department of Public Health. Regulations also reduce the age of persons from 9 to 5 who may receive a vaccination at a pharmacy. DPH also adopted an amendment that will allow a pharmacist to administer the first dose of a controlled substance for the treatment of mental health and substance abuse disorders. These regulations are expected to be published in the next two weeks.
Also in Massachusetts, regarding Long Term Care Facilities and Pharmacies, 105 CMR 721.070(A)(11) provides an exception to the e-prescribing mandate for prescriptions written for long term care (LTC) residents. This exception was set to expire on January 1, 2023, or such later date as determined by the Department. Considering the Centers for Medicaid and Medicare Services (CMS) extending, from January 1, 2023, to January 1, 2025, its implementation of the requirement to e-prescribe Medicare prescriptions in LTC facilities, the Department will follow suit and hereby extends, until January 1, 2025, the exception for prescriptions issued to LTC resident under 105 CMR 721.070(A)(11). Those LTC facilities with e-prescribing in place are encouraged to continue using it.
Please see 105 CMR 721 (mass.gov) and accompanying 2019 ePrescribing Manual for details.
Finally in Massachusetts, while Amoxicillin Oral Powder for Suspension remains on the FDA drug shortage list, Board-licensed pharmacies may compound this product from solid oral dosage forms provided that the FDA guidance on compounding beta-lactam products in shortage is followed to mitigate the potential risk of cross-contamination.
Once the shortage has resolved, use of commercial products must resume.
Please review the Board's Policy on Compounding Copies of Commercially Available Drugs.
For more information, please contact NACDS’ Ben Pearlman at 617-515-2603.
Michigan
NACDS reminds members that pharmacists can prescribe self-administered hormonal birth control under delegated authority, including oral contraceptives, the patch, and the ring, by opting into the program. The change happened under an interpretive statement issued by the state's Licensing and Regulatory Affairs Department (LARA) under direction of a previous executive directive 2022-05 issued by Gov. Gretchen Whitmer (D) in May of 2021. Pharmacists must enter into a delegation agreement; a sample delegation agreement is available on LARA's website. The governor's executive directive in May instructed state departments and agencies to identify and assess opportunities to increase protections for reproductive health care.
Also in Michigan, on October 3, LARA issued a notice that the state will formally begin enforcing Michigan's 2020 e-prescribing law on January 1, 2023. Though the law was originally to take effect in 2021, it included a provision allowing Bureau of Professional Licensing to delay enforcement until the federal Centers for Medicaid and Medicare (CMS) began enforcing the mandate on Part D prescription drug programs. LARA also released an Application for waiver of electronic prescribing requirements form for prescribers and posted an FAQ document. Note that pharmacists are not required to verify that a prescriber qualifies for a waiver when filling paper prescriptions.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.