In The States – Page 73 – Weekly news about states

Montana

The Department of Public Health and Human Services (DPHHS) has received calls regarding denials and prior authorization requirements on stimulants due to the shortages. Many of these can be handled by the pharmacy by calling the prior authorization (PA) call center at 1-800-395-7961. Please try the PA call center before involving the provider or turning the patient away. The DPHHS is approving short term prior authorization to mitigate some of the issues caused by these shortages. If you have questions, please contact Dani Feist, Pharmacy and Home Infusion Program Officer at 406–444–2738.

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

Michael Silber2023-10-20T12:15:15-04:00October 20, 2023|Montana|

Nebraska

The Department of Health and Human Services issued Provider Bulletin 23-26 announcing changes to the Coverage and Payment of Adult Vaccines effective October 1, 2023.

Also in Nebraska, the Department of Health and Human Services announced the next COVID-19 Provider call will be held on November 1 at noon (Central); see details below to join the call. Also, the recording from October 4 COVID-19 Provider call has been posted.

Join from the meeting link:
https://sonvideo.webex.com/sonvideo/j.php?MTID=mc307e2dda218d1060adfed7f454cfc16

Join by phone:
408-418-9388 (access code: 2480 661 3098)

Also in Nebraska, the Department of Health and Human Services posted the 471-000-540 Medicaid Practitioners Fee Schedule for Injectables (October 1, 2023).

Also in Nebraska, the Department of Health and Human Services posted the draft minutes from the September 12 Drug Utilization Review (DUR) Board Meeting. The next DUR Board Meeting will be held on November 14.

Also in Nebraska, the Department of Health and Human Services launched the iServe Nebraska Portal’s new integrated benefit application that will make it easier for Nebraskans to apply for Medicaid and Economic Assistance benefit programs. Nebraskans can apply for benefits such as food, heat, electricity, healthcare, childcare, and other essential needs at the same time using the single, online iServe Nebraska application.

Also in Nebraska, Gov. Jim Pillen (R) approved emergency regulations related to the Let Them Grow Act. Please note the requirements for picking up prescribed medications from a pharmacy. For both puberty blocking drug prescriptions and cross-sex hormone prescriptions for a patient who has not reached the age of majority, these prescribed medications picked up from a pharmacy are required to be picked up by the patient’s parent, legal guardian, or the patient if the patient is an emancipated minor. Additionally, these prescriptions must identify the drugs being prescribed are for the treatment of gender nonconformity or gender dysphoria. The process to implement final regulations for LB 574 will proceed pursuant to the Administrative Procedure Act. The anticipated public hearing date is November 28; a draft of the proposed final regulations will be posted at least 30 days prior to that hearing.

Finally in Nebraska, the Department of Health and Human Services (DHHS) released the final draft of regulations for the Let Them Grow Act. A public hearing will be held on November 28 from 7:00 AM to 7:00 PM at the Lancaster Event Center – Lincoln Room at 4100 N 84th St., Lincoln, NE 68507. People interested are encouraged to provide written comments via mail, fax, or email, no later than 11:59 PM on the day of the hearing. Comments may be faxed to 402-742-2382, emailed to dhhs.regulations@nebraska.gov or mailed to: DHHS Legal Services, PO Box 95026, Lincoln NE 68509-5026. Additional information can be found on the Frequently Asked Questions page on the DHHS website.

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

Michael Silber2023-10-20T12:14:44-04:00October 20, 2023|Nebraska|

New York

NACDS submitted a comment letter in support of the Proposed Rule published in the State Register by the Department of Financial Services on August 16, 2023, related to Definitions, Licensing of Pharmacy Benefit Managers (PBMs), Contracting with Network Pharmacies, Acquisition of PBMs, Consumer Protections and Audits

The Department of Health (NYSDOH (New York State Department of Health)) reported an update to the State Plan Amendment (SPA) allowing reimbursement for Medicaid covered professional services included within the pharmacist / pharmacy intern scope of practice and provided by a pharmacist / intern. For instance, once the new law on oral contraception is effective, this will apply to pharmacists dispensed oral contraception. Also, according to NYSDOH, the reimbursement will be provided to pharmacies, not to pharmacists per the New York SPA 23-0037: “This amendment proposes to allow pharmacists and pharmacy interns to provide Medicaid covered services to the limits of their scope of practice. We conducted our review of your submittal according to statutory requirements in Title XIX of the Social Security Act. This letter is to inform you that New York Medicaid SPA 23-0037 was approved on August 24, 2023, with an effective date of April 1, 2023.”

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

Michael Silber2023-10-20T12:13:48-04:00October 20, 2023|New York|

North Carolina

IMMUNIZING PHARMACISTS’ AUTHORITY TO ADMINISTER COVID-19 AND FLU VACCINES TO PEDIATRIC PATIENTS. With flu and COVID vaccine season upon us, several pharmacists have reached out to Board staff about immunizing pharmacist authority to administer flu and COVID vaccine to pediatric patients. With all the recent changes to North Carolina law and PREP (Public Readiness and Emergency Preparedness) Act declarations, it can be confusing. Here is the skinny on flu and COVID vaccine authority:

PREP Act declarations authorizing pharmacists to administer flu and COVID vaccine to patients aged 3 years and older are still in effect and will be until December 31, 2024.

State law now allows immunizing pharmacists to administer flu and COVID vaccine to patients aged 7 years and older pursuant to protocol and parental permission. State law allows immunizing pharmacists to administer any ACIP-recommended vaccine to patients 6 and older pursuant to prescription and parental permission.

So, for flu and COVID – immunizing pharmacists can administer to patients 3 years and older and can do that under their own authority under the PREP Act. Immunizing pharmacists can also use Dr. Tilson’s statewide standing order to do this for COVID vaccine (which typically makes billing and recordkeeping easier). These paths are available until December 31, 2024.

After December 31, 2024, immunizing pharmacists can administer flu and COVID vaccine pursuant to protocol, but only to patients aged 7 years or older, or pursuant to prescription for patients aged 6 years or older.

For a comprehensive overview of immunizing pharmacist authority, see the FAQ guidance.

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

Michael Silber2023-10-20T12:13:13-04:00October 20, 2023|North Carolina|

Oklahoma

Effective September 1, 2023, pharmacy technicians may administer any vaccine that is approved or licensed by Food and Drug Administration (FDA) if they have successfully completed an Accreditation Council for Pharmacy Education (ACPE)-accredited training program and have current CPR (cardiopulmonary resuscitation) certification. Also, the pharmacy technician must complete one hour of immunization-related ACPE-accredited or Oklahoma State Board of Pharmacy-approved continuing education every year.

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

Michael Silber2023-10-20T12:12:33-04:00October 20, 2023|Oklahoma|

Oregon

The Board of Pharmacy permanently adopted the following rules at the October 2023 Board Meeting effective October 17, 2023, unless otherwise noted: 

Also in Oregon, the Board of Pharmacy announced the agency’s new director, Jamal Fox. Fox has more than 20 years of experience in the public and private sectors. Fox will start his new role with the agency beginning October 25.

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

Michael Silber2023-10-20T12:11:56-04:00October 20, 2023|Oregon|

Rhode Island

Please see the most recent Provider Update for Medicaid. All provider updates may also be found here.

Also in Rhode Island, effective October 1, 2023, Katie Beckett recipients will now be enrolled in a managed care organization for Case Management Services only. Case Management services are provided by CEDARR Center Providers. All other services will still be reimbursed through Medicaid fee for service.

When checking eligibility on the Healthcare Portal (HCP) you will see the following (see sample picture below):

A new row under Benefit Plan Details – Katie Beckett Case Management
A new row under Managed Care Details – Displays the name and dates of the Managed Care Plan the recipient is enrolled in.

If you are a CEDARR provider and the recipient is enrolled in the Katie Beckett case management program, then you must bill your services to the managed care plan on file. All other providers will continue to bill Medicaid Fee for Service.

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

Michael Silber2023-10-20T12:11:10-04:00October 20, 2023|Rhode Island|

South Dakota

The Board of Pharmacy posted their October 2023 Newsletter including the following sections:

South Dakota Board Welcomes Newly Registered Pharmacists and Pharmacies
DSCSA (Drug Supply Chain Security Act) Interoperability Standards Delayed Until November 2024
USP Compounding Chapters Update
Does a Pharmacy Need to be Licensed to Ship Medications to Other States?
The Board Has a New Website
The Board Will Propose a Bill to Increase License Fees in the 2024 Session
DEA (Drug Enforcement Administration) Issues Multiple Guidance Documents in Recent Months
PDMP (Prescription Drug Monitoring Program) Update
Board Meeting Dates, Board of Pharmacy Members and Board of Pharmacy Staff Directory

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

Michael Silber2023-10-20T12:10:19-04:00October 20, 2023|South Dakota|

Tennessee

To assist prescribers and providers, prior authorization (PA) requirements can be bypassed for certain medications when specific medical conditions exist. Those specific medications and diagnoses can be found here. Prescribers are encouraged to include the applicable diagnosis code on written prescriptions for inclusion on the electronic pharmacy claim. The submitted claim should include a Diagnosis Code Qualifier (Field # 492-WE) of “02,” indicating ICD-10, as well as the appropriate Diagnosis Code (Field # 424-DO).

If you have any questions, contact the OptumRx Pharmacy Supports Center at 866-434-5520 or tnrxeducation@optum.com.

Also in Tennessee, the October 31 Drug Utilization Committee (DUR) Board meeting will be held virtually via Microsoft Teams. Please Click Here or Phone number: +1 952-222-7450 Phone Conference ID: 857 579 147#

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

Michael Silber2023-10-20T12:09:45-04:00October 20, 2023|Tennessee|