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.
Indiana
The Family and Social Services Administration (FSSA) posted several bulletins of interest to pharmacies.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Iowa
The Board of Pharmacy announced the following effective March 15:
- ARC 6843C has been adopted and amends Chapter 10, "Controlled Substances" placing one substance into Schedule I of the Iowa Controlled Substances Act (CSA) in alignment with .
- ARC 6844C has been adopted and amends Chapter 37, "Iowa Prescription Monitoring Program" establishing council membership information for the PMP Advisory Council and clarifying that only overdoes-reversal opioid antagonists are required to be submitted to the PMP.
Also in Iowa, the Board of Pharmacy issued a "Notice of Intended Action" related to ARC 6874C amending Chapter 10, "Controlled Substances," and Chapter 12, "Precursor Substances." This proposed rulemaking temporarily adds four substances to Schedule I, excludes one substance from Schedule II and adds one substance as a precursor substance to the Iowa CSA in alignment with response to similar action taken by the DEA ARC 6874C amending Chapter 10, "Controlled Substances," and Chapter 12, "Precursor Substances." This proposed rulemaking temporarily adds four substances to Schedule I, excludes one substance from Schedule II and adds one substance as a precursor substance to the Iowa CSA in alignment with DEA's action. Comments may be submitted until 4:30 p.m. on February 28.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Louisiana
The Department of Health (LDH) announced that they now plan to migrate Medicaid to a single payor system on October 1. All patients will be assigned to a managed care organization and will receive a new universal prescription benefit card.
Also in Louisiana, the Board of Pharmacy met on February 15 & 16.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Massachusetts
MassHealth, the state Medicaid agency, is asking pharmacies to post this flier for notice to recipients of the planned redetermination of all MassHealth beneficiaries that will begin on April 1. One half million Massachusetts residents were added to MassHealth under the PREP Act and individuals may lose their MassHealth coverage and be moved to other state sponsored or commercial health plans.
For more information, please contact NACDS’ Mike Sargent at 207-272-6435.
Missouri
The revised 2023 Pharmacy Practice Guide is available on the Board's website. It contains updated compliance tips and information on recent statutory/rule changes, including:
- Pharmacy Working Conditions
- Technician Supervision & Expanded Technician Activities
- Electronic Final Product Verification (Pharmacists)
- Technology-Assisted Product Verification (Interns & Technicians), &
- Quality Assurance
Also in Missouri, the Department of Health and Senior Services recently issued a revised naloxone standing order.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Montana
HB 379, extending the prohibition on PBMs to require federally certified health entities to identify 340B drug from June 1, 2023 to June 1, 2025, was amended and passed the House Business and Labor Committee on February 14.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Nebraska
The Department of Health and Human Services (DHHS) issued Bulletin 23-04: Nebraska Medicaid Managed Care Contracts 2024. Contracts between DHHS and Molina Healthcare of Nebraska, Nebraska Total Care and United Healthcare have been signed and these organizations will prepare to provide services under the new contract beginning January 1, 2024.
Also in Nebraska, DHHS posted the draft minutes from the November 15, 2022, Drug Utilization Review Board meeting.
Finally in Nebraska, LB 778, amending the Pharmacy Benefit Manager Licensure and Regulation Act, has been scheduled for a hearing on March 21.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
New York
On February 15, the Department of Financial Services published a proposed rule regarding General Duties, Accountability and Transparency Provisions for Pharmacy Benefit Managers. The proposed rule sets forth to clarify, define and limit the duties, obligations, requirements and other provisions relating to pharmacy benefit managers under Public Health Law section 280-a(2) and provides a safe harbor provision for compliance with the regulation. It also defines, limits and clarifies the requirements for pharmacy benefit managers to provide an accounting to health plans and sets forth the terms and conditions of contract relating to pharmacy benefit management services provided to health plans by the pharmacy benefit managers, including provisions related to an appeal to the bureau for a determination on disclosure.
On February 13, NACDS participated in the Community Pharmacy Association of New York State lobby day. NACDS joined with members to advocate for Gov. Kathy Hochul's (D) budget proposal, including the Medicaid Fee-for-Service transition effective on April 1.
For more information, please contact NACDS’ Mike Sargent at 207-272-6435.
North Dakota
SB 2031, designing and implementing a prescription drug reference rate pilot program to study the possibility of controlling excessive prices for prescription drugs, failed in the Senate (14-33).
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Ohio
ODM (Ohio Department of Medicaid) Director Maureen Corcoran announced a proposed 5.7% increase in the Professional Dispensing Fee (PDF) for the SPBM (Single PBM) pharmacy program as part of the biennial state budget. The percentage as proposed would be applied to all three PDF tiers. NACDS has been advocating for an increase since the September announcement of the PDFs for the SPBM The budget also includes an opportunity for pharmacies to enhance PDFs through a outcomes-based incentive payment. No further details are available upon this writing, but NACDS expects to have them soon.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Oregon
The Oregon Board of Pharmacy adopted the following Temporary Rule, effective February 10.
- Division 020 – related to Protocols for COVID-19 Monoclonal Antibody & COVID-19 Antiviral - Effective February 10.
The Emergency Use Authorization (EUA) for each product has been updated. The updated EUA for Paxlovid now differs from the approved statewide drug therapy management protocol which necessitates the protocol's suspension. REGEN-COV is not authorized for use in any US region which also necessitates this protocol's suspension.
- COVID-19 Monoclonal Antibody- REGEN-COV. EUA updated 1/24/2022. REGEN-COV (casirivimab and imdevimab) is not currently authorized in any U.S. region due to the high frequency of circulating SARS-CoV-2 variants that are non-susceptible to REGEN-COV. Therefore, REGEN-COV may not be administered for treatment of COVID-19 under the Emergency Use Authorization until further notice by the FDA.
- COVID-19 Antiviral- Paxlovid. EUA updated 2/1/2023. The U.S. Food and Drug Administration has issued an EUA for the emergency use of PAXLOVID for the treatment of adults and pediatric patients (12 years of age and older weighing at least 40 kg) with a current diagnosis of mild-to-moderate coronavirus disease 2019 (COVID-19) and who are at high risk for progression to severe COVID-19, including hospitalization or death.
Temporarily suspends the statewide drug therapy management protocols for COVID-19 Monoclonal Antibody and COVID-19 Antiviral due to:
- COVID-19 Monoclonal Antibody- REGEN-COV. REGEN-COV (casirivimab and imdevimab) is not currently authorized in any U.S. region.
- COVID-19 Antiviral- Paxlovid. Under Oregon state laws, pharmacists cannot diagnose. The current Paxlovid EUA requires a diagnosis to prescribe Paxlovid, which is not required in the Board's Paxlovid protocol (based on the EUA dated 10/27/2022) and appears to be preempted by federal law.
The FDA has stated that EUAs preempt any differing requirements under states' laws. As a result, the Oregon Board of Pharmacy will not take disciplinary action against persons who act in accordance an EUA, as a result of the FDA's position that state law is preempted. If a complaint is received relating to activities covered under an EUA, the Board will expect the licensee to provide documentation of full compliance with the EUA. Failure to do so may result in disciplinary action.
Also in Oregon, the Board of Pharmacy permanently adopted the following rules at the February 2023 Board Meeting:
- Divisions 019/041 related to Safe Pharmacy Practice Conditions: RPH Autonomy, Outlet Requirements – Effective February 14
- Division 110 related to Pharmacy Prescription Kiosk (PPK) Registration Fee – Effective February 15
- Division 019 related to Definitions – Effective February 14
Also in Oregon, the Board of Pharmacy is seeking subject matter experts (SMEs), including pharmacists, to serve on the Public Health & Pharmacy Formulary Advisory Committee (PHPFAC). The board utilizes SMEs to develop and revised protocols in the Protocol Compendium. If you would like to serve as a SME for the PHPFAC please complete the online form by March 1. Individuals selected will receive confirmation by March 15. Email SME related inquiries to pharmacy.formulary@bop.oregon.gov.
Also in Oregon, the Board of Pharmacy posted the agenda for the Compounding Workgroup meeting on February 21.
Also in Oregon, the Board of Pharmacy posted the agenda for the Interns Workgroup meeting on February 22.
Finally in Oregon, the Oregon Health Authority (OHA) will resume health coverage renewals on April 1 for Oregon Health Plan (OHP) members. OHA is required to review eligibility for all 1.47 million OHP members by June 2024. Anyone who no longer qualifies for OHP coverage still have affordable health coverage options. The Oregon Health Insurance Marketplace (OHIM) will send information to people who are no longer eligible for OHP benefits and advise of potential coverage options and financial help through the Marketplace. The Marketplace Transition Help Center will help people understand their options, how to transition to the Marketplace, and to find help from local health coverage experts.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
South Dakota
HB 1135, legislation related to PBMs and transparency in the pricing of prescription drugs, passed the House (62-5) on February 13. It was referred to the Senate and Health and Human Services Committee.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Tennessee
TPA [Tennessee Pharmacists Association] will offer Mental Health First Aid training to 25 attendees at the TPA Winter Meeting, held in Nashville on February 26–27. Space is limited. Register Today!
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Texas
Register TODAY to participate at the 2023 Texas Pharmacy Day at the Capitol on February 28.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Utah
On March 1, the Department of Workforce Services (DWS) will begin to review all Medicaid cases over the next 12-month unwinding period of continuous eligibility/coverage.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.