Missouri
The legislature convened on January 4, 2023. Several PBM reform bills have been filed, including SB 402/HB 198 and SB 26/HB 197. Also filed were two bills expanding the Pharmacy Practice Act related to the administration of medication by pharmacist including HB 331 and SB 41.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
New York
On January 17, from 1:00 p.m. – 3:00 pm, the Department of Health (DOH) is hosting the next in its series of monthly stakeholder informational webinars about the transition of the pharmacy benefit from Medicaid Managed Care to Medicaid Fee for Service (NYRx). Registration is required in order to access the meeting links. Presentations from past meetings are available on the transition website.
Also in New York, the DOH issued an update to the Medicaid Fee for Service Program "Dispense Brand Name Drug When Less Expensive Than Generic" list effective January 19. Additionally, DOH published an updated standing order for Naloxone under the signature of Dr. Sharon Stancliff.
Finally in New York, as 2022 ended, Gov. Kathy Hochul (D) signed several bills important to pharmacy practice into law, including:
- S4870B authorizing pharmacists to administer certain long acting injectables (Note: rules will need to be promulgated and a new bill for 2023 with minor technical changes to the law has been agreed to.)
- A7469 allows for 30-day emergency refills
- A187 permits pro-rated cost sharing on short fills and maintains the full dispensing fee to enable medication synchronization in the state's Medicaid program
For more information, please contact NACDS’ Ben Pearlman at 617-515-2603.
Montana
LC 1633, related to 340B, was a prefile for the 2023 state legislative session. As drafted, PBMs or health insurers may not:
- Prohibit federally certified health entities or pharmacies from participating in the insurer's network;
- Reimburse a federally certified health entity or pharmacy differently than reimbursing other similarly situated pharmacies;
- Require a claim or a drug to include a modifier to indicate that the drug is a 340B drug, unless the claim is for Medicaid payment; or
- Create restrictions or impose additional charges on patients who choose to receive drugs from a federally certified health entity or pharmacy
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
North Carolina
This is advance notice of reprocessing information that will be sent to affected providers on or about January 17. Due to a system error with the generic dispensing fee, pharmacy claims were paid incorrectly. The affected claims will be reprocessed to apply the correct rate. This reprocessing notice applies to pharmacy claims that were processed and paid in NCTracks from November 1, 2013, through April 7, 2014. The affected claims will be systematically reprocessed as adjustments. No provider action is required. Applicable claims will be reprocessed in the February 7 check write. For more information, visit NCTracks here.
For more information, contact NACDS' Leigh Knotts at 803-243-7207.
Ohio: The Ohio Department of Medicaid (ODM) and Gainwell Technologies, the Single Pharmacy Benefit Manager, are continuing the re-implementation of prior authorizations (PA) based on specific drug classes. Of note, the PA reimplementation only applies to new, initial authorizations, and does not apply to those patients who have previously taken the drug supported by recent claims history prior to January 17. Phase 2 of reimplementation will begin on January 17 and encompass the following drug classes:
- Specialty Medications (PA Fillable Forms)
- Hepatitis C Medications (Hepatitis PA Fillable Form)
- Opioid Medications (Opioid PA Fillable Form)
Please reference the Unified Preferred Drug List (UPDL) posted on the SPBM portal to see the products that require prior authorization. Prior authorizations may be submitted via phone, fax, mail and the SPBM portal. Additional prior authorizations are planned for reimplementation in a similar, incremental fashion during the first quarter of 2023. For questions, contact the Gainwell Help Desk at 1-833-491-0344.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Pennsylvania
Gov.-elect Josh Shapiro (D) has named Valerie Arkoosh, an anesthesiologist and chair of the Montgomery County Commissioners, as his Secretary of the Department of Human Services. Arkoosh led her county's response in the early days of the coronavirus pandemic, which elevated her to the spotlight as Montgomery County was in the epicenter of the virus' spread. She also has been a professor of anesthesiology and obstetrics and pitched an unsuccessful run for Congress in 2014 before being re-elected to the County Commission. He also named:
- Secretary of Health: Debra Bogen, a pediatrician, and the director of the Allegheny County Health Department.
- Secretary of Drugs and Alcohol: Latika Davis-Jones, senior director of behavioral health at Highmark Wholecare, a Medicaid managed care provider in southwest Pennsylvania.
- Secretary of Aging: Jason Kavulich, Lackawanna County Director of Agency on Aging.
- Insurance Commissioner: Mike Humphreys, who has held the role temporarily since last spring.
Also in Pennsylvania, the Department of Human Services (DHS) issued a Medicaid bulletin announcing they will be reinstating pre-COVID provider enrollment requirements effective February 27, 2023; while the PACE Program announced their Part D pharmacy benefit plan partners for 2023.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Rhode Island
See the January 2023 Medicaid Provider Update here.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
South Carolina
Centers for Medicare and Medicaid Services (CMS) has announced the enrollment application fee amount for calendar year 2023 will be $688. This fee is required by CMS with any applicable Healthy Connections Medicaid provider enrollment application.
The South Carolina Department of Health and Human Services (SCDHHS) will collect the application fee before executing a provider agreement. The fee applies to initial enrollment, reactivation, revalidation, or addition of a new practice location. SCDHHS has contracted with the SC.gov Enterprise Payment System to facilitate collection of the application fee. Payments may be made by debit, credit, or e-check. Paper checks will not be accepted. More information on payment options can be found by visiting www.scdhhs.gov/provider and selecting, "Online Application Fee Payment."
The provider enrollment application fee is only applicable to providers CMS has identified as institutional providers. South Carolina Healthy Connections Medicaid recognizes and enrolls the following institutional providers: Ambulatory Surgery Centers, Community Mental Health Centers, Comprehensive Outpatient Rehabilitation Facilities, Durable Medical Equipment, End Stage Renal Disease Facilities, Federally Qualified Health Centers, Home Health Agencies, Hospice, Hospitals, Independent Clinical Laboratories, Pharmacies, Skilled Nursing Facilities and Rural Health Clinics. For more information, please see the Bulletin.
Also in South Carolina, the South Carolina Department of Social Services (SCDSS) is announcing an end to the federally approved Supplemental Nutrition Assistance Program (SNAP) emergency allotments (supplements) to all South Carolina households effective January 31. Since March 2020, the assignment of emergency SNAP allotments (supplements) has brought all authorized households up to the maximum benefit allotment, based on household size.
January 2023 has been approved by the United States Department of Agriculture Food and Nutrition Services as South Carolina's "transition" month, prior to going back to normal SNAP benefit allotments for all households.
Effective February 1, all SNAP households will go back to receiving their regular monthly benefit amount.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Texas
The state legislature will convene its 140-day biennial session on January 10, 2023. Rep. Dade Phelan (R) was elected Speaker of the House.
Also in Texas, the State Comptroller Glenn Hegar (R) announced on January 9 that the state has a $32.7 billion surplus.
Also in Texas, the Health and Human Services Commission's (HHSC) Executive Commissioner Cecile Erwin Young announced that Dr. Jennifer Shuford would serve as Commissioner of the Texas Department of State Health Services (DSHS), replacing Dr. John Hellerstedt. Previously Shuford served as chief state epidemiologist at DSHS.
Finally in Texas, several bills of interest to pharmacies have been filed:
- HB 1105 by Rep. Four Price (R) would make permanent the Public Readiness and Emergency Preparedness Act (PREP Act) authority that authorizes pharmacists to both order and administer routine immunizations for individuals three years of age and older.
- HB 1293 by Rep. Toni Rose (D), the Medicaid transparency reimbursement bill, would establish a rate floor for Medicaid MCOs.
- SB 160 by Sen. Charles Perry (R) would provide for pharmacists to furnish medications for flu, strep and COVID under a written protocol with additional training, if identified through a CLIA Waived test. Also, it would allow for a physician to dispense drugs for flu, step and COVID, if identified through a CLIA-waived test, and dispense all antibiotics and drugs authorized under an emergency rule.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Virginia
NACDS reminds members that Medicaid has recently expanded its list of maintenance medications eligible to be filled with a 90-day supply. Medicaid-covered patients are eligible for the long fills after receiving two 34-day or shorter fills of drugs on the list.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Washington
The legislature convened on January 9, 2023.
Also in Washington, legislation creating a new stand-alone chapter for regulating PBMs was filed this week. SB 5213 and HB 1253 were designed by the Office of the Insurance Commission (IOC) and the Washington State Pharmacy Association (WSPA) to regulate PBMs directly regardless of whether the contract is with a state-regulated plan or a self-funded plan. The bill prohibits requiring the use of mail-order pharmacies (except for specialty drugs), reimbursing pharmacies below costs and excluding pharmacies from the network.
Also in Washington, the Washington State Pharmacy Association (WSPA) Legislative Days are January 25 and February 13. These events will allow all pharmacists, pharmacy students and pharmacy technicians from all practice settings to connect with legislators and colleagues across the state.
Also in Washington, the Health Care Authority recently updated its provider billing guides and fee schedules for Apple Health (Medicaid).
Finally in Washington, the Department of Health (DOH) is developing a campaign in 2023 to encourage families to catch up on immunizations. To accomplish this goal, DOH is surveying health care providers for guidance on what materials and resources are needed.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
California
Last week, the Department of Health Care Services (DHCS) announced plans for the reinstatement of prior authorization and the retirement of the transition policy taking place in a series of phases… II, III and IV. A webpage has been developed for "Medi-Cal Rx Reinstatement" that includes information about the timeline, key days, announcements and alerts and resources. If you already receive Medi-Cal Rx alerts, you will also begin to receive Reinstatement alerts. There is no need to subscribe to an additional listserv according to DHCS staff.
Also in California, the DHCS posted the following alerts and weekly notices on the Medi-Cal Rx Web Portal. Please note the reinstatement resources in New Resources for Reinstatement Education and Support.
- New Resources for Reinstatement Education and Support (December 12)
- COVID-19 Antigen Tests Coverage Reminder (December 9)
- Medi-Cal Rx Weekly Wrap-Up for December 2-8 (December 9)
Also in California, Medi-Cal posted the following:
- Monkeypox Vaccines Reimbursement at the Medicare Rate (December 13)
- Erroneous Cal MediConnect (CMC) Notice (December 9)
- Meet & Greet Event – March 2023 (December 9)
- Meet & Greet Event – February 2023 (December 9)
Finally in California, NACDS and the California Retailers Association (CRA) sent several joint letters to the Board of Pharmacy addressing issues of concern to members.
- With respect to e-prescribing requirements effective January 1, 2023, NACDS and CRA are seeking guidance from the Board about how members can comply with requirements to accept electronic prescriptions without advance notice from a vendor with whom they do not have a current business relationship.
- We are also seeking clarity from the Board via answers to a brief list of questions to provide members the appropriate guidance to aid their efforts to comply with a 2021 law related to pharmacy quotas; recall, this law only applies to companies operating 75 or more pharmacies in the state under one ownership.
- Finally, we are expressing concern with a proposal under consideration by the board to create a "staffing floor" that may lead to pharmacy closures if at least one clerk or pharmacy technician is not on staff and fully dedicated to performing pharmacy-related services while the pharmacy is open; this proposal would also permit the pharmacist on duty to close the pharmacy if, in their opinion, the staffing at the pharmacy is inadequate to safely fill or dispense prescriptions or provide services in a safe manner without fear of retaliation. We asked to work with the board on solutions so that pharmacies can remain open to their patients.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Delaware
On December 9, Gov. John Carney (D) extended the Public Health Emergency (PHE) another 30 days permitting medical providers to continue COVID-19 vaccination and testing programs. This is the 10th extension of the PHE.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Georgia
The Board of Pharmacy shared “Volume 4” of its newsletter. The newsletter is created on a quarterly basis and is intended to provide insights and updates on the profession of pharmacy in the state. The newsletters can be found on the GBOP website for easy access.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Iowa
The Board of Pharmacy adopted the following rules effective January 4, 2023:
- ARC 6685C has been adopted and amends Chapter 23, "Care Facility Pharmacy Practice."
- ARC 6686C has been adopted and amends Chapter 41, "Outsourcing Facilities."
- ARC 6687C has been adopted and amends Chapter 14, "Public Information and Inspection of Records."
- ARC 6688C has been adopted and amends Chapter 12, "Precursor Substances."
- ARC 6689C has been adopted and amends Chapter 10, "Controlled Substances."
Also in Iowa, the Board of Pharmacy published ARC 6696C as a Notice of Intended Action to amend Chapter 3, "Pharmacy Technicians," Chapter 6, "General Pharmacy Practice," Chapter 8, "Universal Practice Standards," Chapter 18, "Centralized Prescription Filling and Processing," Chapter 21, "Electronic Data and Automated Systems in Pharmacy Practice," and Chapter 39, "Expanded Practice Standards." Comments may be submitted until 4:30 p.m. on December 20.
Finally in Iowa, the Department of Health and Human Services, Iowa Medicaid published INFORMATIONAL LETTER NO. 2405-MC-FFS announcing January 2023 Iowa Medicaid Pharmacy Program Changes.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Maryland
The Maryland Pharmacists Association (MPhA) is seeking nominations for two trustee Board positions for 2023-2024. Trustees serve a three-year term. Any active MPhA member in good standing is eligible for nomination and self-nomination is acceptable. Interested parties may submit their nominations online.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Nebraska
The Department of Health and Human Services (DHHS) posted an Interim Guidance for Clinicians to Prioritize Antiviral Treatment of Influenza in the Setting of Reduced Availability of Oseltamivir, an official CDC Health Advisory.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
New York
Gov. Kathy Hochul (D) has vetoed A7889, a bill meant to reform the Medicaid audit process. In her veto message, the Governor cited concerns about the bill preventing Medicaid from recovering legitimate overpayments and any corresponding impact on the loss of federal funds.
Also in New York, on December 20, the State Department of Health is hosting an informational online seminar for all stakeholders about the transition of the pharmacy benefit from Medicaid Managed Care to NYRx, (Medicaid fee-for-service (FFS) pharmacy program). This is part of a series of recurring monthly webinars about this topic. Note that you must complete the registration form to attend. Afterward, a copy of the presentation will be posted on the transition website, where past presentations are available.
Finally in New York, Medicaid's newsletter from November includes a section on pharmacy dispensing/prescribing of emergency contraceptives.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Ohio
The Board of Pharmacy (BOP) released another draft rule for stakeholder feedback from the Pharmacy Workforce Advisory Committee. This rule would establish mandatory breaks for pharmacy personnel. Members may submit comments to the BOP by January 20, 2023. Please note that the document also has guidance related to the current law around protections against employee violation reports to the Board.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Pennsylvania
The Office of Medical Assistance (Medicaid) published Bulletins with updates to the Preferred Drug List effective January 9, 2023, and another about PA (Prior Authorization) instructions for Monoclonal Antibodies.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
South Carolina
The South Carolina Department of Health and Human Services (SCDHHS) will operate on an updated schedule for Healthy Connections Medicaid claims submission and payments to accommodate the December 2022 holidays.
December 2022
Due to observance of the Christmas holiday, Monday, December 19, at 5:00 p.m. is the deadline to submit claims for payment date Friday, December 23. Payments will run Tuesday, December 20, and electronic remittance advice will be available Thursday, December 22. Payments will be dated Friday, December 23, as usual.
Monday, December 26, at 5:00 p.m. is the deadline to submit claims for payment date Friday, December 30. Payments will run Tuesday, December 27, and electronic remittance advice will be available Thursday, December 29. Payments will be dated Friday, December 30, as usual.
January 2023
Due to observance of the New Year's Day holiday, Monday, January 2, at 5:00 p.m. is the deadline to submit claims for payment date Friday, January 6. Payments will run on Tuesday, January 3, and electronic remittance advice will be available Thursday, January 5. Payments will be dated Friday, January 6, as usual. The schedule will return to the normal payment cycle on payment date Friday, January 6, 2023.
Provider Service Center (PSC) Holiday Hours
The PSC will be closed Friday, December 23, and Monday, December 26, in observance of the Christmas holiday, and on January 2, 2023, in observance of the New Year's Day holiday.
Please refer any questions or concerns about this alert to the PSC at 888-289-0709. The PSC's regular hours of operations are 7:30 a.m. – 5:00 p.m. Monday-Thursday and 8:30 a.m.- 5:00 p.m. Friday.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Tennessee
TennCare Prescribing Providers, please see Information and Updates to the TennCare Preferred Drug List (PDL) due to Amoxicillin shortages. We encourage you to review this information thoroughly and contact the OptumRx Pharmacy Supports Center at 866-434-5520 or tnrxeducation@optum.com should you have questions.
Also in Tennessee, TennCare has established a plan for unwinding from the Public Health Emergency. In its first phase, TennCare seeks partnership from healthcare providers to encourage TennCare patients to update their contact information and register for TennCare Connect. Shareable resources are available on the website.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Utah
The Board of Pharmacy posted the agenda for its December 20 meeting.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Vermont
The Department of Vermont Health Access has published updates to the Preferred Drug List (PDL) effective January 1, 2023.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Wisconsin
The Department of Safety and Professional Services announced a new LicensE Public Application Status Lookup toll that makes it easier for employers to track the application status of current and future employees.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Alabama
On December 13, join the Alabama Pharmacy Association’s (APA’s) Year-End Continuing Education Webinar from 6:00-8:00 p.m. (CST) and earn two hours of live credit. Sessions will include “Pharmacy Law” with Stephen Brown, JD, PharmD, Assistant Professor, Samford-McWhorter, and “2023 Legislative Session Primer” with Bobby Giles, RPh, APA Government Affairs Director. Register on the APA website.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.