Colorado
Prior to the end of the regular session sine die on May 8, the legislature approved several bills pharmacies supported that have been signed into law by Gov. Jared Polis (D).
- SB23-162, will increase access to pharmacy services, including (1) pharmacy technicians administering vaccinations, point-of care testing and technical tasks delegated by the pharmacist, (2) increasing the Pharmacy Technician ratio for central fill facilities to 8:1 and (3) allowing Medicaid to reimburse pharmacies for administering vaccines to children under 19 years old.
- HB23- 1201, PBM reform legislation, eliminates spread pricing and provides for more transparency.
- HB23-1227 enhances the Commissioners enforcement authority over PBMs.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Georgia
On May 2, Gov. Brian Kemp (R) signed HB 416 which allows pharmacy technicians to administer all ACIP vaccinations to persons 18 years of age and older. The bill went into effect upon the Governor’s signature.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Iowa
The Department of Health and Human Services (HHS) issued INFORMATIONAL LETTER NO. 2459-MC-FFS RE: Molina Provider Contracting and Training. Molina Healthcare of Iowa will join Amerigroup and Iowa Total Care to provide benefits for IA Health Link and Hawki members on July 1, 2023. HHS will allocate up to one-third of Medicaid members to Molina effective July 1, 2023.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Kentucky
The Cabinet for Health and Family Services (CHFS) has published a COVID Vaccine and Testing FAQ to assist pharmacies specific to the Medicaid Unwinding. It clarifies CHFS' interpretation of pharmacist authority to provide COVID vaccines and testing post-May 11 and the expiration of the PREP Act. https://www.nacds.org/ceo/2023/0512/PHE-Unwinding-COVID-FAQ.pdf
Also in Kentucky, Gov. Andy Beshear (D) signed HB 349, sponsored by pharmacist Rep. Danny Bentley (R). The law expands expedited partner therapy for the treatment of sexually transmitted diseases (STDs) to include more diseases. The bill also permits the retail sale of HIV self-administered testing kits.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Louisiana
While HB 471, by Rep. Barbara Freiberg (R) authorizing pharmacists to order and administer, and pharmacy interns and pharmacy technicians to administer immunizations to children aged seven years and older was scheduled to be heard in the House Health and Welfare Committee on May 10, the sponsor asked that the bill be deferred until May 17. The additional time gives chain pharmacies an opportunity to take action and contact House Health and Welfare Committee members urging them to support HB 471 to preserve patient access for children and families to receive lifesaving vaccines at pharmacies.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Maryland
Beginning July 20, 2023, pharmacies will be required to report Naloxone dispensing to the PDMP (Prescription Drug Monitoring Program) because of passage of a 2022 law. Additionally, the PDMP is changing certain ASAP (American Society for Automation in Pharmacy) fields from “optional” to “required.” For more information, see the updated PDMP RxGov Data Submitter Reference Guide with changes dictated by the naloxone statute, changes to required fields and new guidance from ASAP for v4.2A & v4.2B.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Michigan
NACDS reminds members that the Department of Insurance has posted a draft rule pursuant to the PBM Licensure and Regulation Act. NACDS is currently reviewing the rule and intends to file comments by the June 9 deadline. If there are comments you would like us to include in the letter, please send them to Jill McCormack by close of business on May 26.
Also in Michigan, the Department of Health and Human Services (MDHHS) is soliciting comments from Medicaid Health Plan Common Formulary. The Common Formulary applies to pharmacy claims paid by Medicaid Managed Care Organizations. The public may submit comments on the drugs included or not included on the Common Formulary; new drug products; prior authorization criteria; step therapy criteria and other topics related to drug coverage. The comments will be reviewed by MDHHS and the Michigan Medicaid Health Plan Common Formulary Workgroup. The next drug classes to be reviewed by the Workgroup include Diabetes, GI, P & T Miscellaneous, Non-Drug Products and Endocrine & Metabolic. Changes may be made to the Common Formulary based on comments received. Comments are due June 16 and should be emailed to MDHHSCommonFormulary@michigan.gov .
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Nebraska
The Department of Health and Human Services posted information about the expiration of the federal COVID-19 public health emergency including fee-for-service providers are no longer allowed to extend prior authorizations that existed before the pandemic started through to the end of the pandemic without requiring follow-up visits and cost-sharing, including copayments/copays and premiums, will continue to be waived for members of Nebraska Medicaid until June 1, 2024.
Also in Nebraska, the Department of Health and Human Services announced Medicaid will hold weekly public webinars on the public health unwinding as part of the return to regular eligibility operations.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
North Carolina
Please see the May 2023 North Carolina Medicaid Pharmacy Newsletter.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Oregon
The Oregon Health Authority and the Oregon Department of Human Services announced lifting of COVID-19 response measures as federal health emergency ended. Some changes were effective May 11 while others will take effect in the coming weeks.
Also in Oregon, the Board of Pharmacy posted the agenda for the May 16 meeting of the Compounding Workgroup and the agenda for the May 17 meeting of the Public Health & Formulary Advisory Committee.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Tennessee
PBM Enforcement Update with TDCI (Tennessee Department of Commerce & Insurance). TPA welcomes Jud Jones, PharmD, Manager of PBM Compliance at TDCI on May 17 from 12:00 noon-12:30 p.m. CT and 7:00 p.m.-8:00 p.m. CT to hear the latest on PBM enforcement in the state.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Texas
for HB 1105, by Rep. Four Price (R), legislation that lowers the age to three years old and up for pharmacies to administer all vaccines and immunizations, was referred to the Senate Health and Human Services Committee for a hearing.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Virginia
The Board of Pharmacy issued a document outlining pharmacy’s authority to vaccine and perform COVID testing post the May 11 expiration of the PHE (public health emergency). Notably, the document includes a link to an updated statewide protocol to allow pharmacists and technicians to vaccinate children aged three years and older due to the passage of HB 1323 in 2022.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
West Virginia
The Board of Pharmacy’s April newsletter contains valuable information regarding legislation passed in the 2023 session and its impact on pharmacies, including HB 2754, which will make pharmacies PREP Act immunization authority permanent once rules have been promulgated. The Board’s goal is to do so by July 1, 2023. Of note, the newsletter provides information on an updated, online process to file Collaborative Practice Agreements.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Alabama
This ALERT, related to COVID-19 unwinding as it pertains to Pharmacy and DME [Durable Medical Equipment], has been released.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
California
The Department of Consumer Affairs' (DCA')s printing provider is currently experiencing technical difficulties. As a result, the printing of the Board of Pharmacy's renewals, certificates, licenses and letters is delayed. Printing interruption began on April 13. At this time, DCA does not have an estimated time of restoration. Updates will be provided as more information becomes available.
To verify your license status online: Go to the Board's website and click on License Search in the "Quick Hits" column to view and print your license record. California law allows the printout of a license record from the Board's website to serve as license verification.
Renewing your license: The Board reminds licensees of their responsibility to renew licenses before they expire. Renewal application forms and fees may be submitted up to 60 days before expiration.
- To renew online: Pharmacists, advance practice pharmacists, pharmacy technicians, designated representatives, pharmacies, hospitals and drug rooms may renew licenses online. Go to the Board's website and click on License Renewal Online in the "Quick Hits" column.
- To renew by mail: Go to the Board's website and click on License Renewal by Mail in the "Quick Hits" column.
Also in California, the Board of Pharmacy posted the following reflecting actions taken at the recent April Board Meeting:
- Pharmacist Remote Processing Waiver on Behalf of a Health Care Facility Licensed Pursuant to Health and Safety Code Section 1250
- April 2023 Board Meeting Action Items
Also in California, the Department of Health Care Services (DHCS) posted the following alerts, weekly notices and monthly bulletin on the Medi-Cal Rx Web Portal:
- Reminder: Prior Authorization Signature Requirements (May 4)
- Refill of Continuous Glucose Monitoring (CGM) Supplies (May 2)
- Discontinuation of the COVID-19 Uninsured Group Program (May 1)
- Reinstatement of the Medi-Cal Rx Controlled Substance Policy on Buprenorphine Products (May 1)
- Updates to the List of Covered Emergency Use of Authorization (EUA) COVID-19 Antigen Tests, Effective June 1, 2023 (May 1)
- Updated Appendix H – List of Physician Administered Drugs (PADs) with Reject Code 816 (May 1)
- Medi-Cal Rx Monthly Bulletin for May (May 1)
- Changes to Contract Drugs List (CDL) (May 1)
- Changes to Contract Drugs List (CDL) – Over-the-Counter Drugs (May 1)
- Changes to the Family PACT Pharmacy Formulary (May 1)
- Updates to the Medi-Cal Rx Provider Manual (May 1)
- Medi-Cal Rx Weekly Wrap-up for April 21-27 (April 28)
- Reinstatement Spotlight (April 28)
Finally in California, Medi-Cal posted the following:
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Florida
On May 3, Gov. Ron DeSantis (R) signed into law Senate Bill 1550. Effective July 1, 2023, The Prescription Drug Reform Act codifies the Governor’s actions from last year to require accountability among pharmaceutical middlemen, empower consumers through increased choice among pharmacies and create transparency in prescription drug price increases. More information from the Governor’s office can be found here.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Illinois
Gov. J.B. Pritzker (D) has signed HB 559 (Public Act 103-001), which codifies the COVID Executive Order that was in effect throughout the pandemic and governed the provision of healthcare services.
For Illinois pharmacy, this means the following:
- continuing to test and treat COVID and test for influenza and other health conditions identified by a statewide public health emergency.
- pharmacists may administer flu and COVID vaccinations to patients seven years of age and older under the pharmacists' own authority.
- pharmacists may delegate to technicians the administrative and technical act of performing tests. Technicians must complete an ACPE (Accreditation Council for Pharmacy Education) vaccination training course, basic CPR certificate and complete two (2) hours of immunization related continuing education per licensing period.
- Group or individual policy of accident and health insurance and managed care plans are required to provide coverage on or after January 1, 2025 for pharmacist-provided test and treatment services if the plan provides coverage for the same services provided by a licensed physician, and APRN, or a physician assistant, the pharmacist is included in the health benefit plan's network of participating providers, and reimbursement has been successfully negotiated in good faith between the pharmacist and the health plan.
Also in Illinois, this notice provides information regarding pharmacy billing policies that will resume at the end of the COVID-19 public health emergency (PHE). The PHE is scheduled to end on May 11, 2023. The requirements discussed in this notice apply to the Department of Healthcare and Family Services' (HFS) fee-for-service (FFS) program. The Medicaid managed care organizations (MCOs) do not have prescription limits as in the FFS program. The MCOs follow the Preferred Drug List (PDL) but set their own coverage policies and may have later implementation dates for the requirements below. Pharmacies may contact the applicable MCO with questions.
Effective with dates of service on and after May 12, 2023, the following pharmacy requirements that were in place prior to the PHE will resume:
Refill Too Soon
Pharmacies will no longer be able to override Refill Too Soon (RTS) claims by entering a Submission Clarification Code (420-DK) of 13, Payer, Recognized Emergency/Disaster Assistance Request. When a claim rejects for RTS, the pharmacy will need to request an override through pre-COVID processes. The RTS percentages will also be set back to the same tolerances in place prior to the PHE.
Preferred Drug List (PDL)
Changes made to the preferred drug list (PDL) due to potential drug shortages will be removed from the PDL. During the PHE, all albuterol HFA inhalers, levalbuterol inhalers and generic levalbuterol nebulizer solutions were changed to preferred status. These will revert to the pre-PHE classification.
Updates/changes will be maintained on the Department's website on the PDL webpage.
Quantity for supplies
Blood glucose/reagent test strips quantity will be decreased to a maximum of 200 per month. Lancet quantity will be decreased to a maximum of 200 per month. Providers are reminded to bill an accurate day supply even if it exceeds one month.
Quantity limits will be reinstated for Tamiflu, insulin and suboxone.
OTC (Over-the-Counter) Coverage
The temporary coverage granted during the PHE for acetaminophen and cough suppressants containing guaifenesin, dextromethorphan or their combinations will revert to the same status in place prior to the PHE.
3 Brand Limit
Edits that were removed to allow a customer to receive three brand name drugs during a 30-day period will be put back in place.
4 Prescription Policy
Edits that were removed to allow a customer to receive more than four prescriptions during a 30-day period will be put back in place.
Third Party Liability
Drugs will again be subject to prior approval in situations where the primary insurance did not pay due to a rejection or customer deductible requirement. These edits will resume, and claims will require an override in accordance with pre-PHE billing policy.
Questions regarding this notice may be directed to the Bureau of Professional and Ancillary Services at 877-782-5565.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Indiana
On May 1, Gov. Eric Holcomb (R) signed into law HB 1568, legislation allowing pharmacists to prescribe and dispense hormonal contraception.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Iowa
The Department of Health and Human Services published the following:
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Kansas
Prior to the legislature adjourning on April 28, SB 131, legislation that was amended to include extending the authority for pharmacy technicians to administer vaccines was sent to Gov. Laura Kelly (R). She signed it into law on May 1.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Kentucky
The Department for Public Health recently updated the Yellow Fever Vaccination Center Application to allow pharmacists to apply to participate. Further detail can be found on the Office of Epidemiology webpage.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Louisiana
HB 471 by Rep. Barbara Freiberg (R) authorizing pharmacists to order and administer and pharmacy interns and pharmacy technicians to administer immunizations to children aged seven years and older is scheduled for a hearing in the House Health and Welfare Committee on May 10. The Louisiana Alliance for Retail Pharmacies is urging chain pharmacies to take action to preserve patient access to children and families for lifesaving vaccines at pharmacies.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Maryland
Gov. Wes Moore signed the following bills into law:
- HB 693– Allows pharmacist to delegate administration of certain vaccines to pharmacy technicians: – to adults 18 years of age and older: COVID, flu, pneumonia; and RSV or shingles to patients 50 years of age and older; allows techs to perform remote data entry under supervision. Effective upon signing, April 4, 2023.
- SB 678 – Requires Medicaid, CHIP and commercial insurers to reimburse pharmacies for services within their scope of practice if the plan would otherwise cover. Effective October 1, 2023; signed May 5, 2023.
- HB 374– Pharmacy audits – clarifies that the state's audit law applies to PBMs contracted with Managed Care Plans; adds new auditing thresholds and requirements that apply to all insurers and Managed Care; and requires PBMs to provide a secure electronic method of communication between the pharmacy and the PBM for sharing auditing information by October 2025. Provides that the Department of Insurance may promulgate rules. Effective January 1, 2024; signed May 5, 2023.
- HB 382 -Requires the State Department of Health and Prescription Drug Advisory Board to complete a study on MMC claims for calendar years 2021 and 2022 and on the costs of implementing a pharmacy reimbursement cost-based rate floor in MMC. The study is due to the General Assembly in October 2023. Effective upon signing, April 4, 2023.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Massachusetts
In advance of the May 11 Public Health Emergency ending, the Massachusetts Board of Pharmacy announced the following on May 4:
- In response to the continued public health need for vaccinations, the Board will not be enforcing the supervisory ratios set out in 247 CMR 8.06(3) at licensed pharmacies that are providing vaccination services provided that the following conditions are met:
- A maximum ratio of one pharmacist to six support staff is not exceeded; and
- at least three support staff are interns and / or certified, licensed pharmacy technicians.
- Due to continued staffing shortages, the Board does not intend to take enforcement action against pharmacies that perform and reconcile perpetual inventory counts at least every 15 days as long as back-counts are performed after each prescription is filled.
- Pharmacists, interns and pharmacy technicians may administer vaccines to individuals who are 5 years of age and older in accordance with Policy 2023-02: Vaccine Administration.
- COVID-19 Control Measures, including COVID-19 tests, may be dispensed or administered in accordance with Policy 2023-03: COVID-19 Control Measures.
For more information, please contact NACDS’ Mike Sargent at 207-272-6435.