Louisiana
The Board of Pharmacy held their quarterly meeting on November 17.
Also in Louisiana, Medicaid announced that another Managed Care Organization (MCO), Humana Healthy Horizons, will be added effective January 1, 2023, offering services to Medicaid recipients. The Medicaid Pharmacy Program will now consist of Medicaid Fee-for-Service (FFS) and six managed care organizations (Aetna, AmeriHealth Caritas, Healthy Blue, Humana Healthy Horizons, Louisiana Healthcare Connections, and UnitedHealthcare).
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Massachusetts
A new standing order for over-the-counter (OTC) COVID-19 diagnostic tests has been developed by the Department of Public Health in accordance with M.G.L. c. 94C, s. 19A, which authorizes the issuance of standing orders for licensed pharmacists to dispense a COVID-19 control measures. This standing order is now in effect and should be utilized going forward. Please be aware that the January 14, 2022, Standing Order for Dispensing Over the Counter (OTC) Diagnostic Tests for SARS-CoV-2 is no longer in effect and may no longer be used.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Minnesota
The Department of Health and published its weekly COVID Vaccine Provider Update. Please note you can also link to past updates and sign up to receive future updates in your email on the same page.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Missouri
Quantity limits for albuterol inhalers and nebulizer solutions went into effect on August 28. Adults are now limited to 3 albuterol inhalers (300 rescue doses) every 180 days. Participants of all ages are limited to 120 vials every 2 months. If a provider feels a patient needs albuterol inhalers or nebulizer solutions more than these limits, a letter of medical necessity and progress notes will need to be submitted.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
New York
The Department of Health (DOH) has established a webpage with information and resources for pharmacies regarding the transition of the pharmacy benefit from Managed Care to NYRx. The page will be updated regularly. You can also email the DOH with questions about this issue by putting "pharmacy benefit transition" in the subject line. To sign up for the Medicaid Redesign LISTSERV, please click here.
Also in New York, the DOH issued changes to the prior authorization process and an updated preferred drug list for the NYRx program, effective November 17, 2022.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Ohio
The SPBM (Single Pharmacy Benefit Manager), Gainwell Technologies, sent a communication to pharmacies this week detailing claim recoupments that are planned in the next few weeks to compensate for overpayments in the first three weeks of the migration to the new Medicaid managed care pharmacy system.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Oregon
The Board of Pharmacy is proposing to adopt the following rules. A hearing will be held on November 22 at 9:30 a.m. PT. Written comments may be filed before 4:30 p.m. PT on November 22 via email to pharmacy.rulemaking@bop.oregon.gov.
- Division 019 – related to 2022 HB (House Bill) 4034 Duties of a Pharmacist
- Division 139 – related to 2022 HB 4034 Prohibited Practices
- Division 019 – related to 2022 HB 4096 Out-of-state Volunteer Pharmacist
- Division 062 – related to Drug Distribution Agent
- Divisions 010/019/020 – related to Pharmacist Prescriptive Authority
- Divisions 021/135 – related to Continuing Pharmacy Education
- Divisions 019/141 – related to Pharmacy Prescription Kiosk (PPK)
- Divisions 006/019/031 – related to Definitions
- Division 041 – related to Prescription Labeling Expiration Date
- Divisions 001/102 – related to Procedural & Universal Rules *The board does not intend to adopt these rules in December 2022 – seeking public comment only
- Divisions 025/125 – related to Pharmacy Technicians *The board does not intend to adopt these rules in December 2022 – seeking public comment only
- Divisions 019/020/031/041/115 – related to Pharmacists *The board does not intend to adopt these rules in December 2022 – seeking public comment only
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Texas
Gov. Greg Abbott (R) directed the Texas Education Agency (TEA) and the school superintendents that the COVID-19 vaccine cannot be mandated as part of school entry requirements. Instead, Texas law overrides a recent recommendation from the Centers for Disease Control (CDC) that added the vaccine to immunization schedules for adults and school-aged children. In letters to TEA Commissioner Mike Morath and school superintendents statewide, the Governor explains that his Executive Order No. GA-39, issued on August 25, 2021, allows Texas parents to opt-out of the COVID-19 vaccine for their children and further empowers parents to be the primary decision-makers in their children's healthcare. Also, the Texas Legislature has enabled parents to opt out of vaccinating their children for health reasons and reasons of conscience through several statutes, including Texas Education Code § 38.01(c)(1), Texas Health & Safety Code §§ 161.004(d), 161.0041 and Texas Human Resources Code § 42.043(d).
Also in Texas, the Health, and Human Services Commission (HHSC) Vendor Drug Program (VDP) Medicaid is soliciting feedback on its proposed policies related to the transition of the formulary, preferred drug list and prior authorization requirements to managed care organizations, in accordance with state law. The survey must be completed by 5:00 PM CT on December 4, 2022.
Also in Texas, at the Board of Pharmacy early this month, the Board adopted and proposed several rules.
Finally in Texas, November 14 was the first day of bill filing for the 2023 legislative session that convenes on January 10, 2023. Shortly after Noon, legislators had filed more than 800 bills. Thousands of pieces of legislation are filed each biennial session, but most never make it into law.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Utah
The Board of Pharmacy posted the following:
- September 27 Approved Minutes
- November 15 Meeting – Agenda, audio recording and handouts
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Washington
The House Health Care and Wellness Committee is holding a work session on December 1 to take written and virtual testimony on pharmacy benefit manager impacts on prescription drug costs. NACDS will provide members with the agenda and our comment letter before the hearing.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Alabama
Pharmacist registrations expire December 31, 2022. The Board of Pharmacy is accepting pharmacist license renewals ONLINE ONLY at www.albop.com. The renewal fee is $100 plus $100 for a controlled substance permit. If you are changing your name, send proof of legal name change BEFORE YOU REGISTER ONLINE. If you fail to renew your license by December 31, 2022, but you continue to work as a pharmacist in any way, you will be subject to late fees and discipline. For more information, please contact the Board of Pharmacy directly at 205-981-2280.
Also in Alabama, please see these updated ALERTS for billing for Stand-alone COVID-19 Vaccine Counseling for Recipients Under Age 21 and billing for Stand-alone Vaccine Counseling to Recipients Under Age 21.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Alaska
The Board of Pharmacy's statutes and regulations booklet has been updated to reflect sections 1 – 10 of HB 145, the new pharmacist and pharmacy technicians expanded practice law passed this year. The October 2022 booklet reflects these changes to AS 08.80:
- Permits pharmacists to engage in independent monitoring of drug therapy;
- Clarifies pharmacists can independently prescribe and administer vaccines, related emergency medications, and opioid overdose drugs;
- Permits pharmacy technicians to administer vaccines or related emergency medications, if approved by the board;
- Requires interns and technicians to disclose prescription drug prices;
- Permits pharmacists to provide patient care services outside of a collaborative practice agreement with a physician for general health and wellness, disease prevention and certain conditions, including conditions that involve CLIA-waived tests;
- Removes dosage form from equivalent drug product and
- Updates the definition of "practice of pharmacy"
For more information, contact NACDS’ Mary Staples at 817-442-1155.
California
The Board of Pharmacy has announced an additional meeting of the Standard of Care Ad Hoc Committee schedule for November 16 and posted an agenda for the meeting.
Also in California, the Department of Health Care Services posted the following alerts and weekly notices on the Medi-Cal Rx Web Portal. Please note the Medi-Cal recoupment announcement in "Recommencement of Pharmacy Retroactive Claims Adjustments" document; these recoupments are set to begin in January 2023.
- Medical Supplies: Correction to Limitations for Contraceptive Supply (November 3)
- Medi-Cal Rx Monthly Bulletin for November (November 1)
- Changes to the Contract Drugs List (CDL) (November 1)
- Changes to the Contract Drugs List (CDL) – Over-the-Counter Drugs (November 1)
- Updates to the Medi-Cal Rx Provider Manual (November 1)
- Recommencement of Pharmacy Retroactive Claim Adjustments in November 2022 (October 31)
- Prior Authorization Appeals and Claim Appeals: A Reminder for Providers (October 28)
- Medi-Cal Rx Weekly Wrap-Up for October 21-27 (October 28)
Finally in California, Medi-Cal posted the following:
- Paper RADs, No Pay Documents and EFT Statements Will Soon be Replaced by Electronic Equivalents (November 1)
- Medi-Cal News: Coming Soon: Booster Dose for Novavax and Pediatric Bivalent Pfizer-BioNTech and Moderna COVID-19 Vaccines (October 31)
- Medi-Cal Rx Update – Pharmacy – October 2022 – Bulletin 1026 (October 31)
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Florida
As of September 29, 2022, the Federal Emergency Management Agency (FEMA) issued a major disaster declaration for the following Florida counties affected by Hurricane Ian (DR-4673): Brevard, Charlotte, Collier, DeSoto, Flagler, Glades, Hardee, Hendry, Highlands, Hillsborough, Lake, Lee, Manatee, Monroe, Okeechobee, Orange, Osceola, Palm Beach, Pasco, Pinellas, Polk, Putnam, Sarasota, Seminole, St. Johns, and Volusia.
The Agency for Health Care Administration (Agency) announced it will ensure reimbursement for all services provided in good faith to eligible Florida Medicaid recipients in FEMA designated counties during the Disaster Grace Period. The Agency is defining the Disaster Grace Period for Hurricane Ian as September 29, 2022 through November 30, 2022.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Illinois
This notice implements the section of Public Act 102-0103 that allows pharmacists to bill and be reimbursed for patient care services for hormonal contraceptives. This new policy is effective with dates of service on and after August 1, 2022, and applies to the Medicaid fee-for-service (FFS) program and the HealthChoice Illinois (HCI) managed care organization (MCO) plans.
Also in Illinois, this notice provides an update on coverage of the new COVID-19 bivalent boosters. The update applies to claims for customers covered under traditional Medicaid fee-for-service (FFS) and the HealthChoice Illinois (HCI) managed care organization (MCO) plans.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Kentucky
Magellan published a provider notice outlining September Preferred Drug List changes in Medicaid.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Louisiana
The Board of Pharmacy quarterly meeting is scheduled on November 15 and 16 at the Board's office in Baton Rouge. Prior to the meeting, the agenda and public meeting binder will be accessible here.
Also in Louisiana, Gov. John Bel Edwards (D) appointed 5 members to the 17-member Board of Pharmacy.
- Ricky Indovina, pharmacist with Ochsner Health System to a third six-year term;
- Raymond Strong, PharmD, with Ascension DePaul Services to a second six-year term;
- Pharmacist Jennifer Elliott Dupree with Walmart, a new member to a six-year term;
- Richard Mannino, independent pharmacy owner to a second six-year term and
- Chris Melancon, a new independent staff pharmacist to a six-year term.
Finally in Louisiana, on October 19th, the Medicaid Fee for Service (FFS) Pharmacy Program announced the implementation of an electronic drug prior authorization application to achieve a more streamlined authorization process.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Minnesota
NACDS reminds members that the mandatory Medicaid Cost of Dispensing Surveys are due back to Myers & Stauffer on November 16. Myers and Stauffer mailed and emailed the surveys to pharmacies on October 19. You can access the survey documents, download an electronic version, and find instructions for responding on behalf of multiple locations on Myers & Stauffer’s Minnesota webpage.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
North Carolina
The mandate for health care organizations and providers that serve state-funded patients to connect to the state-designated HIE by January 1, 2023, is fast approaching. The legislative changes enacted in the 2022 Appropriations Act may leave organizations and providers with questions about their connection status. Our General FAQs on NC HealthConnex gives more answers about the impacts on NC HealthConnex participants and non-participants.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Ohio
This week, ODM (Ohio Department of Medicaid) (Ohio Department of Medicaid) reversed its policy that required provider participation in the Vaccines for Children (VFC) program under the SPBM (Single Pharmacy Benefit Manager), Gainwell. To increase access to pediatric vaccines, Gainwell announced they will now cover pediatric vaccine claims by non-VFC providers, reimbursing product costs and an administration fee. NACDS worked jointly with the Ohio Council of Retail Merchants and members to advocate for this policy with both ODM and the Governor’s office.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Oklahoma
The Board of Pharmacy alerted licenses that the Oklahoma Board of Medical Licensure and Supervision (OMLS) has interpreted the laws and rules for Physician Assistants (PAs) prescribing Schedule II prescriptions. OMLS interpretation is that PA's can only prescribe Schedule II drug orders for immediate or on-going administration on-stie, which they define as a hospital, emergency room, ambulatory surgery center, medical clinic, or office in cases of emergency, or state-owned VA long term care facilities with an in-house pharmacy. PAs cannot prescribe Schedule II prescriptions in an outpatient setting for dispensing by a retail pharmacy.
Also in Oklahoma, the Board of Pharmacy will be closed November 30-December 2 so that they can move back to their newly renovated offices at 2920 N. Lincoln Blvd. Ste. A, Oklahoma City, OK 73105.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Oregon
The Board of Pharmacy is seeking applications from persons interested in serving on a workgroup concerning pharmacy interns. For more information, including the online application, visit the “Rules Advisory Committee (RAC) & Workgroup Information” webpage.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Pennsylvania
Gov. Tom Wolf (D) signed HB 1630 last week, just one day after the bill passed the General Assembly. HB 1630 allows the Auditor General access to PBM (Pharmacy Benefit Manager) data in the Medicaid Managed Care Program to perform audits. Notably, with the intent of expanding access to drug therapies, the bill was amended in the Senate Health Committee to repeal the provision in Section 1121.53(c) of 55 Pa. Code that limits payment for prescriptions in Medical Assistance to a 34-day supply or 100 units. Additionally, the following bills of interest to pharmacy were also signed:
- SB (Senate Bill) 225 (Act 146 of 2022) makes changes to prior authorization procedures and requires one form of MAT to be covered by Medicaid and private insurance without prior authorization requirements,
- HB 1393 (Act 111 of 2022) decriminalizes the use of fentanyl test strips for personal use and
- SB 1201 (Act 162 of 2022) requires health insurance policies to provide coverage for prescription eye drop refills at 70% of the prescription duration
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Rhode Island
Please see Medicaid Program November 2022 provider update.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
South Carolina
To comply with provisions of the Families First Coronavirus Response Act, the South Carolina Department of Health, and Human Services (SCDHHS) paused the typical annual eligibility review process for the state’s Healthy Connections Medicaid members effective January 27, 2020. When the current federal COVID-19 public health emergency (PHE) ends, state Medicaid agencies will be required to resume reviewing the eligibility of all Medicaid members. For more information, click here.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.