Pennsylvania
Sen. Ryan Aument’s (R) bill allowing the Auditor General to conduct a full-scale audit of subcontracts with pharmacy benefit managers (PBMs) in Medicaid Managed Care unanimously passed the Senate Health and Human Services Committee this week and is expected to be considered by the full Senate next week.
Also in Pennsylvania, the Office of Medical Assistance Programs has issued a new bulletin regarding billing and payment for the Moderna SARS-CoV-2 Vaccine Booster. This bulletin as well as past bulletins can be found on DHS’ Bulletin search page.
Finally in Pennsylvania, the Board of Pharmacy has posted the agenda for the November 1 meeting.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Tennessee
In collaboration with researchers at the UTHSC College of Pharmacy and grant support from Genentech, Tennessee Pharmacy Association would like to share an opportunity for community-based/outpatient pharmacies to enroll in a study investigating pharmacists’ management of influenza using point-of-care testing. Click here to learn more and enroll.
Also in Tennessee, updated versions of the Preferred Drug List (PDL), criteria PDL and interim criteria PDL are available, as well as the monthly provider notice for October 2022. Below is a summary of the updates:
- The following agents will be added to the PDL as non-preferred:
- Adlarity, Bylvay, Epsolay, Livmarli, Livtencity, Norliqva, Opzelura, Rezurock, Skytrofa, Tavneos, Tarpeyo, Triumeq PD
- Clinical criteria and/or quantity limits will be updated for the following agents:
- Nubeqa, Nucala, Olumiant, Skyrizi
- The following agents will be added to the interim criteria PDL:
- Radicava ORS, Vtama
- Proventil HFA will be moved to preferred on the PDL in response to marketing discontinuation of Proair HFA
Updates to clinical criteria/quantity limits from the Q3 PAC meeting will also became effective on October 1 and were summarized in the September provider notice.
These documents are available on the TennCare website.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Texas
The Board of Pharmacy’s posted the agenda for the November 1 meeting.
Also in Texas, save the date for the next PMP Advisory Committee remote Zoom meeting on December 1. Information will be posted on the Board of Pharmacy’s Committee & Task Force Meetings webpage as it becomes available.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Virginia
The COVID-19 Standing Order has been updated to include the most recently authorized bivalent boosters
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
California
The Department of Health Care Services posted the following alerts and weekly notices on the Medi-Cal Rx Web Portal.
- Diabetic Supplies: Updates to Continuous Glucose Monitoring Systems (October 4)
- Medical Supplies: Continuous Glucose Monitoring Systems and Disposable Insulin Delivery Devices Updates (September 30; Revised October 4)
- Medi-Cal Rx Monthly Bulletin for October (October 1)
- Changes to Contract Drugs List (CDL) (October 1)
- Changes to Contract Drugs List (CDL) – Over-the-Counter Drugs (October 1)
- Changes to Contract Drugs List (CDL) – Authorized Drug Manufacturer Labeler Codes (October 1)
- Changes to Family PACT Pharmacy Formulary (October 1)
- Updates to the Medi-Cal Rx Provider Manual (October 1)
- Diabetic Supplies: Continuous Glucose Monitoring (CGM) Systems Billing Units Reminder, Effective October 1, 2022 (October 1)
- Enteral Nutrition Update: Changes to the List of Covered Enteral Nutrition Products, Effective November 1, 2022, December 1, 2022, and January 1, 2023 (October 1)
- Medical Supplies: Removal of Prior Authorization Requirement for Covered Blood Pressure Cuffs, Effective November 1, 2022 (October 1)
- Medical Supplies: Continuous Glucose Monitoring Systems and Disposable Insulin Delivery Devised Updates (September 30)
- Coming Soon: Bivalent COVID-19 Vaccines (September 30)
- Medi-Cal Rx Weekly Wrap-Up for September 23-29 (September 30)
Also in California, Medi-Cal posted the following:
- Policy Update and Billing Guidance for COVID-19 Oral Antiviral, Paxlovid
- 2022 HCPCS Quarter 4 Update
- 2023 ICD-10-CM/PCS Codes Update
- Medical Supplies Update: MAPC Change for Nonsterile Gloves
- Medi-Cal Update – Pharmacy – September 2022 – Bulletin 1024
Also in California, the Board of Pharmacy posted its Board of Pharmacy Update – October 2022.
In California, Medi-Cal Rx will provide an educational opportunity regarding Brand Medically Necessary Prior Authorizations (DAW 1) and implications for pharmacy providers related to the Dispense as Written (DAW), Brand Medically Necessary (BMN), and Reimbursement – Frequently Asked Questions (FAQs) and Submission of Pricing Prior Authorization for Brand Medically Necessary Medications: Dispense as Written 1 (DAW1), released on September 29. Please join the Zoom meeting on October 10 at 1:00 p.m. Pacific using the following:
https://magellanhealth.zoom.us/j/93157317543?pwd=ZzlGRE9FNWtZWWtqb2FRZzcyMmE3Zz09&from=addon
Password: 924224
or iPhone one-tap (US Toll): +16699006833,93157317543# or +13462487799,93157317543#
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Delaware
Governor John Carney (D) signed HB 399 authorizing a pharmacist to order, test, screen and treat certain health conditions pursuant to a statewide written protocol for CLIA-waived tests approved by the Division of Public Health. These health conditions include flu; Strep A; COVID or other respiratory illness, condition or disease; lice; skin conditions including ring worm and athlete’s foot or other emerging and existing public health threats identified and permitted by the Division of Public Health. A pharmacist may also delegate the administration and technical performance of the CLIA-waived test to an intern or pharmacy technician acting under the supervision of the pharmacist.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Florida
Due to Hurricane Ian, and effective immediately, retail food stores licensed by the Food and Nutrition Service and located in the State of Florida may accept SNAP benefits in exchange for HOT foods and foods intended to be consumed on retailer premises.
These special rules are in effect through October 31, 2022.
When hot foods are purchased with SNAP EBT benefits through October 31, 2022, the purchases are NOT subject to sales tax, as these foods are considered SNAP eligible during this period.
All SNAP authorized retail food stores in the State of Florida are encouraged to post a special notice in the store letting SNAP customers know that they can use their SNAP EBT benefits to purchase hot foods and, where practical, may remain on the premises to consume those foods.
Thank you for your assistance in aiding those impacted by Hurricane Ian.
Also in Florida, the state has Starlink Internet Provider units available to businesses. These are the portable wifi providers donated to the state by Elon Musk. Each unit can provide internet service to 2,000 square feet and can have 120 maximum concurrent devices connected at a time. Multiple units are available to primarily allow a business to have connectivity and secondly to provide hotspots to the public. The first priority is to assist businesses. The ESF in charge of this will assist with set up and provide technical support. Please contact Lorena@FRF.org for more information.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Illinois
The Department of Healthcare and Family Services has posted a new Provider Notice regarding Post Kidney Transplant Preferred Drugs under the Emergency Medical Program.
Also, the Department of Healthcare and Family Services has posted a new Provider Notice regarding Prior Approval Requests for Synagis Dosing.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Indiana
On October 20, the Interim Study Committee on Financial Institutions and Insurance is holding a joint hearing on market concentration of the health insurance industry, hospital industry, health care practitioners, retail pharmaceutical industry, pharmacy benefit manager industry and pharmacy services administration organization industry.
Also in Indiana, Health Coverage Programs (IHCP) posted important information for providers, including:
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Iowa
The Department of Health and Human Services, Iowa Medicaid issued the following:
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Louisiana
The Department of Health (LDH) Medicaid Pharmacy Program issued the following updates:
- Louisiana Medicaid Pharmacy Point of Sale Clinical Authorization and Updates for Select Medications – Effective October 1, 2022
- Louisiana Medicaid Pharmacy Point of Sale (POS) Edits – Effective October 1, 2022
- Louisiana Medicaid Pharmacy Point of Sale Quantity Limits – Effective October 1, 2022
- Louisiana Medicaid Pharmacy Point of Sale (POS) Diagnosis Code – Effective October 1, 2022
- Louisiana Medicaid Pharmacy Point of Sale (POS) Edits for Tramadol/Celecoxib (Seglentis®) – Effective October 1, 2022
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Massachusetts
A statewide standing order is now available for the dispensing of emergency contraception pills (ECP). While not required to dispense ECP under the standing order, a training program is available through the MGH Institute of Health Professions that also offers continuing education credits.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Maryland
The Maryland Department of Health (MDH) is currently accepting applications and nominations for pharmacists to serve on the Maryland Medicaid Drug Use Review (DUR) Board beginning January 2023. The DUR Board is comprised of up to twelve (12) licensed and actively practicing physicians and pharmacists in Maryland. Members are appointed by the Secretary of MDH and serve one term of three (3) years from the date of their appointment with the option to serve an additional three (3) year term. All interested applicants are required to submit a formal application through the Maryland Department of Health’s Office of Appointments and Executive Nominations application link and indicate DUR Board. The deadline to submit applications is October 19, 2022.
Also in Maryland, the Maryland Department of Health (MDH) announced the targeted launch of a new Pharmacy Point of Sale Electronic Claims Management System. They have published a bulletin with details on the functionality of the new system and instructions to attend training in-person or virtually.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Minnesota
The Minnesota Department of Human Services (DHS) held a pharmacy stakeholder meeting this week to discuss the upcoming 2022 fee-for-service pharmacy cost of dispensing survey that will be conducted by Myers and Stauffer. The surveys will be delivered on October 19 to pharmacies via mail (corporate headquarters for chains) and electronically to the email address they have on file. Surveys are to be completed by November 16. Myers and
Stauffer has set up a dedicated email for questions. The same email address may be used for pharmacies to provide an alternative email address for electronic survey delivery or to request an extension, if needed. For more detail on the survey process, see the meeting slide deck and draft survey instrument.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Missouri
The Board of Pharmacy is soliciting comments due October 15 on a proposal establishing requirements for authorized pharmacists dispensing HIV post-exposure prophylaxis as authorized by section 338.730, RSMo.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Nebraska
Gov. Pete Ricketts (R) issued Executive Order 22-05, to expire on December 31, 2022. Executive Order 22-02, which is currently scheduled to expire on September 30, 2022, shall remain in effect through December 31, 2022, and the identical statutory waivers and conditions contained within Executive Orders 21-12 and 21-15 that were extended by Executive Order 22-02 shall remain in effect through December 31, 2022, except that Medication Aide renewals will no longer be deferred after March 31, 2022. The Department of Health and Human Services prepared FAQs related to Executive Order 22-05.
Also in Nebraska, the Department of Health and Human Services (DHHS) announced the next COVID Update call will take place on October 12 at noon (Central). To join the all, dial 1-408-418-9388 and enter access code: 2485 909 6350 or use the meeting link: https://sonvideo.webex.com/sonvideo/j.php?MTID=m18465ba5a677a644d13049ac859b21dc
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Nevada
The Board of Pharmacy posted the agenda for the two-day hybrid virtual/in-person October 13 and 14 meeting.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
New York
New York: A grassroots alert supporting advocacy efforts in NYS (New York State) for the move of pharmacy benefits from Medicaid Managed Care to Fee for Service effective 4/1/23 (known as NYRx). Click here to access the alert
Please ask all your NY pharmacies and their staff members to act TODAY using this easy-to-use one click Alert to counter efforts by those opposed to NYRx who are actively trying to get NY lawmakers to repeal or delay it.
This policy is particularly important for Medicaid patients’ access to pharmacy care and for the community pharmacies that support them.
Also in New York, a request was sent out from the NY Department of Financial Services (DFS) last month. To clarify, please just send data to the Department directly, as directed below. Do not copy NACDS. However, if you do share that data with the state, I would ask that you let us know that you shared data with the Department so we will, at a minimum, be able to tell how many of our members responded with their own companies’ data. NACDS will be commenting and documents from other states highlighting the PBM issues.
The Department is inviting submissions of data or documented evidence from the public related to pricing models and pharmacy reimbursement practices by pharmacy benefit managers (“PBMs”) in New York State.
Responses should be emailed to PBM@dfs.ny.gov, with “PBM2022-06” included in the subject line. Failure to include “PBM2022-06” in the subject line may result in your comment not being considered. The deadline for responses is October 31, 2022.
For more information, please contact NACDS’ Ben Pearlman at 617-515-2603.
North Carolina
To ensure beneficiaries can seamlessly receive care on day one, the North Carolina Department of Health and Human Services (NCDHHS) will delay the implementation of the NC Medicaid Managed Care Behavioral Health and Intellectual/Developmental Disabilities Tailored Plans until April 1, 2023.
Tailored Plans, originally scheduled to launch December 1, 2022, will provide the same services as Standard Plans in Medicaid Managed Care and will also provide additional specialized services for individuals with significant behavioral health conditions, Intellectual/Developmental Disabilities and traumatic brain injury.
The delayed start of Tailored Plans allows Local Management Entity/Managed Care Organizations, which will operate the Tailored Plans, more time to contract with additional providers to support member choice and to validate that data systems are working appropriately. The decision is supported by the leadership of the state’s six LME/MCOs.
While the start of Tailored Plans will be delayed, specific new services will still go live December 1, 2022.
More information regarding the beneficiary choice period and other key dates leading up to the April 1, 2023, launch will be shared by NCDHHS in the coming weeks. For more information about Tailored Plans, please visit NC Medicaid’s Tailored Plan website.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Ohio
As you are aware, Ohio Medicaid (ODM) implemented the Single PBM, Gainwell, at Midnight on October 1. NACDS has been working with members, ODM and Gainwell daily to provide solutions as they work through technical issues causing denials, many of which have since been resolved or temporarily patched over. To report any major system issues, please use the dedicated email that Gainwell/ODM is monitoring in real-time. If you need NACDS’ assistance to emphasize significant issues, please contact Jill McCormack.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Pennsylvania
Gov. Tom Wolf (D) issued a news release this week announcing that the Naloxone Standing Order has been expanded to include the 2 Dose Formulation and encouraging patients to bring a copy of the standing order to pharmacies to request the drug. NACDS reminds members that the PA Naloxone Copay Assistance Program will reimburse pharmacies up to $75 for patient copays when the patient is hesitant to pick up the prescription due to cost. For practical operational reasons, the claim must be adjudicated on the current PACE Program system. However, a claim for ANY insured patient regardless of what type of insurance they have – commercial or public – qualifies. There are no criteria to proving financial hardship on the pharmacy because access is the point of the program.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Texas
The Drug Utilization Review Board posted the agenda for October 21 meeting. Refer to the Texas Drug Utilization Review Board Handbook for the instructions about submitting written materials to the board before the meeting and public testifying on the day of the meeting.
Also in Texas, the Health and Human Services Commission (HHSC) updated the July 2022 Medicaid Preferred Drug List on September 28 and provided the following updates:
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Washington
The Pharmacy Quality Assurance Commission (PQAC) is conducting a survey to assess current pharmacy practices pertaining to accessible labeling for both patients with visual and/or print disabilities and patients who require that prescription information be translated into another language besides English. The survey also includes whether such options are already made available, and what technological, financial or resource-based obstacles prevent such options from being offered. Any licenses are strongly encouraged to participate in the survey.
Also in Washington, the fourth quarter Preferred Drug List (PDL) has been posted to the Reports webpage. This PDL is used by Uniform Medical Plan and the Department of Labor and Industry.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Arkansas
Gov. Asa Hutchinson (R) appointed Mark White as the Secretary of the Department of Human Services, replacing Cindy Gillespie.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
California
The Department of Health Care Services posted the following alerts and weekly notices on the Medi-Cal Rx Web Portal.
- Submission of Pricing Prior Authorization for Brand Medically Necessary Medications: Dispense as Written (DAW 1) (September 29)
- Enteral Nutrition: Powder Dispensed in Packets, Billing Units Reminder (September 27)
- CoverMyMeds: Provider Support (September 27)
- Enteral Nutrition Update: Changes to the List of Covered Enteral Nutrition Products, Retroactive to September 1, 2022 (September 23)
- Medi-Cal Rx Weekly Wrap-Up for September 16-22 (September 23)
Also in California, this week, Medi-Cal posted "Medi-Cal Provider "Coffee Break" Event."
Finally in California, the Board of Pharmacy posted the agenda for the Enforcement and Compounding Meeting scheduled for October 4.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.