Virginia
The Department of Health has issued a Standing Order to help pharmacies adjudicate test kit claims and receive reimbursement. It has been posted on the VDH website, but here is the direct link as well.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Washington
The Health Care Authority (HCA) announced that the Human papillomavirus (HPV) vaccine is now a covered benefit under the Family Planning Only programs, effective February 1, 2022. For billing information, please refer to the Family Planning Billing Guide on the HCA website.
Also in Washington, in advance of the February 3rd House Finance Committee hearing, NACDS sent letters to members of the Committee and leadership stating our opposition to HB 2091, legislation that would increase the Business and Occupation (B&O) tax on prescription drug wholesalers.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Alabama
The newest Medicaid ALERT regarding COVID-19 “At Home” Tests billed through pharmacy can be found here.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
California
The Board of Pharmacy distributed the following:
- COVID-19 Vaccine Updates for Pharmacists
- Joint Statement on Western States Recommendation of Expanded Pfizer – BioNTech Booster Eligibility for 12- to 15-Year Olds
- Statement Regarding Dispensing Prescriptions Not Transmitted Electronically
- Information and Additional Resources Regarding e-Prescribing Requirements
Also in California, the following alerts have been posted to the Medi-Cal Rx Web Portal:
- Medi-Cal Rx Coverage of OTC COVID-19 Antigen Test Kits (January 26)
- Prior Authorization Required: Reject Code 75 (January 26)
Finally in California, the Office of Administrative Law has approved amendments to the following regulations:
- Pharmacists Initiating and Administering Vaccines. (Effective immediately)
- Address Change Notification. (Effective April 1)
- Ownership, Management, and Control of Pharmacies and Other Regulated Business Entities. (Effective April 1)
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Colorado
On February 14, the Board of Pharmacy is holding a Joint Stakeholder meeting to allow interested parties to provide feedback on the proposed revisions to the Statewide Protocol for Prescribing Hormonal Contraceptive Patches and Oral Contraceptives, and the Colorado Self-Screening Contraception Risk Assessment Questionnaire
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Illinois
The Illinois Department of Healthcare and Family Services has posted a new Provider Notice regarding Emergency Instructions for COVID-19 Home Test Kits. You may view the new Notice here.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Indiana
Currently the Health Commissioner of the State Department of Health or the Commissioner’s designated public health authority can issue standing orders, prescriptions, or protocols to administer or dispense certain immunizations for individuals who are at least 11 years old. SB 3, a bill that includes a provision that would lower the age limit to five years old, passed Third Reading in the Senate and now advances to the House for further consideration.
Also in Indiana, legislation that would have allowed pharmacists to prescribe hormonal contraceptives failed to get heard in the Senate Health and Provider Services Committee. (SB189)
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Iowa
The Department of Public Health published the COVID-19 Therapeutics Information Brief (1.25.22) including the following updates:
- Bamlanvimab/Etesevimab and REGEN-COV no longer authorized for use by FDA
- Allocations for mAbs, PrEP and Antivirals
- Disposal of extra doses of Nirmatrelvir from blister packs for patients with low eGFR
- COVID-19 treatment guidelines when there are logistical or supply constraints
- Patient prioritization for outpatient Anti-SARS-CoV-2 therapies with supply constraints
- FDA expands use of REMDESIVIR
- COVID-19 treatment guidelines for Evusheld
The next Therapeutics Information Brief will be February 2.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Louisiana
The Board of Pharmacy’s Regulation Revision Committee will meet in Baton Rouge on February 2nd to consider several legislative proposals including changing the age thresholds in pharmacy immunization law to match age thresholds in PREP Act. [01-12-2022] Consideration of Legislative Proposal 2022-H ~ Immunizations (Draft #1) If approved by the Committee, the items will be considered by the full Board on February 17th.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Maryland
Gov. Hogan (R) has issued an Executive Order that provides for staffing flexibility to pharmacies as they engage in COVID-19 vaccinations and testing.
Also in Maryland, the Department of Health has published an Advisory regarding Epidolex prescriptions due to a conflict between the federal and state scheduling process.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Massachusetts
MassHealth has released its most recent Fact Sheet to reflect recent modification in regulations regarding oral contraceptives and 340 drugs.
For more information, please contact NACDS’ Ben Pearlman at 617-515-2603.
Missouri
The Board of Pharmacy filed a revised emergency rule effective February 4, 2021, that will allow Missouri licensed interns and technicians located in other states to perform remote data entry.
Also in Missouri, due to system limitation, MO HealthNet will reimburse pharmacy providers $0.01 for the full course of the therapeutic and the full dispensing fee. Pharmacy providers must submit a cost to MO HealthNet in excess of the Professional Dispensing Fee (PDF) to receive full reimbursement of the PDF. MO HealthNet will also cover home tests currently payable at $12 per test plus the PDF.
Finally in Missouri, MO HealthNet in partnership with Missouri Board of Pharmacy’s Rx Cares for Missouri Program and the Missouri Department of Health & Senior Services (DHSS), kicked off the “Safe At Home” Patient Safety Opioid Initiative. It allows MO HealthNet to reimburse pharmacy providers who dispense at-home medication disposal packets to eligible MO HealthNet participants who are at risk of experiencing an opiate-related overdose. MO HealthNet has selected DisposeRx® packets as the preferred medication disposal packet. These convenient at-home medication disposal packets will allow MO HealthNet participants to dispose of unused opioids safely and easily, preventing accidental overdoses.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Nebraska
The Department of Health and Human Services announced the next COVID-19 Medicaid Provider call will take place on February 2 at noon (Central).
Also in Nebraska, the Department of Health and Human Services made available the new COVID-19 Ad Hoc Fee Schedule (1.1.2022), including adjustments to payments for administration of COVID-19 vaccines.
Also in Nebraska, the Department of Health and Human Service posted the revised fee schedule for injectables effective January 1, 2022 REVISED.
Also in Nebraska, the Department of Health and Human Services issued Provider Bulletin 22-05A to notify providers that effective January 15, 2022, OTC COVID at-home tests will be covered by Medicaid. The reimbursement policy is up to $12.00 for a kit containing one test or up to $24.00 for a kit containing two tests is allowed.
Finally, the Department of Health and Human Services issued Provider Bulletin 22-06 announcing changes to the Tobacco Cessation Program. Effective December 26, 2021, enrollment in the Nebraska Tobacco Free Quitline is no longer required to be able to receive tobacco cessation products; enrollment is still encouraged.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Nevada
Effective January 1, 2022, all controlled substance prescriptions MUST be transmitted to a pharmacy by electronic prescribing, except for the following prescriptions:
- a) Issued by a veterinarian;
b) Issued under circumstances where:
Electronic transmission is unavailable due to technologic or electronic failure; or
2. The drug will be dispensed at a pharmacy located outside of this State;
c) Issued by a practitioner who will also dispense the drug;
d) For which electronic prescribing is prohibited by federal law;
e) Issued pursuant to a protocol for research; or
f) Issued under circumstances in which the practitioner determines that:
1. The patient is unable to obtain the drug in a timely manner if the prescription is given by electronic transmission; and
2. Delay will adversely affect the patient’s medical condition.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
New Hampshire
Medicaid is ready to process at home COVID antigen tests. The necessary changes to be able to process the tests were completed last Friday (1/21/22), the pharmacy fax blast was sent out Friday afternoon as planned and is also posted online. Medicaid has issued a notice along with a standing order from DHHS for the at home tests that pharmacies may use. Dr. Ballard’s NPI number is on the order.
For more information, please contact NACDS’ Ben Pearlman at 617-515-2603.
New Jersey
The Board of Pharmacy has finalized three regulations dealing with patient counseling documentation requirements, increased out of state permit fees, and removal of waiting period to retake pharmacist exams.
For more information, please contact NACDS’ Ben Pearlman at 617-515-2603.
North Carolina
Dr. Betsey Tilson, State Health Director, rescinded the following Statewide Standing Orders due to the high prevalence of the Omicron variant of SARS-CoV-2 virus in North Carolina for which these therapies are not an effective treatment:
- Statewide Standing Order for Subcutaneous Administration of Casirivimab/ Imdevimab (REGEN-COV) Monoclonal Antibodies
- Statewide Standing Order for Intravenous Administration of Casirivimab/ Imdevimab (REGEN-COV) Monoclonal Antibodies
- Statewide Standing Order for Intravenous Administration of Bamlanivimab/ Etesevimab Monoclonal Antibodies
The recission orders can be accessed here: https://covid19.ncdhhs.gov/guidance#vaccination-info-for-providers
These Statewide Standing Orders may be reactivated in the future depending on the effectiveness of the therapies on circulating variants.
Also in North Carolina, reminder effective Jan. 10, 2022, NC Medicaid-enrolled pharmacies may bill for FDA approved over the counter (OTC) COVID-19 tests dispensed for use by NC Medicaid beneficiaries in a home setting, with or without a prescription issued by an NC Medicaid-enrolled provider. NC Medicaid Direct beneficiary implementation date is Jan. 10, 2022. Refer to beneficiaries’ managed care plan for guidance on the specific plan’s implementation date.
Finally, NC Medicaid will cover one kit per claim per date of service, with a maximum of four test kits every 30 days. Covered test kits are listed below. Please note that some kits will include two tests.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Ohio
The Board of Pharmacy recently posted the following documents on their webpage:
Updated COVID Therapeutics Guidance
Authorization for National Guard to Serve as Pharmacy Technician Trainees
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Oklahoma
The National Association of Insurance Commissioners (NAIC) announced that Oklahoma Insurance Commissioner Glen Mulready would serve as chair of the NAIC Health Insurance and Managed Care (B) Committee for the 2022 term.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Oregon
The Board of Pharmacy posted the agenda and meeting materials for the February 9-11, Board Meeting.
Also in Oregon, the Board of Pharmacy issued a notice requesting fiscal impact for Pharmacy Prescription Lockers (PPL) from stakeholders. Note: any information provided to the Board becomes a public record.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Pennsylvania
The state has reissued billing guidance for the Pharmacy Naloxone Copay Assistance Program, because of claims – otherwise eligible- but rejected due solely to coding errors. The claims are eligible for correction for payment. NACDS reminds members that naloxone claims from any patient, regardless of type of insurance coverage, are eligible for the copay to be reimbursed to the pharmacy. The program, which NACDS and PACDS helped the Governor’s Opioid Taskforce develop with member input, is funded through federal grants and meant to incentivize greater naloxone access to all Pennsylvanians. It is run on the PACE program system merely to streamline the adjudication process for pharmacies.
Also in Pennsylvania, The Department of Human Services published a Bulletin for COVID Oral Antiviral Treatments billing procedures and codes for pharmacies.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Virginia
The Board of Pharmacy issued the following clarification regarding pharmacy technicians’ authority to administer vaccines:
As part of his COVID Action Plan, Governor Glenn Youngkin signed Executive Order 11, to give flexibility and support to healthcare providers, hospitals and other healthcare facilities. Paragraph 13 of Executive Order 11 increases the number of persons performing the duties of a pharmacy technician that a pharmacist may supervise to five (5) and exempts pharmacy technicians performing COVID-19 administrative tasks from being counted in the ratio. Please be advised that the administration of a CLIA-waived test or vaccine does not constitute an administrative task. Additionally, the decision regarding the number of pharmacy technicians a pharmacist will supervise, and whether any other duty constitutes a COVID-19 administrative task, is a decision that must be made by the Pharmacist-in-Charge or pharmacist on duty, pursuant to 18VAC110-20-112(A) and 18VAC110-20-110(C). The Executive Order shall remain in effect until February 21, 2022, unless sooner amended or rescinded by further executive order or directive.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Washington
Apple Health (Medicaid) covers over–the–counter (OTC) COVID-19 tests with or without a prescription for clients. An adjudicated pharmacy claim is required for reimbursement. Pharmacies may not bill for test administration of an OTC COVID-19 test as these tests should be used by the patient in the home setting.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
West Virginia
The Insurance Commissioner has issued Pharmacy Freedom of Choice and Pharmacy Reimbursement Bulletins based on the passage of HB 2263 in 2021. Please note the Bulletins include information or members wanting to report potential violations to the Insurance Commissioner.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
California
On January 10, Gov. Gavin Newsom (D) released his proposed 2022-23 State Budget. Both the Governor’s Budget Summary (See page 109+ for Health and Human Services) and Proposed Budget Detail have been posted. Of interest in the Health and Human Services section include:
- Savings related to Medi-Cal Rx Implementation ($327 Million)
- Savings related to Pharmacy Recoupment (See bottom of page 10.) ($100 Million)
Legislative hearings and negotiations will begin and February and continue through May. The Governor will release a revised budget in May.
Also in California, the Department of Health Care Services published the following alerts:
- Alert Summary for the Week of January 9-14
- Medi-Cal Rx Customer Service Center Main Menu Prompt Options
- DHCS COVID-19 Vaccine Administration Provider FAQs – January 7, 2022
- Reject Code 73: Max Refill
- Medi-Cal Rx Finance Portal Job Aid Available
Also in California, the Board of Pharmacy sent a notice about reissued pharmacy law waivers in response to Gov. Gavin Newsom’s (D) declaration of emergency and the nation declaration of emergency.
- Duty to Consult (Title 16, California Code of Regulations, section 1707.2(a))
- Prelicensure Inspection at Proposed Location of an Automated Drug Delivery System (ADDS) – Business and Professions Code sections 4119.11(a)(9) and BPC 4427.2(e)
- Signature Requirement for Receipt of Delivery of Drugs (BPC section 4059.5)
- Requirement for Consulting Pharmacist to Make Quarterly Visits to Clinic (BPC sections 4182(a) & (b)/BPC 4192(a) & (b))
Also in California, the Board of Pharmacy issued a Notice of Meeting and Agenda for the Teleconference Medication Error Reduction and Workforce Committee Meeting on January 27. Meeting materials will be posted on the website in advance.
Finally in California, the Board of Pharmacy published a Notice of Meeting and Agenda for the Teleconference Public Board Meeting scheduled to be held January 27-28. Meeting materials will be posted on the website in advance.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.