Wisconsin
The Department of Safety and Professional Services announced it earned a $1.4 million grant from the Federal Bureau of Justice Assistance for its Enhanced Prescription Drug Monitoring Program (ePDMP). The grant funds will be used to modernize the self-service functionality and provide improved data quality, better customer support and greater user satisfaction.
For more information, please contact NACDS’ Mike Sargent at 207-272-6435.
Alabama
Reminder, Alabama Administrative Rule 420-4-1-.04 requires pharmacists to report to the State Health Officer or designee the dispensing of anti-tuberculosis medications and dispensing of antiretroviral medications to an infant.
Also in Alabama, all previously published expiration dates related to the COVID-19 public health emergency (PHE) are once again extended by the Alabama Medicaid Agency. The new expiration date is the earlier of November 30, 2022, the conclusion of the COVID-19 national emergency, or any expiration date noticed by the Alabama Medicaid Agency through a subsequent ALERT.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
California
The Department of Health Care Services posted the following alerts and weekly notices on the Medi-Cal Rx Web Portal.
- Coverage of Sterile Syringes with Needles (Non-Insulin) (October 26)
- Reminder for Providers Regarding Patient Privacy (October 26)
- Historical Pricing and Reimbursement Corrections for Ixinity, Alprolix, Eloctate, and NovoSeven 4Q 2021 through Q3 2022 (October 25)
- Bivalent COVID-19 Vaccines Administration Now a Benefit (October 21)
- Medical Rx Weekly Wrap-Up for October 14-21 (October 21)
Also in California, the Board of Pharmacy issued its Annual Notice of Availability of Precedential Decisions Index. The index and the text of the precedential decisions are available on the Board’s webpage.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Kentucky
Patients and pharmacies in the Commonwealth took a giant leap forward this week when Anthem announced they will be enrolling pharmacists as network providers. The move is a result of the enactment of a law that provides for pharmacy payment parity; HB 48 of 2021 required Kentucky health plans to reimburse pharmacists for services within a pharmacist’s scope of practice that are otherwise covered by the plan, if provided by another healthcare provider. Coupled with a pharmacist’s current authority to provide more than a dozen clinical services under Board of Pharmacy Protocols, Anthem members will have widespread convenient access to treatment at pharmacies for ailments such as flu, strep and tobacco cessation. Pharmacies interested in enrolling in the network should contact kyprovidercontracting@anthem.com. For more information, please see the Kentucky Pharmacists Association’s (KPhA’s) latest news release. NACDS applauds KPhA for its work with Anthem and its leadership in our joint support for HB 48.
Also in Kentucky, Medicaid has proposed a rule that may make it easier for pharmacies to provide vaccine services to kids with Medicaid coverage. The rule change eliminates the requirement to use Vaccines for Children (VFC) stock and strikes current language that states Medicaid will not reimburse for the cost of any vaccine if already available through the VFC program. NACDS interprets this to mean that pharmacies do not have to be enrolled in VFC to immunize and be reimbursed for Medicaid-covered kids. NACDS is seeking member feedback to determine whether this change would be significant to your vaccination efforts. Please review this rule and send Jill McCormack your comments by November 18.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Massachusetts
Latest edition of MassHealth Pharmacy Facts has been distributed to MassHealth Pharmacy providers.
Also in Massachusetts, MassHealth has issued the attached corrected bulletin #352 relative to the reporting and payment of overpayments received from MassHealth. The original bulletin was issued in September 2022.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Nebraska
The Department of Health and Human Services (DHHS) posted the COVID-19 Fee Schedule Bivalent Booster Updated (revised 10.27.2022).
Also in Nebraska, the DHHS announced Medicaid’s next COVOID update call will be held on November 2 at noon (Central). To join the call, dial 408-418-9388 (access code) 2492 610 1342 or use the meeting link:
https://sonvideo.webex.com/sonvideo/j.php?MTID=m3aab184252403e62a6ff312be38e9d54
Also in Nebraska, the Board of Pharmacy posted its agenda for the November 7 meeting.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
North Carolina
To help providers, the Department of Health and Human Services updated its Provider Guidance on Therapeutics to include detailed up-to-date information. Providers are encouraged to read the guidance. More information is available on the Therapeutics Information for Providers webpage.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
New York
NACDS will be attending the annual meeting for the Community Pharmacy Association of New York in Albany on November 15th. At this meeting, the priorities and strategies for the 2023 legislative session will be reviewed.
Also in New York, our comments, that were reviewed by New York members will be submitted to the Department of Financial Services for the October 31st deadline. If your company is also submitting your own comment letter, please be sure to place PBM2022-06 in the subject line.
For more information, please contact NACDS’ Mike Sargent at 207-272-6435.
Ohio
This week, Ohio Medicaid announced the payment schedule for the Supplemental Managed Care Dispensing Fee and that the fee has been increased due to the compressed schedule of payments. The payment schedule is:
Payment 5 – Between November 1 – 15, 2022 (July – Sept 2022 claims)
Payment 6 – Between February 1 – 15, 2023 (Oct – Dec 2022 claims)
Payment 7 – Between May 1 – 15, 2023 (Jan – March 2023 claims)
Payment 8 – No later than August 15, 2023 (April – June 2023 claims)
Note that the November payment will be issued by the Medicaid MCOs (Managed Care Organizations) and, as in the past, will be included in your weekly claim payments. However, the balance of the payments will come from Gainwell, the SPBM (Single Pharmacy Benefit Manager), as a separate payment. The FAQ document includes more detail.
Also in Ohio, Medicaid has prepared a toolkit for providers to prepare for the expiration of the federal Public Health Emergency (PHE). The materials are focused on the “unwinding” patient eligibility that will result at the end of the PHE.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Oregon
The Oregon State Pharmacy Association announced the results of its PBM study conducted by 3 Axis Advisors to review reimbursement trends between payers and retail pharmacies between 2019 and 2021.
Also in Oregon, the Board of Pharmacy posted its agenda for its Strategic Planning Meeting scheduled to be held on November 10.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Pennsylvania
On the last day of the 2021-22 session, a PBM transparency bill backed by NACDS and PACDS (Pennsylvania Association of Chain Drug Stores), passed the Senate unanimously and is on its way to Gov. Tom Wolf (D) for signature. HB 1630 allows the Auditor General access to PBM data in the Medicaid Managed Care Program to perform audits. Notably, 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.
Also in Pennsylvania, the Department of Human Services released the final regulation for IRRC No. 3308 – Interrelationship of Providers (14-549) allowing providers to co-locate. Providers who received a waiver of the previous regulation will still be operating under that waiver until the final form regulation takes effect. The regulation will be considered at the Independent Regulatory Review Commission (IRRC) meeting on December 8 and comments are accepted until 48 hours prior to the meeting.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Alabama
Please find an ALERT describing the addition of state-licensed pharmacist Paxlovid prescribing to eligible patients in accordance with the FDA. This ALERT has been disseminated to all enrolled pharmacies.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
California
The Department of Health Care Services posted the following alerts and weekly notices on the Medi-Cal Rx Web Portal.
- Diabetic Supplies: Update to the Minimum Quantity for FreeStyle Libre 3 (October 14)
- Medi-Cal Rx Weekly Wrap-Up for October 7-13 (October 14)
- Medical Supplies: Continuous Glucose Monitoring Systems and Disposable Insulin Delivery Devices Updates (October 7)
- Medical Supplies: Disposable Insulin Delivery Devices Updates (October 7)
- Medi-Cal Rx Weekly Wrap-Up for September 30-October 6 (October 7)
Also in California, Medi-Cal posted the following:
- Coming Soon: Monkeypox Vaccine Reimbursement at the Medicare Rate (October 14)
- October 2022 Pharmacy Medi-Cal Update Bulletin 1025 (October 14)
- October 2022 Durable Medical Equipment and Medical Supplies Medi-Cal Update Bulletin 565 (October 14)
Also in California, Gov. Gavin Newsom (D) announced the State of Emergency and the associated Executive Orders N-39-20 and N-75-20 will end on February 28, 2023. The Department of Consumer Affairs subsequently posted that upon the State of Emergency ending, active waivers that were used under the authority of the State of Emergency and Executive Orders will also expire. For future updates, check the DCA waiver webpage or the Board of Pharmacy website.
Finally in California, the Board of Pharmacy posted the following:
- Standard of Care Agenda and Meeting Materials – October 25 at 9:00 a.m. PDT
- Full Board Agenda and Meeting Materials – October 25 at 1:30 p.m. PDT and October 26 at 9:00 a.m. PDT
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Delaware
On October 13, 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 8th extension of the PHE.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Florida
The Department of Revenue Executive Director Jim Zingale announced extended due dates for corporate income tax filers impacted by Hurricane Ian following the recent declaration from the Internal Revenue Service (IRS). Eligible taxpayers that file Florida corporate income tax returns, as well as Florida corporate income tax installment payments, with original due dates or extended due dates falling on or after September 23, 2022, and before March 2, 2023, will now have a due date of March 2, 2023. This tax relief is applicable to affected businesses anywhere in Florida.
Additional information is available on the Tax Relief for Victims of Hurricane Ian webpage on IRS.gov. Taxpayers outside Florida who require assistance with corporate tax filing may contact the Department’s taxpayer services at (850) 488-6800 or GTAHurricaneHelp@floridarevenue.com.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Indiana
In advance of the October 20 Interim Study Committee on Financial Institutions and Insurance joint hearing on market concentration of the health insurance industry, NACDS submitted a letter focusing on market concentration in the PBM (Pharmacy Benefits Managers) industry and its impact on retail community pharmacies and patient health.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Iowa
The Board of Pharmacy posted its agenda and meeting materials for the October 25 meeting. The meeting will be held via Zoom and in-person at the Board of Pharmacy office.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Louisiana
Gov. John Bel Edwards (D) appointed several members to serve on the Board of Pharmacy — independent pharmacist Richard Mannino and Walmart pharmacist Jennifer Dupree.
Also in Louisiana, Medicaid continues to enroll providers who have missed the September 30, 2022, deadline.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Massachusetts
Effective December 19, 2022, MassHealth will make it mandatory for certain designated generic drugs, other designated low-net-cost drugs and drugs listed as preferred in the Brand Name Preferred section of the MassHealth Drug List to be dispensed in a 90-day supply. These drugs will be designated on the MassHealth Drug List A-Z list with a footnote of M90. Policy details can be found here.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
New York
On Tuesday, October 18, 2022, the New York State Department of Health (DOH) hosted a public online seminar about the transition of the pharmacy benefit from Medicaid Managed Care to NYRx, the Medicaid Fee-For-Service (FFS) pharmacy program. A copy of the presentation is now available. Valuable information and resources for Medicaid members and providers are also available on the DOH pharmacy transition website. Questions about the transition should be directed to NYRx@health.ny.gov. Please include “Pharmacy Benefit Transition” in the subject line.
For more information, please contact NACDS’ Mike Sargent at 207-272-6435.
Nebraska
On October 13, the Department of Health, and Human Services (HHS) posted the COVID-19 Fee Schedule Bivalent Booster Update.
Also in Nebraska, the HHS posted the Aducamumab (Aduhelm) prior authorization form for Fee-for-Service to its website.
Finally in Nebraska, the Credentialing Review (407) Program will meet on October 26 regarding Pharmacy Technicians. The agenda has been posted on the Credential Review (407) Pharmacy Technician webpage.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
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.