Oregon
The Board of Pharmacy posted the agenda and meeting materials for its meeting being held December 14-16.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Rhode Island
Please see the December 2022 provider update found here on the Executive Officer of Health and Human Services (EOHHS) website.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Tennessee
Gov. Bill Lee (R) named Dr. Ralph Alvardo, MD, FACP as the Commissioner for Tennessee Department of Health. Dr. Alvardo brings decades of diverse professional experience to Tennessee, which includes nearly 30 years as an attending physician, serving in the Kentucky State Senate since 2015 and leading the Senate Health and Welfare Committee as chairman since 2019.
Also in Tennessee, TennCare announces additional drugs to the CoverRx list, including Synthroid, Armour Thyroid and Nicotine Replacement Therapy (NRT). The TennCare CoverRx coverage was effective December 1.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Texas
NACDS provided comments to the Health and Human Services Commission’s Vendor Drug on proposed policies related to the transition of the Medicaid pharmacy formulary, preferred drug list and prior authorization requirements to managed care organizations.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Washington
NACDS provided comments in advance of the Washington State House Health Care and Wellness Committee’s December 1 workshop meeting on “Pharmacy Benefit Manager Impacts on Prescription Drug Cost and Regulatory Developments.” In our letter, NACDS urged legislative action to curb harmful pharmacy benefit manager (PBM) practices including patient-steering, limiting pharmacies’ participation in provider networks and reimbursement practices that result in below-cost reimbursement to pharmacy providers.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Alabama
All previously published expiration dates related to the COVID-19 public health emergency (PHE) are once again extended by the Alabama Medicaid Agency (Medicaid). The new expiration date is the earlier of December 31, 2022, the conclusion of the COVID-19 national emergency or any expiration date noticed by the Alabama Medicaid Agency through a subsequent ALERT. Medicaid is preparing now for the end of the COVID-19 PHE. Medicaid partners can assist in relaying a consistent and simple message to the Medicaid recipients by sharing key messages from the Agency in your newsletters, social media posts and other means of communication.
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.
- 45-Day Countdown – Cal MediConnect Transition to Medicare Medi-Cal Plans (November 16)
- Update to Policy and Billing Guidance for Pharmacy Providers on COVID-19 Oral Antiviral, Paxlovid (November 11)
- Policy and Payment Allowance Update for Provider-Purchased Bebtelovimab for Treatment of COVID-19 (November 11)
- Medi-Cal Rx Weekly Wrap-Up for November 4-10 (November 11)
- NCPDP (National Council for Prescription Drug Programs) Reject Code 80 and Diagnosis Documentation of Code 1 Restriction (November 9)
- Changes to the Family PACT Pharmacy Formulary (November 7)
- Prior Authorization Required: Reject Code 75 Reminder (November 4)
- Medi-Cal Rx Weekly Wrap-Up for October 28-November 3 (November 4)
Also in California, Medi-Cal posted the following:
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Colorado
Gov. Jared Polis (D) named House Speaker Alec Garnett as his new chief of staff.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Indiana
The Indiana Health Coverage Programs will host an online seminar on December 1 to discuss provider notices published during November.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Iowa
The Department of Health and Human Services, Iowa Medicaid published INFORMATIONAL LETTER NO. 2402-MC-FFS announcing the November Towns Halls will be held on Thursday, December 1, 2022, due to the Thanksgiving holiday. Visit the website for details, including registration information.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
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.