Florida
Effective January 1, 2022, the UnitedHealthcare of Florida, Inc., and UnitedHealthcare Insurance Company Dual-Eligible Special Needs Plans (D-SNP) changed their names to Care Improvement Plus South-Central Insurance Company d/b/a UnitedHealthcare Dual Complete. All member benefits, provider networks, and plan telephone numbers remain the same. United Healthcare continues to be responsible for the services provided to members of United Healthcare Dual Complete Plan including Medicare and Medicaid services. The website will remain www.UHCCommunityPlan.com
Contact numbers: Member and Provider Services: 1-844-560-4944
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Georgia
Immunization Delivery Training for Pharmacy Technicians. A 6.0 hour CE program consisting of both home-study and live training. Under HHS authorization (PREP Act 10.20.20) trained pharmacy technicians can administer certain vaccines under the supervision and authorization of a pharmacist. GPhA is offering live training on
Saturday, February 19, 2022
9:00 am – 12:00 pm
Georgia Pharmacy Association Classroom
GPhA’s Immunization Delivery Training program for Pharmacy Technicians is recognized as an education provider for the Pharmacy Technician Certification Board’s (PTCB) Immunization Administration Assessment-Based Certificate. CLICK HERE for more information and to register!
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Illinois
The Illinois Department of Healthcare and Family Services has posted the October 21, 2021 D & T Advisory Board Meeting Minutes at the following link.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Iowa
The Department of Human Services, Iowa Medicaid Enterprise (IME) published INFORMATIONAL LETTER No. 2306-MC-FFS announcing plans for the 2022 Pharmacy Cost of Dispensing Study.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Kentucky
SB 25 passed the General Assembly last week and extended COVID executive orders until 4/4/22. Of interest to pharmacy, this bill continues emergency dispensing, remote work for pharmacists, and the ordering and administering vaccinations and COVID-19 testing.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Maryland
The Maryland Insurance Administration (MIA) has released its report on the impact of Rutledge v. PCMA court decision and the subsequent Webhi decision on Maryland law and the MIA’s ability to regulate Pharmacy Benefits Managers (PBMs) relationships with pharmacies in Maryland. The report was mandated by the passage of HB 601 of 2021. It concluded that, should the legislature pass legislation regulating PBMs when providing services to an ERISA plan, ERISA would not preempt the MIA’s enforcement of those laws. The report also provides a summary of previously passed laws related to PBMs in Maryland and MIA’s current methods of enforcing them. The report cites comments jointly submitted from NACDS and the Maryland Association of Chain Drug Stores last fall, which highlighted examples of pro-pharmacy laws that align with the Rutledge decision.
Also in Maryland: On December 15, the Department of Health (MDH) issued an updated Vaccination Matters Order and guidance.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Massachusetts
The Massachusetts Drug Control Program has recently released a reminder regarding the dispensing of generic drugs.
For more information, please contact NACDS’ Ben Pearlman at 617-515-2603.
Minnesota
The Division of Insurance of the Department of Commerce’s Final Rule on PBM Licensure and Regulation was adopted with the revisions, published in the register, and became effective Jan 18. For further detail and background or to read stakeholder comments, including those filed by NACDS, go to the Department’s rulemaking page.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Montana
The Board of Pharmacy reminds pharmacies that the temporary emergency rule (MAR 24-174-77) expired on January 11, 2022; this temporary rule included the removal of the pharmacist to pharmacy technician ratio for purposes of vaccine and testing administration and allowed other healthcare providers authorized to administer vaccines to assist pharmacists with vaccine administration. Since these provisions are no longer in effect, the pharmacist to pharmacy technician ratio is 1:4 per ARM 24.174.711.
Also in Montana, the Board of Pharmacy issued a Notice of Public Hearing on Proposed Amendment in MAR 24-174-78. This proposed amendment removes the pharmacist to pharmacy technician ratio, provides for certain pharmacist-in-charge oversight in staffing and allows for other healthcare providers authorized to administer vaccines to assist pharmacists with vaccine administration. The Public Hearing will be held via remote conferencing on February 4. Written comments must be received no later than 5:00 p.m. on February 11.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Nebraska
The Department of Health and Human Services published Provider Bulletin 22-04 with recent updates on COVID-19 vaccines consistent with CDC guidance. It also published reimbursement for oral antiviral medications, vaccines, and monoclonal antibody administration. Of note, for COVID-19 oral antiviral medications purchased and provided by the government, Medicaid will pay its standard dispensing fee for fee-for-service members. The state’s Medicaid managed care health plans may pay a contractual dispensing fee to the pharmacy for Medicaid members enrolled in the health plan.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
New Hampshire
Medicaid will be issuing a pharmacy notice regarding coverage of COVID at home antigen tests as soon as it is ready to process the claims. It is anticipated that claims processing will begin around January 25.
For more information, please contact NACDS’ Ben Pearlman at 617-515-2603.
New York
Yesterday Governor Kathy Hochul (D) released her executive budget for SFY 2022-23 which contains several provisions impacting pharmacies. Several provisions deal with the scope of pharmacy practices including:
- NYSDOH (New York State Department of Health) Oversight of Certain Professions: Transfers the oversight of Health/Mental Hygiene professions including pharmacists from NYSED to NYSDOH.
- Pharmacist CLIA-Testing: Allows licensed pharmacists to perform non-invasive CLIA-waived tests like other qualified healthcare professionals and authorizes licensed pharmacists to serve as direct limited-service laboratory, directors ordering and administering such tests
- CDTM: Makes current CDTM law which expired this year permanent
- Medication Administration: Changes scope of practice laws to allow certified medication aides to administer routine medications under certain conditions, allows physicians and NPs to issue non patient specific standing orders to COVID-19, flu, and upper respiratory illness testing, and allows any individual to collect specimens from patients for COVID-19 or flu testing per training and under supervision of a registered nurse, NP, or physician
Opioids/Addiction
- Naloxone/MAT: Requires pharmacies to maintain a stock of a 30-day supply of at least one version of opioid antagonists/naloxone and MAT/Buprenorphine, as permitted within DEA rules and wholesaler thresholds. Last week with the help of members, we educated OASAS about these restrictions and are glad to see they included language recognizing the limitations on pharmacies ability to stock these medications. See language in proposal attached, comments welcomed.
- Expanding Alcohol Awareness: Expands alcohol awareness programs to include other forms of addiction and recreational cannabis
Also in New York, The New York Board of Pharmacy has just released its updated NYS Drug Price List dated December 2021, including the required sign that must be posted offering the list to the public upon request.
For more information, please contact NACDS’ Ben Pearlman at 617-515-2603.
North Carolina
State Health Director Dr. Betsey Tilson has issued a statewide standing order which will allow insurance coverage to cover costs for COVID home tests, including Medicaid. The link to the order can be found here. It can also be found here under the Provider Section.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Virginia
On January 20, Governor Youngkin (R) declared that a limited state of emergency exists in the Commonwealth due to COVID-19 and issued Executive Order 11 to provide relief for hospitals and healthcare workers. The Order is effective until February 21, 2022. Among other provisions, the order allows healthcare providers, pharmacists, pharmacy interns, and pharmacy interns with active licenses in other states to practice in Virginia; increases the pharmacy technician ratio to 5:1 and exempts pharmacy technicians performing only administrative functions from the count. Additionally, it permits licensed practical nurses to administer COVID-19 vaccines without the supervision of a registered nurse or licensed medical practitioner. It also provides certain liability protections to providers who act in good faith to protect patients.
Following the release of the Executive Order, the Board of Pharmacy emailed a communication to licensees waiving restrictions around pharmacy central/remote processing and the utilization of pharmacists and pharmacy technicians located in other states.
Also in Virginia: The Department of Health has issued an updated Naloxone Standing Order signed by Dr. Colin Greene.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Washington
In advance of the January 17th House Health Care and Wellness Committee hearing on HB 1852 / SB 5840 legislation that would require by January 1, 2023, prescription label translations in 15 languages for both the directions for use and the side effects of the drug, the latter which is not currently required to be on the label, NACDS submitted this statement for the record opposing the bill.
NACDS has substantial concerns that although well-intentioned, this bill would impose new requirements for labeling prescriptions in multiple languages that would be redundant to the ways that pharmacies ensure meaningful access to care for individuals with limited English proficiency under 45 CFR 92.201. Moreover, we are concerned that the requirements of this bill go beyond what is practical and could potentially undermine the numerous ways that pharmacies already provide translation services to their patients. We, therefore, urge Washington lawmakers to reject his impractical legislation.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
West Virginia
The Insurance Commissioner issued two Bulletins to underscore prohibited activities by PBMs because of the passage of HB 2263 of 2021. Specifically, the Bulletins address pharmacy Freedom of Choice and Pharmacy Reimbursement. The latter has an effective date of January 1, 2022.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
California
Medi-Cal Rx posted the following alerts. To view all alerts, visit Bulletins & News on the Medi-Cal Rx website.
- Claim Submission Reminders (January 11)
- Prior Authorization Required: Reject Code 75 (January 9)
- Pharmacy Claims Reject Code 65 – Resolved (January 9)
- Alert Summary for the Week of January 3-7 (January 7)
Also in California, note the recently issued Billing Guidance for Pharmacy Providers on COVID-19 Oral Antivirals (January 6).
Also in California, the Board of Pharmacy issued a pharmacy law waiver for Prescriber Dispensing of COVID-19 Oral Therapeutic Medication to Emergency Room Patients.
Finally in California, the Board of Pharmacy has rescheduled its next quarterly two-day meeting. The new meeting dates are January 27-28. Committee meeting materials have also been posted.
- January 18, 2022
- January 19, 2022
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- Licensing Committee, 9 a.m.
- Communication and Public Education2:30 p.m.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Colorado
The Department of Health Care Policy and Finance (HCPF) announced today that they received approval from CMS to further increase the Health First Colorado and CHP+ reimbursement rate for COVID-19 vaccine administration to $61.77 for the first two doses, retroactive to September 1, 2021. This rate is triple the typical Medicaid vaccine administration rate and 50% above the Medicare rate.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Delaware
The Delaware Board of Pharmacy has proposed revisions to its rules and regulations. All comments are due by February 3, 2022.
For more information, please contact NACDS’ Ben Pearlman at 617-515-2603.
Illinois
The Illinois Department of Healthcare and Family Services has posted a new Provider Notice regarding Pharmacy Instructions for COVID-19 Vaccine for Children Ages 5-11. You may view the new Notice at the following link as well as a new Provider Notice regarding Pharmacy Billing of Subcutaneous Monoclonal Antibody Treatment. You may view that new Notice at the following link.
Also in Illinois, the Illinois Department of Healthcare and Family Services has posted an Updated DME Fee Schedule. Please note: Corrections have been made to codes L0637, A4230 and A4231. You may view the new Fee Schedule at the following link.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Iowa
The Department of Human Services published INFORMATIONAL LETTER NO. 2305-MC-FFS-CVD to inform providers about pharmacy coverage of oral COVID-19 therapeutics. See “Pharmacy Coverage Summary” on page 2.
Also in Iowa, the Board of Pharmacy published its November 10, 2021 meeting minutes.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Kentucky
Rep. Steve Sheldon (R) has introduced legislation to comprehensively regulate Pharmacy Benefit Managers. House Bill 203 would regulate PBMs in commercial and self-insured plans, as well as the state employee plan. The bill includes patient choice of pharmacy protections and measures that protect pharmacy reimbursed. It would also prohibit mandatory mail order, require any rebates to reduce patients’ out-of-pocket costs and set a pharmacy reimbursement floor based on NADAC + professional dispensing fee. Additionally, it would require PBMs to treat 340B claims like other prescription claims for reimbursement purposes.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Louisiana
Referencing the federal law and regulations, the Board of Pharmacy’s Regulation Revision Committee sent to the full Board for final consideration at the February 16 meeting draft CLIA guidelines confirming that properly credentialed pharmacies may perform moderately complex lab testing.
Also in Louisiana, the Department of Health (LDH) Bureau of Health Services Financing issued a Provider Update on reimbursement for COVID-19 booster shots and third doses for Medicaid Fee for Service (FFS) Pharmacy Program and Managed Care Organizations (MCOs). Effective January 18th, Louisiana Medicaid will reimburse enrolled pharmacies for the administration fee or $37.08 or billed charges, and not for the ingredient for COVID-19 vaccines. No dispensing fee shall be reimbursed.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Maryland
The Maryland Insurance Administration (MIA) has released its report on the impact of Rutledge v. PCMA and the subsequent Webhi decision on Maryland law and the MIA’s ability to regulate Pharmacy Benefits Managers (PBMs) and their relationship with pharmacies in Maryland. The report was mandated by the passage of HB 601 of 2021. It concluded that, should the legislature pass legislation regulating PBMs when providing services to an ERISA plan, ERISA would not preempt the MIA’s enforcement of those laws. The report also provides a summary of previously passed laws related to PBMs in Maryland and MIA’s current methods of enforcing them. The report cites comments from NACDS and the Maryland Association of Chain Drug Stores submitted last fall, which highlighted examples of pro-pharmacy laws that align with the Rutledge decision.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Missouri
Gov. Parson’s (R) ended the COVID-19 State of Emergency on December 31, 2021, ending all remaining COVID-19 related waivers authorized under EO 21-09. The Board of Pharmacy issued guidance on the expiration of the Emergency Declaration.
Also in Missouri, the Department of Social Services MO Health Net (Medicaid) clarified reimbursement for COVID-19 antiviral treatment. Pharmacy providers filling prescriptions for Paxlovid or molnupiravir will be reimbursed the current professional dispensing fee at the time the prescription is dispensed. For pharmacies to receive the full dispensing fee, the Usual & Customary charge submitted to MO HealthNet must be more than the current professional dispensing fee. Non-pharmacy providers such as clinics, hospitals, and ERs do not receive a professional dispensing fee.
For more information, contact NACDS’ Mary Staples at 817-442-1155.