Washington
The Pharmacy Quality Assurance Commission (PQAC) will meet on December 12. The agenda and meeting materials have been posted.
Also in Washington, the Health Care Cost Transparency Board (Cost Board) is holding its first Public Hearing on December 12. The full meeting packet is available on the meetings and materials page.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
California
The Department of Health Care Services posted the following:
- November 2024 Pharmacy Medi-Cal Update Bulletin
- November 2024 Durable Medical Equipment and Medical Services Medi-Cal Update Bulletin
Also in California, the Department of Health Care Services posted the following alerts and weekly notice on the Medi-Cal Rx Web Portal:
- Mass Adjustment for COVID-19 Vaccine Incentive Fee for Impacted Claims with a Date of Service October 1, 2022, through December 31, 2023
- Medi-Cal Rx Weekly Wrap-up for November 8-14
- State of Emergency Override Activation: Submission Clarification Code 13
Finally in California, the Board of Pharmacy proposed the following rules:
- Discontinuation of Business
- Notice of Proposed Action
- Initial Statement of Reasons
- Proposed Text
- 45-Day Comment Period: November 15, 2024, to December 30, 2024
- Quality Assurance Programs
- Notice of Proposed Action
- Initial Statement of Reasons
- Proposed Text
- Notice of Modified Text
- Modified Text
- 15-Day Comment Period: November 15, 2024, to December 2, 2024
- Please send your company’s comments on the modified text to Sandra Guckian by November 25, 2024.
- Compounded Drug Preparations
-
- Board Requested Format for Submitting Comments
- 30-day Comment Period: November 8, 2024, to December 9, 2024
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Illinois
Please see the updated Continuous Glucose Monitor (CGM) Prior Authorization Criteria from the Department of Healthcare and Family Services.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Iowa
The Department of Health and Human Services (HHS), Iowa Medicaid posted INFORMATIONAL LETTER NO. 2641-MC-FFS-D – Ownership and Control Disclosure (OCD) Reminder effective upon receipt.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Nebraska
The Board of Pharmacy posted the draft November 4 meeting minutes.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
New York
On November 20, the State Department of Financial Services made final PBM market conduct regulations. The regulations will become effective on November 27, 2024. The market conduct regulations require the following:
- Allow Home Delivery. Prohibit PBMs from barring any in-network pharmacies from providing mail order or delivery services, which will increase patients’ access to home delivery from their community pharmacy;
- List Pharmacy Directories. Increase transparency to consumers and employers by requiring PBMs to list formularies and pharmacy directories online, and prohibiting PBMs from punishing a consumer who relies on said information;
- Address Consumer Inquiries. Require PBMs to post a telephone number and email address for consumers to direct their questions to, and PBMs must respond in a reasonable amount of time;
- Prohibit Steering. Prohibit anti-competitive practices that steer consumers away from their community pharmacy to larger pharmacies affiliated with the PBM;
- Treat Pharmacies Fairly. Prohibit PBMs from unfairly passing losses onto pharmacies when the PBM mistakenly approved dispensing a drug and then seeks to retroactively deny reimbursement to the pharmacy;
- Allow Electronic Submissions. Reduce administrative burdens and costs on small pharmacies by allowing them to submit information to and receive information from PBMs electronically; and
- Apply Same Standards. Prevent the abuse of audits against small pharmacies who are not affiliated with a PBM by requiring PBMs to apply the same audit standards across all in-network pharmacies.
Also in New York, on November 20, NYRx, the Medicaid Pharmacy Benefit Program, held its monthly pharmacy industry call. Two items on the agenda were (1) Non-Individual Specific Prescription for Self-Administered Hormonal Contraceptives with Pharmacy Dispensing Protocol
For more information, please contact NACDS’ Ben Pearlman at 617-515-2603.
North Carolina
The COVID-19 Statewide Standing Orders (SWSOs) authorized under North Carolina Session Law 2022-74, Sec. 9G.7.(a)-(e) and extended under Session Law 2023-65, Sec. 9G.7, will expire on December 31, 2024. No additional extensions have been provided.
If your facility currently uses the SWSOs issued by Dr. Elizabeth Tilson, State Health Director, to facilitate COVID-19 vaccinations, action is required to prevent disruptions in vaccine administration. Coordinate with your lead physician or medical director to develop standing orders or protocols that will take effect by January 1, 2025. Action Required:
- Review and prepare to transition to facility-specific standing orders by coordinating with your medical leadership.
- Finalize and implement new standing orders or protocols by January 1, 2025.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Oregon
The Oregon Health Authority announced the Immunization Policy Advisory Team will meet on December 5, 2024, from 12:00 noon-2:00 pm via Zoom. The final agenda will be available at the meeting or via email request three days before the meeting date by contacting imm.info@odhsoha.oregon.gov. Participation in the meeting requires registering in advance using this link. Those who register will receive a confirmation email with additional information.
Also in Oregon, the Drug Price Transparency Program (DPT) will host its annual hearing on December 4, 2024, at 10:00 am. The hearing will be held in person at 350 Winter St. NE, Salem and online. The agenda features panel discussions about drug advertising and drug rebates, along with an overview of the 2024 Drug Price Transparency report to the Oregon Legislature. Learn more on the DPT website and find the link to join the hearing online.
Finally in Oregon, the state is expected to beat its record of 910 pertussis (whooping cough) cases by the end of 2024. As of November 13, Oregon reported a total of 827 cases in 23 counties during 2024. At least one person, an older adult, has died. The Oregon Health Authority urges anyone over age 10 years who has not received the single-dose Tdap (tetanus, diphtheria, and pertussis) vaccine to get it now.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Tennessee
The Division of TennCare issued Provider_Notice_Contraceptives_11.05.24.pdf. Effective January 1, 2025, in response to the amended Tennessee Code Annotated (TCA), Title 56, Chapter 7, Part 23 (Public Chapter No. 732), TennCare and CoverKids members are eligible to receive up to a 12-month supply of self-administered hormonal contraceptives (e.g., oral, topical and vaginal) in a single dispensing. A smaller quantity may be provided if requested by the member or if specified by the healthcare provider.
This legislation does not apply to contraceptives administered by a healthcare provider, such as intrauterine devices, implants and injectable contraceptives.
For TennCare members, please refer to the TennCare-PDL (Preferred Drug List) (optumrx.com) for a list of preferred contraceptives. Non-preferred contraceptives still require prior authorization (PA) approval before a single 12-month supply can be dispensed.
For CoverKids members, please refer to CoverKids Select Standard Formulary (optumrx.com) for a list of covered contraceptives.
All standard point-of-sale edits (e.g., quantity limits, refill too soon, duplicate therapy, etc.) associated with contraceptives will remain in place.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Alabama
Pharmacist registrations with Board of Pharmacy expire December 31, 2024. The Board of Pharmacy is accepting pharmacist license renewals online only. As a reminder, the Board transitioned to a new database last month. The new system and renewal process look different, and the changes will require individuals to create a new account to renew licenses. Pharmacies and facilities will not need to create a new account. Instead, each pharmacy will be linked to the supervising pharmacist, and each facility will be linked to the designated representative. For information, watch the tutorial videos on the ALBOP YouTube channel.
Also in Alabama, effective January 1, 2025, the Alabama Medicaid Agency’s Durable Medical Equipment (DME) Program will cover E2298, PWR SEAT ELEVATION SYS (Power Seat Elevation System), for adults 21 years of age and older. Prior authorization (PA) will be required. E2298 will continue to be covered for children under 21 years of age with a PA. The limit will be one (1) per two (2) calendar years for both adults and children. Policy questions concerning this provider notice should be directed to the DME Program at (334) 242-5050.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Alaska
The Board of Pharmacy met on November 14. The agenda and public meeting packet are posted on the Board’s website.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Arizona
This week, state legislators met to elect new caucus leadership as follows:
- House Republicans:
- House Speaker Steve Montenegro (R-Goodyear)
- House Majority Leader Michael Carbone (R-Buckeye)
- House Majority Whip Julie Willoughby (R-Chandler)
- House Democrats:
- Minority Leader Oscar De los Santos (D-Laveen)
- Minority Assistant Leader Nancy Gutierrez (D-Tucson)
- Minority Co-Whip Quantá Crews (D-Phoenix)
- Minority Co-Whip Stacey Travers (D-Phoenix)
- Senate Republicans:
- President Warren Petersen (R-Gilbert)
- Majority Leader Janae Shamp (R-Surprise)
- Majority Whip Frank Carroll (R-Sun City West)
- Majority Whip Frank Carroll (R-Sun City West)
- Senate Democrats:
- Minority Leader Priya Sundareshan (D-Tucson)
- Assistant Minority Leader Flavio Bravo (D-Phoenix)
- Minority Whip Rosanna Gabaldón (D-Green Valley)
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Arkansas
NACDS sent a support letter to Arkansas Commissioner of Insurance Alan McClain on Rule 128, the Pharmacy Benefits Manager Compensation Requirements for Network Adequacy, Fair and Reasonable Pharmacy Reimbursements. Without meaningful actions, like Emergency Rule 128 which protects patients by prohibiting health plans and PBMs administering benefits on behalf of a health plan from recouping or recovering any increased costs to dispense from a patient at the point of sale through increased co-insurance, co-payment, or deductibles, more dollars will continue to flow to PBMs instead of reducing Arkansans’ prescription drug costs and safeguarding access to their trusted and convenient pharmacies. The enforcement of Rule 128 by Commissioner McClain will protect vital access to lifesaving prescription drugs and pharmacy services for Arkansans across the state.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
California
The Department of Health Care Services posted the following alerts, weekly notice, and monthly bulletin on the Medi-Cal Rx Web Portal:
- Reminder: Dual Eligible Special Needs Plan Deeming Periods
- Medi-Cal Rx Weekly Wrap-up for November 1-7
- Medi-Cal Rx Finance Portal “Download All Files” Error – Issue Resolved
- How to Resolve Reject Code 16 – M/I Prescription/Service Reference Number
- Medi-Cal Rx Weekly Wrap-up for October 25-31
- Medi-Cal Rx Monthly Bulletin for November
- Changes to Medi-Cal Rx Contract Drugs List
- Updates to Medi-Cal Rx Provider Manual
- 90-Day Countdown: Pediatric Integration of Members 21 Years of Age and Younger
Also in California, Proposition 36, The Homelessness, Drug Addiction and Theft Reduction Act, passed resulting in various changes to criminal and drug laws, including increasing penalties for some offenses, and providing treatment programs for people with drug addictions. Proposition 36 increases punishment for some theft and drug crimes in three ways: 1) turns some misdemeanors into felonies; 2) lengthens some felony sentences; and 3) requires some felonies be served in prison.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Colorado
State House Democrats elected their slate of leaders for the 2025 session, including re-electing House Speaker Julie McCluskie (D), who is entering her fourth and final term. The full House must ratify Rep. McCluskie’s nomination when it convenes on January 8, 2025.
Also in Colorado, Senate Republicans elected new leaders this week. State Sen. Paul Lundeen (R) remains as Minority Leader.
Finally in Colorado, Phase III of the Medicaid program Accountable Care Collaborative (ACC) is scheduled to begin July 1, 2025. The Department of Health Care Policy and Financing (HCPF) developed the program with stakeholder input to improve quality of care, close health disparities, improve care access, improve the member as well as provider experience and manage costs, which is critical to protecting member coverage, benefits and provider reimbursements, especially in tight state budget years.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Connecticut
On November 7, the Department of Consumer Protection finalized regulations on the Sale of Non-legend Drugs in Vending Machines.
For more information, please contact NACDS’ Ben Pearlman at 617-515-2603.
Indiana
The Health Coverage Programs (IHCP) posted provider Bulletin BT20244172, pharmacy provider updates approved by the Drug Utilization Review Board in October 2024.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Kansas
The Board of Pharmacy posted the November newsletter. It includes an update on the new Continuous Quality Improvement (CQI) regulations adopted earlier this year.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Kentucky
MedImpact announced that they identified Managed Care and Fee-for-Service claims adjudicated between August 23 and September 11, 2024, that were inadvertently paid at an inactive National Average Drug Acquisition Cost (NADAC) rate. Most of the rates utilized were lower than the active rate, but not all. The identified claims will be adjusted within 30 days to recalculate pricing to the NADAC pricing rates effective August 21, 2024, where appropriate. They will appear on your Remittance Advice (RA) or 835 to reflect the underpayment or overpayment. Impacted claims will not be recouped in totality; instead, they will only address the difference between the inactive and active NADAC rate.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Louisiana
Legislators returned to Baton Rouge earlier this month for the third session this year to consider Gov. Jeff Landry’s (R) tax overhaul package.
Also in Louisiana, the Department of Health issued Informational Bulletin 24-42 updating the immunization fee schedules.
Also in Louisiana, the Board of Pharmacy continues to make progress on the proposed rule changes expanding the eligibility criteria for obtaining a pharmacy technician candidate registration by providing alternatives to a board-approved, nationally accredited pharmacy technician training program. The proposed rule changes remove the definition of Training Program and instead define Pharmacy Technician Educator, which includes a board-approved, nationally accredited training program, a Louisiana Department of Education program with a pharmacy technician career path and a Louisiana licensed pharmacist providing training in a permitted pharmacy. The Board submitted the second summary report to the Joint Legislative Oversight Committee on Health & Welfare.
Also in Louisiana, after the August public hearing on Automated Medication Systems (AMS), the Board submitted the second summary report to the Joint Legislative Oversight Committee on Health & Welfare.
Also in Louisiana, since five of the Board members’ terms expired on June 30, 2024, Gov. Jeff Landry (R) appointed Andy Soileau to replace Blake P. Pitre, who had served 42 years on the Board, and Butch Ray to replace Rock LeBas. The Governor also reappointed pharmacist Robert Cloud, Kevin LaGrange and consumer member Don Resweber.
Also in Louisiana, the Department of Health (LDH), in partnership with the Department of Public Safety and Corrections (DPSC), submitted an application to the Centers for Medicare and Medicaid Services (CMS) for an 1115 demonstration waiver to improve access to critical pre- and post-release services for Medicaid-eligible individuals who are incarcerated. This new waiver would allow Louisiana Medicaid to provide approved substance use treatment services, case management and a 30-day supply of all prescription medications to eligible individuals.
Finally in Louisiana, the Board of Pharmacy will meet on November 19-20, 2024; new officers and committee chairs will be chosen during this meeting.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Maine
On September 16, MaineCare sent a message advising pharmacies that copays for pharmacy services would resume effective October 1, 2024, in conjunction with the end of the American Rescue Plan Act (ARPA). Follow up messages were also sent on September 27 and September 30.
Pursuant to MaineCare Benefits Manual Chapter 1 Section 1.09-1(B), no provider may deny services to a member for failure to pay a copayment.
As a reminder, effective October 1, 2024:
- MaineCare reinstates copayments for Section 80: Pharmacy Services.
- MaineCare no longer covers over-the-counter COVID-19 tests.
- The federal government is supplying four free COVID-19 test kits.
- The COVID-19 vaccine administration fee through the pharmacy benefit returns to $5.00.
For more information, please contact NACDS’ Ben Pearlman at 617-515-2603.
Michigan
The Department of Health and Human Services will be conducting CHAMPS System maintenance this weekend. As a result, the system will not be available between 6:00 pm EST on November 16 through 9:00 am EST on November 17, 2024. Providers with questions should contact Provider Support at 1-800-292-2550 or ProviderSupport@Michigan.gov.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Minnesota
The Prescription Drug Affordability Board has posted the agenda for its November 26, 2024, meeting.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Missouri
MO HealthNet completed the annual review of all drug coverage criteria for the Prior Authorization Process.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
New Hampshire
The state legislature released the Final Report of the Committee to Study the Impact of Pharmacy Benefit Manager Operations on Cost, Administration and Distribution of Prescription Drugs. The report recommends PBM legislation for 2025 that addresses improvements to the state’s pricing and appeals processes laws.
For more information, please contact NACDS’ Ben Pearlman at 617-515-2603.