Minnesota
The Minnesota Department of Human Services (DHS) has contracted with Myers and Stauffer to conduct the 2022 pharmacy cost of dispensing survey to evaluate the fee-for-service Medicaid pharmacy reimbursement methodology. A stakeholder virtual meeting will be held October 4, 2022, at 9 am CDT. If you wish to attend the meeting, please contact Jill McCormack for the log-in information.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Mississippi
Conduent pharmacy point-of-sale claims system to shut down on Thursday, Sept. 29, 2022, as part of Fiscal Agent transition – Mississippi Division of Medicaid. Contact Medicaid for any questions you may have.
Also in Mississippi, the Mississippi Public Health Institute would like your input regarding planned opioid-related training for healthcare providers. This survey should take approximately 3 minutes to complete. Responses will be disconnected from any identifying information provided prior to the analysis of survey results. This survey was developed for needs assessment only and does not meet the definition of human research.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Missouri
The Board of Pharmacy mailed all Missouri pharmacies the regulatory sign that is now required to be posted in the pharmacy.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Nevada
At the September Board of Pharmacy meeting, Board members voted against extending a temporary emergency regulation re-instating the 6:1 pharmacy technician to pharmacist ratio that expired in July of 2022.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
North Carolina
on December 1, 2022, North Carolina will launch the NC Medicaid Managed Care Behavioral Health and Intellectual/Developmental Disabilities Tailored Plans. “This plan is an integrated health plan for individuals with significant behavioral health needs and intellectual/developmental disabilities (I/DDs)” On October 12, 2022, at 8:00 am EST NC Medicaid will host an online seminar to provide valuable information about each of the contracted Tailored Plan managed care organizations, and to provide an opportunity for pharmacists to ask questions about what to expect, operational changes and processes. The target audience for the Webinar includes pharmacy owners, managers and those who submit pharmacy benefit claims for Medicaid beneficiaries.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
New York
The Medicaid Department updated the Medicaid Fee-for-Service Providers Dispense Brand Name Drug when Less Expensive than Generic Program.
Effective 10/6/2022, the following changes will be made to the Dispense Brand Name Drug
When Less Expensive Than the Generic Program:
- Daytrana, Nexavar, Pradaxa and Ventolin HFA will be ADDED to the program
- ProAir HFA will be REMOVED from the program.
In conformance with State Education Law, which intends patients receive the lower cost drug
alternative, brand name drugs included in this program:
- Do not require 'Dispense as Written' (DAW) or 'Brand Medically Necessary' on the
prescription.
- Have a generic copayment.
- Are paid at the Brand Name Drug reimbursement rate or usual and customary price,
whichever is lower (SMAC/FUL are not applied).
- Do not require a new prescription if the drug is removed from this program.
IMPORTANT BILLING INFORMATION
Pursuant to this program, prescription claims submitted to the Medicaid program do not require the submission of Dispense as Written/Product Selection Code of '1'; Pharmacies should submit DAW code 9 (Substitution Allowed by Prescriber but Plan Requests Brand). Pharmacies will receive a NCPDP (National Council for Prescription Drug Programs) reject response of "22" which means missing/invalid DAW code if other DAW codes are submitted. The only exception to this, is DAW code 1 and "Brand Medically Necessary" on the prescription.
For more information, please contact NACDS’ Ben Pearlman at 617-515-2603.
Ohio
NACDS reminds members that at midnight on Saturday Oct. 1 the state's SPBM (Single Pharmacy Benefit Manager), Gainwell, will being processing managed care pharmacy claims. Beginning October 1, pharmacy benefits for managed Medicaid members will be covered by the Single Pharmacy Benefit Manager (SPBM), Gainwell Technologies. Gainwell's provider manual, also known as the pharmacy reference guide, is the primary resource guide providing key information to pharmacy providers, pharmacy support staff, and prescribers. The provider manual includes information related to pharmacy claims submission, reimbursement rates, pharmacy network requirements, the specialty pharmacy program, claims processing, utilization management, and prior authorization. More information can be accessed at ODM's Next Generation website or the Gainwell Ohio Pharmacy website.
Also in Ohio, the Board of Pharmacy has posted the agenda for Public Hearing 10.26.22 and a document regarding the Pathway to Pharmacy Technician Registration for Veterans
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Oregon
The Oregon Health Authority announced Nevada has jointed Oregon and Washington to offer the ArrayRx Card, a prescription discount card, formerly referred to as the Oregon/Washington Prescription Discount Card.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Pennsylvania
Due to recent technical issues with the Pennsylvania Licensing System (PALS) website, the Board of Pharmacy announced that the renewal period for Pharmacist Licenses and Authorizations to Administer Injectables for Pharmacists, has been extended to October 31, 2022. The renewal extension does apply to CE (Continuing Education) credits. However, if licensees earn CE between October 1- 31, 2022, to use for the 2022 license renewal, they cannot count those same CE credits toward the 2024 license renewal. Updates will be posted to the Board website. For general details on license renewal go to PALS.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Tennessee
Tennessee Pharmacy Association will provide one-hour OSHA training via online seminar, starting on Tuesday, Sept. 27, 2022. Ten different time slots are available. Register today
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Texas
The Select Committee on Health Care Reform is meeting on October 3rd to examine the potential impact of delayed care on the state’s health care delivery system, health care costs, and patient health outcomes. They will also study delays during the pandemic in obtaining preventive and primary health services, such as well-childcare, prenatal care, screenings for cancer and chronic disease, behavioral health, urgent care, chronic illness, and immunizations.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Utah
The Board of Pharmacy recently posted the following:
- July 26 Signed Meeting Minutes
- Board of Pharmacy Meeting Agenda – September 27
- Next Scheduled Meeting – October 25 (Agenda is pending.)
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Virginia
The Board of Pharmacy has posted the draft minutes from the September 6 meeting. Note that they approved emergency regulations to comply with treatment provisions passed into law in 2022 under HB (House Bill) 1323 that allows pharmacists to prescribe tobacco cessation medications. Specifically, they approved the changes to apply to all current statewide protocols reflecting new requirements under HB 1323 and added tobacco cessation treatment to the permitted protocols. Additionally, the board proposed amendments to its workforce regulations pursuant to HB 1324.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
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 October 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. To learn more about the "Yellow Postcard" campaign and the Communication Toolkit, please visit here.
Also in Alabama, effective October 1, 2022, the Alabama Medicaid Agency will remove prior authorization (PA) from levalbuterol tartrate HFA (generic Xopenex HFA). Brand Xopenex HFA will now require PA and update the PDL (Preferred Drug List) to reflect the quarterly updates listed here.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Alaska
The Board of Pharmacy's upcoming meeting will be held on September 22nd – 23rd via Zoom. A public copy of the board packet will be available on the meetings page soon: https://www.commerce.alaska.gov/web/cbpl/ProfessionalLicensing/BoardofPharmacy/BoardMeetings.aspx
Day 1 – Sep 22
Dial: +871 6050 7807,,074861#
Registration: https://us02web.zoom.us/meeting/register/tZMscemtrjwiGtP4XtYOfDDhb7SvvHQcL5xa
Agenda: https://www.commerce.alaska.gov/web/Portals/5/pub/PHAagenda_2022_09_Day1.pdf
Day 2 – Sep 23
Dial: +839 3607 3617,,960860#
Registration: https://us02web.zoom.us/meeting/register/tZckdO-oqTgsG9OKqbjnmAn0HWtv8gClqFja
Agenda: https://www.commerce.alaska.gov/web/Portals/5/pub/PHAagenda_2022_09_Day2.pdf
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Arkansas
The Insurance Department issued a Bulletin reminding all licensed PBMs that they are not allowed to charge pharmacies fees during credentialing or re-credentialing. Further, the Commissioner advised the PBM (Pharmacy Benefit Manager) industry that they may not charge a fee related to claims processing unless approved by the Commissioner.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
California
NACDS and the California Retailers Association (CRA) sent the following joint letters to Gov. Gavin Newsom (D):
- Requesting his signature on SB (Senate Bill) 1259, which would allow pharmacists to furnish opioid antagonists, approved by the U.S. Food and Drug Administration, without a prescription. Gov. Newsom subsequently signed the bill on September 2 (Chapter 245, Statues of 2022).
- Requesting a veto of the AB (Assembly Bill) 852, related to e-prescribing, because it was not amended as requested. Anticipating that a veto is unlikely, we also reached out to the Governor's legislative secretary and asked that, if the bill does get signed, the Governor include a signing message as follows: In approving AB 852, it is not my intent to force pharmacies to accept an electronic prescription without first having the time to ensure that the software via which the electronic prescription is submitted is compliant with Section 688(b)(3), as well as time for the pharmacy to undertake necessary system changes to become compatible with the software.
- Stating a neutral position on AB 1341, legislation prohibiting the sale of dietary supplements for weight loss or over-the-counter diet pills to individuals under 18 years of age without a prescription. As currently drafted, AB 1341 does not require retailers to limit customer access to dietary supplements, e.g., caging requirement, that was our primary concern with the bill.
Also in California, NACDS along with the California Pharmacists Association and the California Retailers Association jointed over 30 additional organizations in a letter to Gov. Gavin Newsom (D) thanking him for facilitating access by diabetes patients to continuous glucose monitors (CGMs) and care by exempting CGMs from Medi-Cal provider cuts in this year's State Budget. CGMs were added as a covered Medi-Cal benefit for adult patients with diabetes just this past January. However, because of the cross operation of a decade-old law (AB 97 Ch.3/2011), Medi-Cal reimbursements for CGMs were below actual costs, making it unfeasible for some providers to offer these life-changing medical devices to patients.
Also in California, the Board of Pharmacy posted the following:
- September 2022 is Opioid, Heroin, Fentanyl, and Prescription Drug Abuse Awareness Month
- Board of Pharmacy Update – August 2022
Also in California, the Department of Health Care Services posted the following alerts and weekly notices on the Medi-Cal Rx Web Portal.
- Enteral Nutrition Update to the List of Covered Enteral Nutrition Products, Retroactive to September 1, 2022 (September 14)
- One-Week Countdown – Reinstatement of Prior Authorization Requirements for 11 Drug Classes (September 9)
- Medi-Cal Rx Weekly Wrap-Up for September 2-8 (September 9)
- Two-Week Countdown – Reinstatement of Prior Authorization Requirements for 11 Drug Classes (September 2)
- Medi-Cal Rx Weekly Wrap-Up for August 26-September 1 (September 2)
- Medi-Cal Rx Monthly Bulletin for September (September 1)
- Changes to Contract Drugs List (CDL) (September 1)
- Changes to Contract Drugs List (CDL) – Over-the-Counter Drugs (September 1)
- Changes to Family PACT Pharmacy Formulary (September 1)
- Updates to Medi-Cal Rx Provider Manual (September 1)
- Medical Supplies: Updates to the List of Covered Disposable Insulin Delivery Devices (September 1)
- Diabetic Supplies: Updates to Continuous Glucose Monitoring Systems (September 1)
- Maximum Allowable Ingredient Cost 30-day Pharmacy Provider Notice (September 1)
- Reminder to Providers: COVID-19 Oral Antivirals for Uninsured Group (August 30)
- Phase I, Wave III Prior Authorization Submission (August 26)
- Medi-Cal Rx Weekly Wrap-Up for August 19-25 (August 26)
- COVID-19 Vaccine Now a Benefit for Pediatric Population (August 23)
- Enteral Nutrition Update: Renastep (Vitaflo, USA, LLC) Product-Specific Criteria Removed, Effective September 1, 2022 (August 22)
- Medi-Cal Rx Weekly Wrap-Up for August 12-18 (August 19)
- 30-day Countdown – Reinstatement of Prior Authorization Requirements for 11 Drug Classes (August 16)
- Prior Authorization Reinstatement Reference Guide (August 16)
- Phase I, Wave III List of Drug Impacted by Prior Authorization Reinstatement (August 16)
- COVID-19 Vaccine: Single Booster Dose for Children Ages 5-11 (August 15)
- Medi-Cal Rx Weekly Wrap-Up for August 5-11 (August 12)
Also in California, Medi-Cal posted the following:
- Coming Soon: Bivalent Booster Dose for Select COVID-19 Vaccines (September 14)
- October 2022 Medi-Cal Provider "Coffee Break" Event (September 12)
- Medi-Cal Update – Pharmacy – August 2022 – Bulletin 1022 (August 31)
- Monkeypox (Mpox) Vaccine Administration; General Updates (Updated August 29)
- Reminder: COVID-19 Oral Antivirals for Uninsured Group (August 22)
Finally in California, the CRA reported that SB 301, the state's version of the federal INFORM Consumers Act, has been sent to Gov. Newsom for his signature or veto.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Colorado
The Department of Health Care Policy and Financing (HCPF) announced that Adela Flores-Brennan, MA, JD is the new Medicaid Director, reporting to Executive Director Kim Bimestefer. Flores-Brennan will also assume the role of Office Director, leading our newly titled Health Policy Office (formerly Health Programs Office), which designs, maintains and oversees Health First Colorado and CHP+ medical policies and contracts. HCPF also announced the formation of a new Office of Medicaid and CHP+ Behavioral Health Initiatives and Coverage being led by Cristen Bates who will serve as Director. Bates’ office will govern HCPF’s specific behavioral health policies, benefits, special projects, and strategies that were previously part of our Health Programs Office. Bates will hold the role of Deputy Medicaid Director.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Delaware
On September 15, Gov. John C. Carney (D) approved the Seventh Extension of Declaration of a Public Health Emergency for the State of Delaware.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
District of Columbia
DCHF announced they will hold their quarterly pharmacy forum meeting on September 20 at 10am and September 21 at 1pm. To register to attend and receive meeting link and agenda please contact Amwilliams1@magellanhealth.com.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Illinois
The Illinois D&T Advisory Board will be reviewing the Biologic Modifiers at its October 20, 2022 meeting. All clinical and financial submissions are due to the Department by 3:00pm CST September 29, 2022. Please submit to: HFS.SupplementalRebaleProgram@illinois.gov.
Also in Illinois, the Department of Healthcare and Family Services has posted a new Provider Notice regarding Sexual Assault Treatment Program Private Insurance Opt-Out Alternative Per Public Act 102-1097.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Indiana
The Family and Social Services Administration’s (FFSA) Indiana Health Coverage Programs (IHCP) Medicaid announced that effective July 1, 2023, all managed care plans will cover both preferred and nonpreferred drugs, maintain the same clinical criteria requirements and use the same format for prior authorization (PA) as the fee-for-service (FFS) program.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Iowa
The Department of Health and Human Services, Iowa Medicaid issued the following:
- INFORMATIONAL LETTER NO 2377-MC Iowa Medicaid Managed Care Town Halls September 2022
INFORMATIONAL LETTER NO 2375-MC HHS Announces Winning Bidders for IA Health Link RFP (RFP MED-23-005) - INFORMATIONAL LETTER NO 2370-MC-FFS October 2022 Iowa Medicaid Pharmacy Program Changes
- INFORMATIONAL LETTER NO 2369-MC-FFS Participation in the Federal Fiscal Year (FY) 2024 Payment Error Rate Measurement (PERM) Program
- INFORMATIONAL LETTER NO 2368-MC-FFS 2022 Iowa Medicaid Annual Provider Training
- HHS Announces New Mission, Vision and Brand
- HHS Announces Intent to Award New Managed Care Contracts
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Kentucky
The Board of Pharmacy has filed an emergency and ordinary amendment to allow pharmacists to prescribe and receive Medicaid reimbursement for Paxlovid. Specifically, the amendment removes the list of specific conditions that require a Board-approved protocol for pharmacists to be authorized to treat patients with illnesses. Instead, the regulation would allow a pharmacist to utilize any protocol approved by the board to provide treatment services. This emergency amendment will allow for any prescriber–approved protocol to be reviewed for approval by the Board of Pharmacy. If the regulation is approved, the physician Director of Medicaid Services can also sign a prescriber–approved protocol for any pharmacist to initiate the dispensing of Paxlovid for Medicaid patients. Additionally, the board approved a new board authorized protocol for Paxlovid. The emergency regulation was effective immediately, but the ordinary version must be go through the promulgation process with the Board. NACDS expects the physician community to oppose this regulation and encourages members to join us in submitting supportive comments by September 30. Further detail and contact information for comments are on the regulation webpage.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Louisiana
The Department of Health (LDH (Louisiana, the Department of Health)) Medicaid Pharmacy Facts includes detailed information on Medicaid's Fee-for-Service (FFS) Pharmacy Program and the managed care organizations (MCO) coverage and reimbursements for flu and COVID booster.
- Effective September 15, 2022, enrolled pharmacies will be reimbursed for the influenza vaccines and administration of the vaccines when given to Medicaid recipients, who are 19 years of age and older when the administering pharmacist is an enrolled Medicaid provider. The cost of the vaccine will not be reimbursed for recipients under the age of 19, only the administration fee will be reimbursed, as these vaccines are available through the Louisiana Vaccines for Children (VFC) program. The Louisiana Board of Pharmacy rules and regulations allow a vaccinating pharmacist to administer the influenza vaccine to individuals seven years of age and older.
- On September 23, 2022, with an effective date of August 31, 2022, the Louisiana Medicaid's Fee-for-Service (FFS) Pharmacy Program and the managed care organizations (MCO) are covering the bivalent COVID-19 vaccine booster, with Emergency Use Authorization (EUA). The federal government covers the cost of the COVID-19 vaccine. Therefore, Louisiana Medicaid will reimburse enrolled pharmacies the administration fee only. Coverage for the Pfizer, Janssen (Johnson & Johnson), and Moderna COVID-19 primary vaccine series will continue.
- Louisiana Medicaid is hosting a series of provider webinars regarding the upcoming Provider Enrollment deadline.
For more information, contact NACDS’ Mary Staples at 817-442-1155.