Illinois
This notice relays information released from the Drug Enforcement Administration (DEA) regarding removal of the DATA Waiver (X-Waiver) requirement for practitioners prescribing buprenorphine. This information applies to customers covered under the Medicaid fee-for-service (FFS) program and by the managed care organizations (MCOs).
Previously, the federal government required practitioners with DEA licenses to also obtain a special waiver (known as an X-Waiver because the DEA Registration Number began with an X) to prescribe medications such as buprenorphine for the treatment of opioid use disorder (OUD) in office-based settings outside of federally registered opioid treatment programs. Health care providers were also restricted in the number of patients with OUD they could treat.
Section 1262 of the Consolidated Appropriations Act, 2023 (also known as the Omnibus bill), removes the federal requirement for practitioners to submit a Notice of Intent (have a waiver) to prescribe buprenorphine for the treatment of OUD. All practitioners who have a current DEA registration that includes Schedule III authority may now prescribe buprenorphine for OUD. There are no longer any annual limits on the number of patients that a prescriber may treat for OUD with buprenorphine. The January 12, 2023, letter from the DEA to waiver registrants identified these changes.
Pharmacies need to be aware of this change, as HFS [Department of Healthcare and Family Services] has received complaints that prescribers without a DEA X-Waiver are having trouble getting their prescriptions honored at local pharmacies.
Questions regarding this notice may be directed to the Bureau of Professional and Ancillary Services at 877-782-5565 for the FFS population or the applicable MCO.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Iowa
The Department of Health and Human Services published INFORMATIONAL LETTER NO. 2428-MC-FFS with April 2023 Iowa Medicaid Pharmacy Program Changes related to the following:
- New Drug Prior Authorization (PA) Criteria
- Changes to Existing PA Criteria
- Removal of PA Criteria
- Point-of-Sale Billing Updates
- DUR [Drug Utilization Review] Update
Also in Iowa, effective April 1, the Department of Health, and Human Services (Iowa HHS) will no longer require positive COVID-19 tests to be reported to the state Public Health Division. Since the development and widespread availability of rapid in-home tests – which are not required to be reported – the case and positive test counts in the state are no longer as meaningful as they once were. Iowa has no mandatory reporting order for any other respiratory viral illnesses such as influenza, RSV, and rhinovirus.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Montana
HB 710, legislation permitting pharmacy interns and technicians to administer immunizations, was introduced on February 21 and passed the Business and Labor Committee on February 24. After SB 239 failed to advance, the Montana Retail Association and the Montana Pharmacy Association found a new sponsor to pursue this legislation.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Nebraska
The Department of Health and Human Services (DHHS) published Provider Bulletin 23-06: Continuous Glucose Monitoring Updated Medicaid Reimbursement Policy that provides an update to Provider Bulletin 22-22 regarding coverage for eligible beneficiaries with diabetes effective January 1, 2023.
Also in Nebraska, the Board of Pharmacy posted a revised agenda for the March 6 meeting.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
New York
On February 21, the State Department of Health held an online seminar to update interested parties on the latest information regarding the Medicaid Pharmacy Benefit Transition from Managed Care to NYRx effective April 1. The next presentation and meeting will be March 21 at 1:00 p.m.
Also in New York, the Department of Financial Services (Department) Pharmacy Benefits Bureau ("PBB") announced a final request for public engagement as the Department looks to develop nation-leading regulatory standards for Pharmacy Benefit Managers (PBMs).
This request asks for information on PBM audits of pharmacies, which are meant to eliminate or reduce fraud, waste, and abuse, but often are overly burdensome and costly without meeting this intended goal. Instead, pharmacy owners are taken away from providing healthcare, requiring them to review and defend claims from years in the past at the sole direction of PBMs without justification. The information collected will inform the scope of regulations necessary to ensure audits follow a clear and transparent process and have guardrails in place to meet the goal of preventing fraud, misuse, and waste. The Department is in the process of developing a series of PBM regulations that together will form the most comprehensive regulatory framework in the country.
For more information, please contact NACDS’ Mike Sargent at 207-272-6435.
North Dakota
Engrossed HB 1095,legislation to include comprehensive medication management services in health benefit plans, unanimously passed the House and was sent to the Senate where it was referred to the Human Services Committee. A hearing has been scheduled for March 7 at 9:00 a.m.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Oregon
Dana Hittle has been appointed as the permanent Medicaid director and will oversee Oregon’s Medicaid program, including the Oregon Health Plan. Hittle previously served as interim state Medicaid director for the last two years and, before that, was deputy Medicaid director.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
South Dakota
HB 1135, legislation related to PBMs, passed both the House and the Senate, and will be sent to the Gov. Kristi Noem (R) for her signature. This legislation includes requirements for PBM licensure, prohibits retroactive fees except in certain situations and the collection of renumeration fees and adds criteria for drugs to be placed on the MAC list.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Tennessee
TennCare is now in Phase II of its plan to unwind from the Public Health Emergency. They have created a communications toolkit and offered several other resources that healthcare providers, including pharmacies, can use to share more information with TennCare patients to ensure their coverage does not fall through.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Texas
Rep. Dr. Tom Oliverson (R), chair of the House Insurance Committee, filed HB 2021, legislation that applies existing law intended to protect patients and pharmacies to all PBMs operating in Texas. The PBMs and Health plans are orchestrating opposition leveraging the Texas Association of Business and the Texas State Chamber of Commerce, mounting an aggressive campaign saying that preempting ERISA hurts employer's ability to offer quality, affordable health care and prescription options that best fit the needs of their employees.
Also in Texas, NACDS and Texas Federation of Drug Stores (TFDS) pharmacists and interns from HEB and Walgreens spent time at the Capitol meeting with new members and staff to educate them on pharmacy's priority issues: Medicaid reimbursement rate floor and making the PREP Act flexibilities permanent by lowering the age to 3 years for pharmacists and pharmacy technicians to administer vaccinations without a prescription.
Finally, the House Public Health Committee convened an organizational meeting on February 27 to discuss an organizational meeting and will be taking invited testimony from the Texas State Board of Pharmacy (TSBP), the Texas Department of State Health Services, and the Texas Health and Human Services Commission.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Virginia
Pharmacy made tremendous advances in the Commonwealth in the 2023 Regular Legislative Session that will dramatically improve patient care and advance practice. HB 2274, allowing pharmacists to test and treat for flu, COVID, strep and UTIs (urinary tract infections) under a statewide Board of Pharmacy protocol, is on Governor’s desk for signing, along with its companion, SB 948. The bills are the final piece in updating Virginia’s law to match the PREP Act. Notably, the Legislature also passed SB 1538 to clarify that Medicaid must reimburse for all the pharmacy-based services currently authorized in the Commonwealth. The bill applies to both Fee-for–Service and Managed Care. NACDS thanks the Virginia Association of Chain Drug Stores (VACDS), the Virginia Pharmacists Association (VPhA) and members for their tremendous efforts on the ground during this short session. NACDS will continue to update members as the bill signing process unfolds.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Washington
NACDS sponsored the Washington State Pharmacy Association’s successful Pharmacy Days at the Capitol on January 25 and February 13. More than 120 students and pharmacists participated in 60 appointments with legislators advocating for PBM reform and, in general, for the profession of pharmacy, promoting convenient access to healthcare services. Pharmacist James Lin from Kroger-QFC met with Sen. Javier Valdez (D).
For more information, contact NACDS’ Mary Staples at 817-442-1155.
West Virginia
Our priority bills continue to advance in the Legislature. HB 2754, that would make the pharmacy immunization allowances from the federal PREP Act permanent in state law, was approved by the Senate Health and Human Resources Committee and is now on the Senate Floor for a final vote. The Senate passed an omnibus Rules package, SB 361, that authorizes the Board of Pharmacy to promulgate a rule increasing the pharmacy technician ratio from 1:4 to 1:6. The same bill also includes a final rule modernizing collaborative practice agreements to allow for population-based care. Notably, the collaborative practice rule is currently effective as an emergency rule. The package now awaits action in the House Judiciary Committee, as does Committee Substitute SB 345, a bill that would provide legislative approval of the PBM rule pursuant to the passage of HB 2263 of 2021.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Alaska
The Board of Pharmacy met on February 17 and 18.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Arizona
The Board of Pharmacy Task Force Committee-Rules Writing meeting will be held on February 22 at 9:00 a.m. An agenda has not been posted on the website.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
California
The Department of Health Care Services posted the following alerts and weekly notices on the Medi-Cal Rx Web Portal. Please note the reinstatement resources and information below.
- Evusheld® No Longer Authorized to Prevent COVID-19 (February 14)
- NCPDP Reject Code 83 – Duplicate Paid/Captured Claim (February 14)
- Reminder: Establishing Medical Necessity (February 14)
- Mpox Treatment Drug, Tecovirimat (TPOXX® or ST-246), as a Medi-Cal Pharmacy Benefit (February 13)
- Boostrix™ Claims System Issue (February 13)
- Medi-Cal Rx Weekly Wrap-up for February 3-9 (February 10)
- Reinstatement Spotlight (February 10)
Also in California, Medi-Cal posted the following:
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Colorado
The Department of Health Care Policy and Financing will be communicating to providers on rolling back certain flexibilities that will expire when the public health emergency.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Indiana
The Family and Social Services Administration (FSSA) posted several bulletins of interest to pharmacies.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Iowa
The Board of Pharmacy announced the following effective March 15:
- ARC 6843C has been adopted and amends Chapter 10, "Controlled Substances" placing one substance into Schedule I of the Iowa Controlled Substances Act (CSA) in alignment with .
- ARC 6844C has been adopted and amends Chapter 37, "Iowa Prescription Monitoring Program" establishing council membership information for the PMP Advisory Council and clarifying that only overdoes-reversal opioid antagonists are required to be submitted to the PMP.
Also in Iowa, the Board of Pharmacy issued a "Notice of Intended Action" related to ARC 6874C amending Chapter 10, "Controlled Substances," and Chapter 12, "Precursor Substances." This proposed rulemaking temporarily adds four substances to Schedule I, excludes one substance from Schedule II and adds one substance as a precursor substance to the Iowa CSA in alignment with response to similar action taken by the DEA ARC 6874C amending Chapter 10, "Controlled Substances," and Chapter 12, "Precursor Substances." This proposed rulemaking temporarily adds four substances to Schedule I, excludes one substance from Schedule II and adds one substance as a precursor substance to the Iowa CSA in alignment with DEA's action. Comments may be submitted until 4:30 p.m. on February 28.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Louisiana
The Department of Health (LDH) announced that they now plan to migrate Medicaid to a single payor system on October 1. All patients will be assigned to a managed care organization and will receive a new universal prescription benefit card.
Also in Louisiana, the Board of Pharmacy met on February 15 & 16.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Massachusetts
MassHealth, the state Medicaid agency, is asking pharmacies to post this flier for notice to recipients of the planned redetermination of all MassHealth beneficiaries that will begin on April 1. One half million Massachusetts residents were added to MassHealth under the PREP Act and individuals may lose their MassHealth coverage and be moved to other state sponsored or commercial health plans.
For more information, please contact NACDS’ Mike Sargent at 207-272-6435.
Missouri
The revised 2023 Pharmacy Practice Guide is available on the Board's website. It contains updated compliance tips and information on recent statutory/rule changes, including:
- Pharmacy Working Conditions
- Technician Supervision & Expanded Technician Activities
- Electronic Final Product Verification (Pharmacists)
- Technology-Assisted Product Verification (Interns & Technicians), &
- Quality Assurance
Also in Missouri, the Department of Health and Senior Services recently issued a revised naloxone standing order.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Montana
HB 379, extending the prohibition on PBMs to require federally certified health entities to identify 340B drug from June 1, 2023 to June 1, 2025, was amended and passed the House Business and Labor Committee on February 14.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Nebraska
The Department of Health and Human Services (DHHS) issued Bulletin 23-04: Nebraska Medicaid Managed Care Contracts 2024. Contracts between DHHS and Molina Healthcare of Nebraska, Nebraska Total Care and United Healthcare have been signed and these organizations will prepare to provide services under the new contract beginning January 1, 2024.
Also in Nebraska, DHHS posted the draft minutes from the November 15, 2022, Drug Utilization Review Board meeting.
Finally in Nebraska, LB 778, amending the Pharmacy Benefit Manager Licensure and Regulation Act, has been scheduled for a hearing on March 21.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
New York
On February 15, the Department of Financial Services published a proposed rule regarding General Duties, Accountability and Transparency Provisions for Pharmacy Benefit Managers. The proposed rule sets forth to clarify, define and limit the duties, obligations, requirements and other provisions relating to pharmacy benefit managers under Public Health Law section 280-a(2) and provides a safe harbor provision for compliance with the regulation. It also defines, limits and clarifies the requirements for pharmacy benefit managers to provide an accounting to health plans and sets forth the terms and conditions of contract relating to pharmacy benefit management services provided to health plans by the pharmacy benefit managers, including provisions related to an appeal to the bureau for a determination on disclosure.
On February 13, NACDS participated in the Community Pharmacy Association of New York State lobby day. NACDS joined with members to advocate for Gov. Kathy Hochul's (D) budget proposal, including the Medicaid Fee-for-Service transition effective on April 1.
For more information, please contact NACDS’ Mike Sargent at 207-272-6435.