Nebraska
Gov. Pete Ricketts (R) issued Executive Order 22-05, to expire on December 31, 2022. Executive Order 22-02, which is currently scheduled to expire on September 30, 2022, shall remain in effect through December 31, 2022, and the identical statutory waivers and conditions contained within Executive Orders 21-12 and 21-15 that were extended by Executive Order 22-02 shall remain in effect through December 31, 2022, except that Medication Aide renewals will no longer be deferred after March 31, 2022. The Department of Health and Human Services prepared FAQs related to Executive Order 22-05.
Also in Nebraska, the Department of Health and Human Services (DHHS) announced the next COVID Update call will take place on October 12 at noon (Central). To join the all, dial 1-408-418-9388 and enter access code: 2485 909 6350 or use the meeting link: https://sonvideo.webex.com/sonvideo/j.php?MTID=m18465ba5a677a644d13049ac859b21dc
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Nevada
The Board of Pharmacy posted the agenda for the two-day hybrid virtual/in-person October 13 and 14 meeting.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
New York
New York: A grassroots alert supporting advocacy efforts in NYS (New York State) for the move of pharmacy benefits from Medicaid Managed Care to Fee for Service effective 4/1/23 (known as NYRx). Click here to access the alert
Please ask all your NY pharmacies and their staff members to act TODAY using this easy-to-use one click Alert to counter efforts by those opposed to NYRx who are actively trying to get NY lawmakers to repeal or delay it.
This policy is particularly important for Medicaid patients’ access to pharmacy care and for the community pharmacies that support them.
Also in New York, a request was sent out from the NY Department of Financial Services (DFS) last month. To clarify, please just send data to the Department directly, as directed below. Do not copy NACDS. However, if you do share that data with the state, I would ask that you let us know that you shared data with the Department so we will, at a minimum, be able to tell how many of our members responded with their own companies’ data. NACDS will be commenting and documents from other states highlighting the PBM issues.
The Department is inviting submissions of data or documented evidence from the public related to pricing models and pharmacy reimbursement practices by pharmacy benefit managers (“PBMs”) in New York State.
Responses should be emailed to PBM@dfs.ny.gov, with “PBM2022-06” included in the subject line. Failure to include “PBM2022-06” in the subject line may result in your comment not being considered. The deadline for responses is October 31, 2022.
For more information, please contact NACDS’ Mike Sargent at 207-272-6435.
North Carolina
To ensure beneficiaries can seamlessly receive care on day one, the North Carolina Department of Health and Human Services (NCDHHS) will delay the implementation of the NC Medicaid Managed Care Behavioral Health and Intellectual/Developmental Disabilities Tailored Plans until April 1, 2023.
Tailored Plans, originally scheduled to launch December 1, 2022, will provide the same services as Standard Plans in Medicaid Managed Care and will also provide additional specialized services for individuals with significant behavioral health conditions, Intellectual/Developmental Disabilities and traumatic brain injury.
The delayed start of Tailored Plans allows Local Management Entity/Managed Care Organizations, which will operate the Tailored Plans, more time to contract with additional providers to support member choice and to validate that data systems are working appropriately. The decision is supported by the leadership of the state’s six LME/MCOs.
While the start of Tailored Plans will be delayed, specific new services will still go live December 1, 2022.
More information regarding the beneficiary choice period and other key dates leading up to the April 1, 2023, launch will be shared by NCDHHS in the coming weeks. For more information about Tailored Plans, please visit NC Medicaid’s Tailored Plan website.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Ohio
As you are aware, Ohio Medicaid (ODM) implemented the Single PBM, Gainwell, at Midnight on October 1. NACDS has been working with members, ODM and Gainwell daily to provide solutions as they work through technical issues causing denials, many of which have since been resolved or temporarily patched over. To report any major system issues, please use the dedicated email that Gainwell/ODM is monitoring in real-time. If you need NACDS’ assistance to emphasize significant issues, please contact Jill McCormack.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Pennsylvania
Gov. Tom Wolf (D) issued a news release this week announcing that the Naloxone Standing Order has been expanded to include the 2 Dose Formulation and encouraging patients to bring a copy of the standing order to pharmacies to request the drug. NACDS reminds members that the PA Naloxone Copay Assistance Program will reimburse pharmacies up to $75 for patient copays when the patient is hesitant to pick up the prescription due to cost. For practical operational reasons, the claim must be adjudicated on the current PACE Program system. However, a claim for ANY insured patient regardless of what type of insurance they have – commercial or public – qualifies. There are no criteria to proving financial hardship on the pharmacy because access is the point of the program.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Texas
The Drug Utilization Review Board posted the agenda for October 21 meeting. Refer to the Texas Drug Utilization Review Board Handbook for the instructions about submitting written materials to the board before the meeting and public testifying on the day of the meeting.
Also in Texas, the Health and Human Services Commission (HHSC) updated the July 2022 Medicaid Preferred Drug List on September 28 and provided the following updates:
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Washington
The Pharmacy Quality Assurance Commission (PQAC) is conducting a survey to assess current pharmacy practices pertaining to accessible labeling for both patients with visual and/or print disabilities and patients who require that prescription information be translated into another language besides English. The survey also includes whether such options are already made available, and what technological, financial or resource-based obstacles prevent such options from being offered. Any licenses are strongly encouraged to participate in the survey.
Also in Washington, the fourth quarter Preferred Drug List (PDL) has been posted to the Reports webpage. This PDL is used by Uniform Medical Plan and the Department of Labor and Industry.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Arkansas
Gov. Asa Hutchinson (R) appointed Mark White as the Secretary of the Department of Human Services, replacing Cindy Gillespie.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
California
The Department of Health Care Services posted the following alerts and weekly notices on the Medi-Cal Rx Web Portal.
- Submission of Pricing Prior Authorization for Brand Medically Necessary Medications: Dispense as Written (DAW 1) (September 29)
- Enteral Nutrition: Powder Dispensed in Packets, Billing Units Reminder (September 27)
- CoverMyMeds: Provider Support (September 27)
- Enteral Nutrition Update: Changes to the List of Covered Enteral Nutrition Products, Retroactive to September 1, 2022 (September 23)
- Medi-Cal Rx Weekly Wrap-Up for September 16-22 (September 23)
Also in California, this week, Medi-Cal posted "Medi-Cal Provider "Coffee Break" Event."
Finally in California, the Board of Pharmacy posted the agenda for the Enforcement and Compounding Meeting scheduled for October 4.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Florida
As previously announced in a provider alert dated June 28, 2022 Provider Alert, the Agency for Health Care Administration (Agency) has been implementing Referring, Ordering, Prescribing, and Attending (ROPA) requirements as directed by the 21st Century Cures Act (Cures Act) and by the Centers for Medicare and Medicaid Services (CMS). Previous provider alerts on National Provider Identifier (NPI) requirements for ROPA providers can be found on the Agency's website in the Provider Message Archive. Providers must be enrolled with Florida Medicaid in accordance with Title 42, Code of Federal Regulations, Section 455.410(b).
All Fee-For-Service claims submitted January 1, 2023, or after from a non-exempt provider type that does not have a ROPA provider listed on the claim will be denied. The exempted provider types that will not require a ROPA on the claim are listed below, all other provider type claims must have a ROPA provider identified by NPI on the claim for reimbursement by Florida Medicaid.
In a provider alert dated June 28, 2022, the Agency previously set the effective date as October 1, 2022. To allow providers more time to prepare, we have extended the effective date to January 1, 2023. In addition, the Agency has continued to evaluate the effected provider types and has added several types to the exempted list.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Indiana
Gov. Eric Holcomb (R) administration that the state has $6.1 billion in reserve following the closeout of its fiscal year, having collected $353 million more in revenue than the current budget needs. Because of the new law passed during the special session, the first one billion dollars in excess goes to paying down debt in the teacher pension fund. The remaining surplus will be disbursed to taxpayers as part of the Governor’s inflation relief plan.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Louisiana
The Board of Pharmacy Regulation Revisions Committee will be meeting on October 11 at their office in Baton Rouge to discuss these regulatory proposals.
Also in Louisiana, the Department of Insurance Office of the Commissioner promulgated Regulation 122 defining the roles and responsibilities solely within the purview of pharmacy benefit managers and pharmacy services administrative organizations.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Maine
The agenda has been posted for the October 6th Board of Pharmacy meeting.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Mississippi
New Medicaid Paper Claims Billing Manual available online. In preparation for the Mississippi Division of Medicaid's (DOM) transition to a new Fiscal Agent effective Oct. 3, a newly developed Paper Claims Billing Manual, produced by Gainwell Technologies, is available on the is available on the DOM website.
The Paper Claims Billing Manual is designed to offer guidance and assistance to providers submitting claims for reimbursement to DOM, including detailed information specific to the submission of paper claims.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Missouri
The Board of Pharmacy next Lunch with the Chief Inspector online seminar is taking reservations for the October 13th compliance update.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Nebraska
The Department of Health and Human Services announced the selection of three health plans to provide health care services in Heritage Health, the state’s Medicaid managed care program. Molina Healthcare of Nebraska, Nebraska Total Care and UnitedHealth Care of the Midlands were selected; contracts will be effective January 1, 2024.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Nevada
The state joined Washington and Oregon in offering the ArrayRx card, a state-backed discount card program.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
New Mexico
The Immunization Coalition and Department of Health Immunization Program have put together a brief survey to gauge how provider offices handle vaccines for their adult patients.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
New York
As referenced in the 1% Across the Board (ATB) Medicaid Rate Increase, the New York State Department of Health revised the Medicaid Fee-for-Service (FFS) pharmacy professional dispensing fee to comply with this change. Effective September 22, 2022, the professional dispensing fee will change from $10.08 to $10.18 for covered outpatient drugs, when applicable. This was based on the enacted budget and was effectuated by Centers for Medicare and Medicaid Services (CMS) state plan approval. This does include retroactive adjustments to the dispensing fee back to April 1, 2022. Those adjustments will be processed at a future date, details will be forthcoming.
For more information, please contact NACDS’ Mike Sargent at 207-272-6435.
North Carolina
Please find here a notice from North Carolina Medicaid to permanently transition to a specific dispensing fee for North Carolina Medicaid based on the Cost-of-Dispensing Study performed every five years. This fee is currently $10.24. Also, included in this notice is North Carolina Medicaid's decision to allow for more than one dispensing fee per month.
Also in North Carolina, see the Medicaid Special Pharmacy Newsletter providing Revised Procedures for Prior Authorization of palivizumab (Synagis®) for Respiratory Syncytial Virus Season 2022/2023 – Coverage starts Oct. 1, 2022.
Finally, effective with date of service Aug. 31, 2022, the NC Medicaid and NC Health Choice programs cover Pfizer-BioNTech COVID-19 Vaccine, Bivalent (Original and Omicron BA.4/BA.5) – 12 years of age and older (N/A) for use in the Physician Administered Drug Program (PADP) when billed with HCPCS code 91312 – Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, bivalent spike protein, preservative free, 30 mcg/0.3 mL dosage, tris-sucrose formulation, for intramuscular use.
Effective with date of service Aug. 31, 2022, the NC Medicaid and NC Health Choice programs cover Moderna COVID-19 Vaccine, Bivalent (Original and Omicron BA.4/BA.5) – Booster Dose (N/A) for use in the Physician Administered Drug Program (PADP) when billed with HCPCS code 91313 – Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, bivalent, preservative free, 50 mcg/0.5 mL dosage, for intramuscular use. More information.
Providers are encouraged to review this information. All bulletin articles, including those related to COVID-19, are available on DHB's Medicaid Bulletin webpage.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Oklahoma
Gov. Kevin Stitt (R) appointed pharmacists Randy Curry D.Ph., and Shonda Lassiter, D.Ph, to the Board of Pharmacy.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Oregon
The Board of Pharmacy posted the agenda and meeting materials for its October 12-14 meeting.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Rhode Island
Please find the October 2022 provider update here.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Texas
The Board of Pharmacy has moved to the George H. W. Bush State Office Building. Their new mailing address is Texas State Board of Pharmacy, 1801 Congress Avenue, Suite 13.100, Austin, TX 78701. All telephone numbers, emails and faxes remain the same.
In advance of the October 3 Texas House Select Committee on Health Care Reform, NACDS submitted a statement recommending allowing pharmacists to permanently order and administer CDC/ACIP -recommended vaccines for ages 3 and older; permitting certified pharmacy technicians to also administer vaccinations to the same age group; and initiate corresponding treatment pursuant to the result of CLIA-waived tests.
For more information, contact NACDS’ Mary Staples at 817-442-1155.