Pennsylvania
Legislation that would allow the state Auditor General to have access to PBM's data from the Medicaid Managed Care program passed the House unanimously this week. House Bill 1630, sponsored by Rep. Jonathan Fritz (R), now goes to the Senate for consideration.
Also in Pennsylvania, the Board of Pharmacy has posted the agenda for their September 27th meeting.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
South Carolina
Effective for dates of service on or after Sept. 15, 2022, the South Carolina Department of Health, and Human Services (SCDHHS) will expand coverage for additional pneumococcal immunizations for Healthy Connections Medicaid members 19 years of age and older under the pharmacy and medical benefit.
SCDHHS will reimburse providers for the administration of the immunizations in accordance with the Centers for Disease Control and Prevention (CDC) and the Advisory Committee on Immunization Practices (ACIP) Adult Immunization Schedule for the following Healthcare Common Procedure Coding System (HCPCS) codes:
- Pneumococcal 15-valent conjugate vaccine (PCV15): HCPCS Code 90671
- Pneumococcal 20-valent conjugate vaccine (PCV20): HCPCS Code 90677
The new codes will be reflected on the Physicians Fee Schedule and updates to the Physicians Services provider manual will be available by Sept. 15, 2022.
Pharmacy reimbursement utilizes the standard basis of payment for the fee-for-service pharmacy benefit at the lowest of:
- The actual acquisition cost (AAC) plus a professional dispensing fee (PDF) of $10.50;
- The state's maximum allowable cost plus a PDF of $10.50; or,
- The usual and customary charges to the public.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Texas
The Health and Human Services Commission's (HHSC) Executive Commissioner Cecile Erwin Young announced that Dr. Jennifer Shuford will serve as interim commissioner of the Texas Department of State Health Services (DSHS), effective October 2022, replacing Dr. John Hellerstedt who is retiring from state service. Shuford currently serves as chief state epidemiologist at DSHS. She is also a member of the Texas Medical Association, where she serves as a consultant to TMA's Committee on Infectious Diseases.
Also in Texas, the September draft specialty drug list has been posted. Comments are due by September 22, 2022.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Virginia
The Department of Health has issued an updated standing order for COVID vaccines reflecting current CDC (Centers for Disease Control) recommendations.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Washington
The Health Care Authority (HCA) has made the following updates to its COVID-19 monoclonal antibody policy concerning HCPCS code Q0222:
- Do not bill using HCPCS code Q0222 if the product was received free of charge through the United States Government (USG)-purchased inventory.
- Bill HCA for commercially purchased products only.
See Apple Health Monoclonal Antibody Treatment COVID-19 clinical policy, under COVID-19, Policies, and billing guidance for more information regarding the policy and procedure codes involved.
HCA revised the COVID-19 Fee Schedule. See HCA's Provider billing guides and fee schedules, under COVID-19.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Wisconsin
The Dept. of Health Services recently announced the following:
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Alabama
The Alabama Medicaid Agency will provide a COVID-19 public health emergency (PHE) update for Medicaid providers and partners on September 15, 2022. Agency representatives will share how the Agency is preparing for the end of the PHE and the return to normal operations. The meeting is offered for attendees both in-person or virtual (online or by phone).
Medicaid providers, staff, operating state agencies, professional groups, advocacy groups, and all partners who interact with Medicaid recipients are encouraged to attend.
Also in Alabama, please find the updated Synagis® Criteria for Summer 2022 (as part of the 2021-2022 Season); and the Use of Synagis® in the 2022–2023 Season here.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Arkansas
Test & Treat Protocols for both strep and flu were finally approved by the Arkansas Medical Board in August. Previously, these rules were approved by the Pharmacy Board in June. Act 503 passed in 2021 authorized Arkansas pharmacists to test, screen, and treat patients for influenza and pharyngitis caused by streptococcus A within the framework of a written statewide protocol. Arkansas pharmacists may develop their own policies and procedures and begin offering the service, and bill for these services utilizing their own NPI number.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
California
Medi-Cal posted the following:
- New ICD-10-CM and ICD-10-PCS Codes Related to COVID-19
- Durable Medical Equipment and Medical Supplies bulletin – August 2022 – Bulletin 563
- Medi-Cal Update – Pharmacy – August 2022 – Bulletin 1021
- Beneficiary Eligibility Verification Reminder
Also in California, the Department of Health Care Services posted the following alerts on the Medi-Cal Rx Web Portal.
- Coming Soon: COVID-19 Vaccine for Children 6 Months and Up (August 9)
- Code 1 Documentation and Postponement of Implementation of NCPDP (National Council for Prescription Drug Programs) Reject Code 80 (August 8)
- Medi-Cal Rx Weekly Wrap-Up for July 29-August 4 (August 5)
Finally in California, the Board of Pharmacy communicated the following:
- Enforcement and Compounding Committee Meeting Agenda – August 25, 2022
- Standard of Care Committee Meeting Agenda and Meeting Materials – August 25, 2022
- Full Board Meeting Agenda and Meeting Materials – August 25, 2022
- August 2022 issue of "The Script", the Board's newsletter
- Order of Adoption for Approved Regulation: Notification of Temporary Closure – Effective October 1, 2022
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Colorado
Gov. Jared Polis' (D) administration and the Department of Health Care Policy & Financing (HCPF) announced partnerships with key supply chain partners that will help Colorado operationalize the importation of drugs. Colorado's Canadian Importation Program, once approved by the Food and Drug Administration (FDA), estimated it will save Coloradoans an average of more than 60% on prescription medications.
Also in Colorado, on August 28 the Division of Profession and Occupations will hold a Joint Stakeholder online seminar with Pharmacy and other Healthcare Boards with prescriptive authority to solicit input from stakeholders on the implementation of House Bill 22-1115, clarifying certain provisions in the Prescription Drug Monitoring Program.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Illinois
The Illinois Department of Healthcare and Family Services has posted a new Provider Notice regarding Pharmacy COVID-19 Vaccination and Booster Update.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Indiana
Gov. Eric Holcomb (R) convened an 11-day special session in late July. Both Senate Bill 1, the "abortion ban bill," and Senate Bill 2, the "tax refund bill" passed and were signed into law. Early in the session the Indiana Pharmacists Association rallied pharmacists to advocate for an amendment allowing pharmacists prescribing self-administered hormonal contraceptives, but the amendment failed by one vote, 48-49.
Also in Indiana, the Senate President Pro Tem Rodric Bray (R) named Sen. Chris Garten (R) as the new Majority Floor Leader, replacing Sen. Mark Messmer (R) who served as the floor leader since 2018.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Iowa
The Board of Pharmacy posted its agenda and meeting materials for the August 24 meeting. Of interest, note the “Review of Proposed Edits to the Board’s Statewide Protocols and Vote on Approval” for Point-of-Care Test and Treat for both Influenza and Strep A. Also, under “Rules and Legislation,” note items #4 related to the PMP and #5 related to registered nurses engaging in the practice of nursing pursuant to a pharmacist’s order.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Kentucky
The Emergency Prescription Assistance Program (EPAP) has been authorized in areas of the state impacted by severe storms and flooding. EPAP is a federal program managed by the Department of Health and Human Services, which provides an efficient way for community pharmacies to process claims for prescription medications, vaccines, limited medical supplies and limited durable medical equipment (DME) provided to individuals who are from a disaster area declared by the President and who do not have any form of health insurance coverage.
Also in Kentucky, The Board of Pharmacy has filed an emergency and ordinary amendment to 201 KAR 2 380, amending the board authorized protocol regulations by removing the specific conditions. Instead, a pharmacist may utilize any protocol approved by the board to provide healthcare services. Additionally, the board approved a new board authorized protocol for Paxlovid. The board list of approved protocols can be found at https://pharmacy.ky.gov/Pages/Board-Approved-Protocols.aspx
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Louisiana
The Department of Insurance (LDI) released a summary report on the process of promulgating Regulation 122, which defines the roles and responsibilities solely within the purview of pharmacy benefit managers and pharmacy services administrative organizations as required by a newly enacted statute, R.S. 22:1660.9(C).
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Minnesota
The Department of Commerce has published the 2021 PBM Transparency Report. The Minnesota Pharmacy Benefit Manager Licensure and Regulation Act requires Pharmacy Benefit Managers (PBMs) to submit transparency reports to the Department of Commerce. The report summarizes the responses from all PBMs who submitted transparency reports to the Department, pursuant to Minn. Stat. § 62W.06, Sub’d. 2.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Missouri
Pharmacies need to establish policy and procedures, quality assurance programs, and validate the technology prior to the initial use for two new product verification rules that go into effect on August 30, 2022.
- 20 CSR 2220-2.011 Electronic Final Product allows pharmacists to use an electronic verification system (EVS) to verify the accuracy of a final prescription. EVS allows the pharmacist to see an exact, clear, and unobstructed visual image of the filled prescription contents and the label affixed to the container. No further manipulation of the prescription occurs after the pharmacist's electronic verification is complete other than applying the required container lid or seal. Manipulation does not include preparing a finished prescription/medication order for mailing, delivery, storage or bagging the prescription.
- 20 CSR 2220-2.012 Technology Assisted Prescription/Medication Order Verification for Interns Pharmacists and Pharmacy Technicians allows an "authorized pharmacy technician" or an "authorized intern pharmacist" to verify a final prescription using a Technology Assisted Verification System (TAVS) for non-controlled medications only. TAVS is an electronic system that utilizes barcode technology or another electronic process to electronically verify the final medication prescription or medication order has been properly dispensed and to electronically verify the prescription/medication order has been properly labeled for the correct patient.
Additional summaries of newly revised and recently promulgated pharmacy rules are available in the Board's latest newsletter.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Nevada
In response to a request from chain pharmacy, September 7 & 8 Board of Pharmacy meeting, the Board will discuss and potentially act on the Adoption of an Emergency Regulation in increase the number of pharmaceutical technicians and pharmaceutical technicians in training that a pharmacist may supervise at one time from four to six. The Retail Association of Nevada (RAN) and NACDS encourage members to send a letter of support in advance of the meeting.
Also in Nevada, pharmacists can now bill the state's Medicaid program for hormonal contraceptive and HIV prevention services. The Board posted two guidance documents on the new laws that allow pharmacists to dispense self-hormonal contraceptives without a prescription, and allow pharmacists to prescribe and dispense PEP and PrEP drugs.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
New Mexico
The Legislative Health and Human Services Committee in early August to discuss state strategies for prescription drug access, access to pharmacy care, controlling the excessive cost of drugs, and pharmacy supply chain stakeholders (wholesalers, pharmacy benefit managers, manufacturers, and Insurers).
For more information, contact NACDS’ Mary Staples at 817-442-1155.
North Carolina
The North Carolina COVID-19 state of emergency sunsets on August 15, 2022. For more information on how it affects pharmacy practice please click here.
Also in North Carolina, pharmacy claims processing under Behavioral Health and Intellectual/Developmental Disabilities (I/DDs) Tailored Plans. Pharmacy Point of Sale (POS) claims for members enrolled in Tailored Plans will be temporarily managed by NCTracks when the plans launch on Dec. 1, 2022, through March 31, 2023. Beginning on April 1, 2023, these claims will be managed by the Tailored Plans. This change was made due to a key Pharmacy Benefit Manager (PBM) unexpectedly leaving the NC Medicaid market in late 2021, which required some Tailored Plans to procure another PBM.
There will be no impact to members' pharmacy benefits during this transition period. From Dec. 1, 2022, through March 31, 2023, member ID cards will not include pharmacy information. A new card will be issued for April 1, 2023, indicating the new RxBin and PCN numbers for the Tailored Plans.
NC Medicaid will reach out to members, pharmacists, and providers in the coming months with additional information about this transition. For more information, please see the Medicaid bulletin Pharmacy Point of Sale Process at Tailored Plan Launch.
Finally, please see August 2022 NC Medicaid Pharmacy Newsletter which contains information on the below.
- NC Medicaid Pharmacy Point-of-Sale Billing for Pharmacist-Prescribed Paxlovid
- October 2022 Drug Use Review (DUR) Board Meeting
- Reminder Regarding the Naloxone Standing Order
- Pharmacy Point of Sale Process at Tailored Plan Launch
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Ohio
Below are added items posted on the Board of Pharmacy's website:
- 202208 – Board Meeting Agenda – August 2022.pdf
- Important Dates.pdf
- Remote Order and Prescription Entry by Pharmacy Technicians and Pharmacy Interns.pdf
- Remote Order and Prescription Processing by Pharmacists.pdf
- Wholesale Sales of Non-Controlled Dangerous Drugs Conducted Local Health Departments.pdf
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Oregon
The Oregon Health Authority's Immunization Policy Advisory Team (IPACT) will meet September 1 via Zoom. To register in advance for this meeting, use this link.
Also in Oregon, the Oregon Health Authority released its 2021 Coordinated Care Organization (COO) Metrics Report. Although statewide performance showed improvement on most of the 14 incentive measures, the exceptions were two immunization measures related to youth immunizations which were down 7.7% for adolescents and 8.3% for immunizations received by the child's second birthday. These continue to be affected by the disruptions in preventive care that occurred during the pandemic.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Texas
The Board of Pharmacy adopted the pharmacy counseling waiver and non-sterile compound rules at the August 2nd meeting. A summary of all the rules adopted is available here.
Also in Texas, the Board of Pharmacy created an infographic clarifying for pharmacists the requirement to check a patient’s controlled substance history in the Prescription Monitoring Program (PMP) before dispensing opioids, benzodiazepines, barbiturates, or carisoprodol. The Board inspectors have found that some integrated pharmacy management systems require that the pharmacist manually initiate a report request by clicking to “View/Show Report” and access the full controlled substance history report for the patient to comply with the mandated PMP lookup requirement. However, if your integrated pharmacy management system loads both the patient score and the full patient report, the pharmacist does not need to load the report separately to be compliant with the mandate.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
California
Medi-Cal posted the following:
- News: “Coming Soon: Novavax COVID-19 Vaccine Authorization” – The Department of Health Care Services is aggressively pursuing the necessary system and operational changes required to enable successful claims adjudication for administration of the Novavax COVID-19 vaccine. (August 3)
- News: “New Provider Financial Data Request Form Available” – Providers should use the Financial Data Request Form for questions regarding missing warrants, copies of Remittance Advice Details (RADs), accounts receivable transactions, and copies of 1099s. (August 3)
- News: “New Approval Messages for COVID-19 Uninsured Group User Guide” was posted to the Medi-Cal News – COVID-19 Uninsured Group (UIG) coverage will be updated with new approval messages for qualifying individuals. (July 29)
- Alert: “Temporary Problem for Real-Time Eligibility Transactions” – The Medi-Cal Program has been affected by a temporary problem that has affected all providers using CalPOS leased line connection for Real-Time eligibility transactions. (July 29)
Also in California, the Department of Health Care Services posted the following alerts on the Medi-Cal Rx Web Portal.
- Enteral Nutrition Updates to the List of Covered Enteral Nutrition Products, Effective September 1, 2022, and December 1, 2022 (August 1)
- Medi-Cal Rx Monthly Bulletin for August (August 1)
- Changes to Contract Drugs List (CDL) (August 1)
- Updates to the Medi-Cal Rx Provider Manual (August 1)
- Electronic Claims Agreement – Submission Deadline Extended (July 29)
- Medi-Cal Rx Weekly Wrap-Up for July 22-28 (July 29)
Finally in California, the Board of Pharmacy communicated the following:
- NEW Pharmacy Law Waiver: Prescriber Dispensing of Tecovirimat (TPOXX or ST-246) Oral Antiviral Medication to Emergency Room Patient (BPC sections 4068(a)(1), 4068(a)(5), 4068(a)(6), 4076.5 and 4427.2(a))
- Next Standard of Care Committee Meeting – August 25, 2022 (NEW DATE)
- Notice of Second Modified Text to amend sections 1793.5 and 1793.6 and to add section 1793.65 to Title 16 of the California Code of Regulations related to Pharmacy Technicians and Second Modified Text; written comments will be accepted until August 17, 2022.
- Effective January 1, 2023, Order of Adoption amending Division 17 of Title 16 of the California Code of Regulations, section 1715.65, related to Inventory Activities and Inventory Reconciliation Reports of Controlled Substances
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Iowa
The Board of Pharmacy published the following rulemaking.
- Adopted (effective August 31, 2022)
- ARC 6416C adopted and amends Chapter 3, “Pharmacy Technicians”, and Chapter 6, “General Pharmacy Practice” related to pharmacist delegation of technical functions.
- ARC 6417C adopted and amends Chapter 8, “Universal Practice Standards”, and Chapter 19, “Nonresident Pharmacy Practice”
- ARC 6418C adopted and amends Chapter 12, “Precursor Substances”
- Notice of Intended Action (Comments may be submitted until 4:30 p.m. on August 16, 2022.)
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.