Virginia
NACDS reminds members that Medicaid has recently expanded its list of maintenance medications eligible to be filled with a 90-day supply. Medicaid-covered patients are eligible for the long fills after receiving two 34-day or shorter fills of drugs on the list.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Washington
The legislature convened on January 9, 2023.
Also in Washington, legislation creating a new stand-alone chapter for regulating PBMs was filed this week. SB 5213 and HB 1253 were designed by the Office of the Insurance Commission (IOC) and the Washington State Pharmacy Association (WSPA) to regulate PBMs directly regardless of whether the contract is with a state-regulated plan or a self-funded plan. The bill prohibits requiring the use of mail-order pharmacies (except for specialty drugs), reimbursing pharmacies below costs and excluding pharmacies from the network.
Also in Washington, the Washington State Pharmacy Association (WSPA) Legislative Days are January 25 and February 13. These events will allow all pharmacists, pharmacy students and pharmacy technicians from all practice settings to connect with legislators and colleagues across the state.
Also in Washington, the Health Care Authority recently updated its provider billing guides and fee schedules for Apple Health (Medicaid).
Finally in Washington, the Department of Health (DOH) is developing a campaign in 2023 to encourage families to catch up on immunizations. To accomplish this goal, DOH is surveying health care providers for guidance on what materials and resources are needed.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
California
Last week, the Department of Health Care Services (DHCS) announced plans for the reinstatement of prior authorization and the retirement of the transition policy taking place in a series of phases… II, III and IV. A webpage has been developed for "Medi-Cal Rx Reinstatement" that includes information about the timeline, key days, announcements and alerts and resources. If you already receive Medi-Cal Rx alerts, you will also begin to receive Reinstatement alerts. There is no need to subscribe to an additional listserv according to DHCS staff.
Also in California, the DHCS posted the following alerts and weekly notices on the Medi-Cal Rx Web Portal. Please note the reinstatement resources in New Resources for Reinstatement Education and Support.
- New Resources for Reinstatement Education and Support (December 12)
- COVID-19 Antigen Tests Coverage Reminder (December 9)
- Medi-Cal Rx Weekly Wrap-Up for December 2-8 (December 9)
Also in California, Medi-Cal posted the following:
- Monkeypox Vaccines Reimbursement at the Medicare Rate (December 13)
- Erroneous Cal MediConnect (CMC) Notice (December 9)
- Meet & Greet Event – March 2023 (December 9)
- Meet & Greet Event – February 2023 (December 9)
Finally in California, NACDS and the California Retailers Association (CRA) sent several joint letters to the Board of Pharmacy addressing issues of concern to members.
- With respect to e-prescribing requirements effective January 1, 2023, NACDS and CRA are seeking guidance from the Board about how members can comply with requirements to accept electronic prescriptions without advance notice from a vendor with whom they do not have a current business relationship.
- We are also seeking clarity from the Board via answers to a brief list of questions to provide members the appropriate guidance to aid their efforts to comply with a 2021 law related to pharmacy quotas; recall, this law only applies to companies operating 75 or more pharmacies in the state under one ownership.
- Finally, we are expressing concern with a proposal under consideration by the board to create a "staffing floor" that may lead to pharmacy closures if at least one clerk or pharmacy technician is not on staff and fully dedicated to performing pharmacy-related services while the pharmacy is open; this proposal would also permit the pharmacist on duty to close the pharmacy if, in their opinion, the staffing at the pharmacy is inadequate to safely fill or dispense prescriptions or provide services in a safe manner without fear of retaliation. We asked to work with the board on solutions so that pharmacies can remain open to their patients.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Delaware
On December 9, Gov. John Carney (D) extended the Public Health Emergency (PHE) another 30 days permitting medical providers to continue COVID-19 vaccination and testing programs. This is the 10th extension of the PHE.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Georgia
The Board of Pharmacy shared “Volume 4” of its newsletter. The newsletter is created on a quarterly basis and is intended to provide insights and updates on the profession of pharmacy in the state. The newsletters can be found on the GBOP website for easy access.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Iowa
The Board of Pharmacy adopted the following rules effective January 4, 2023:
- ARC 6685C has been adopted and amends Chapter 23, "Care Facility Pharmacy Practice."
- ARC 6686C has been adopted and amends Chapter 41, "Outsourcing Facilities."
- ARC 6687C has been adopted and amends Chapter 14, "Public Information and Inspection of Records."
- ARC 6688C has been adopted and amends Chapter 12, "Precursor Substances."
- ARC 6689C has been adopted and amends Chapter 10, "Controlled Substances."
Also in Iowa, the Board of Pharmacy published ARC 6696C as a Notice of Intended Action to amend Chapter 3, "Pharmacy Technicians," Chapter 6, "General Pharmacy Practice," Chapter 8, "Universal Practice Standards," Chapter 18, "Centralized Prescription Filling and Processing," Chapter 21, "Electronic Data and Automated Systems in Pharmacy Practice," and Chapter 39, "Expanded Practice Standards." Comments may be submitted until 4:30 p.m. on December 20.
Finally in Iowa, the Department of Health and Human Services, Iowa Medicaid published INFORMATIONAL LETTER NO. 2405-MC-FFS announcing January 2023 Iowa Medicaid Pharmacy Program Changes.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Maryland
The Maryland Pharmacists Association (MPhA) is seeking nominations for two trustee Board positions for 2023-2024. Trustees serve a three-year term. Any active MPhA member in good standing is eligible for nomination and self-nomination is acceptable. Interested parties may submit their nominations online.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Nebraska
The Department of Health and Human Services (DHHS) posted an Interim Guidance for Clinicians to Prioritize Antiviral Treatment of Influenza in the Setting of Reduced Availability of Oseltamivir, an official CDC Health Advisory.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
New York
Gov. Kathy Hochul (D) has vetoed A7889, a bill meant to reform the Medicaid audit process. In her veto message, the Governor cited concerns about the bill preventing Medicaid from recovering legitimate overpayments and any corresponding impact on the loss of federal funds.
Also in New York, on December 20, the State Department of Health is hosting an informational online seminar for all stakeholders about the transition of the pharmacy benefit from Medicaid Managed Care to NYRx, (Medicaid fee-for-service (FFS) pharmacy program). This is part of a series of recurring monthly webinars about this topic. Note that you must complete the registration form to attend. Afterward, a copy of the presentation will be posted on the transition website, where past presentations are available.
Finally in New York, Medicaid's newsletter from November includes a section on pharmacy dispensing/prescribing of emergency contraceptives.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Ohio
The Board of Pharmacy (BOP) released another draft rule for stakeholder feedback from the Pharmacy Workforce Advisory Committee. This rule would establish mandatory breaks for pharmacy personnel. Members may submit comments to the BOP by January 20, 2023. Please note that the document also has guidance related to the current law around protections against employee violation reports to the Board.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Pennsylvania
The Office of Medical Assistance (Medicaid) published Bulletins with updates to the Preferred Drug List effective January 9, 2023, and another about PA (Prior Authorization) instructions for Monoclonal Antibodies.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
South Carolina
The South Carolina Department of Health and Human Services (SCDHHS) will operate on an updated schedule for Healthy Connections Medicaid claims submission and payments to accommodate the December 2022 holidays.
December 2022
Due to observance of the Christmas holiday, Monday, December 19, at 5:00 p.m. is the deadline to submit claims for payment date Friday, December 23. Payments will run Tuesday, December 20, and electronic remittance advice will be available Thursday, December 22. Payments will be dated Friday, December 23, as usual.
Monday, December 26, at 5:00 p.m. is the deadline to submit claims for payment date Friday, December 30. Payments will run Tuesday, December 27, and electronic remittance advice will be available Thursday, December 29. Payments will be dated Friday, December 30, as usual.
January 2023
Due to observance of the New Year's Day holiday, Monday, January 2, at 5:00 p.m. is the deadline to submit claims for payment date Friday, January 6. Payments will run on Tuesday, January 3, and electronic remittance advice will be available Thursday, January 5. Payments will be dated Friday, January 6, as usual. The schedule will return to the normal payment cycle on payment date Friday, January 6, 2023.
Provider Service Center (PSC) Holiday Hours
The PSC will be closed Friday, December 23, and Monday, December 26, in observance of the Christmas holiday, and on January 2, 2023, in observance of the New Year's Day holiday.
Please refer any questions or concerns about this alert to the PSC at 888-289-0709. The PSC's regular hours of operations are 7:30 a.m. – 5:00 p.m. Monday-Thursday and 8:30 a.m.- 5:00 p.m. Friday.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Tennessee
TennCare Prescribing Providers, please see Information and Updates to the TennCare Preferred Drug List (PDL) due to Amoxicillin shortages. We encourage you to review this information thoroughly and contact the OptumRx Pharmacy Supports Center at 866-434-5520 or tnrxeducation@optum.com should you have questions.
Also in Tennessee, TennCare has established a plan for unwinding from the Public Health Emergency. In its first phase, TennCare seeks partnership from healthcare providers to encourage TennCare patients to update their contact information and register for TennCare Connect. Shareable resources are available on the website.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Utah
The Board of Pharmacy posted the agenda for its December 20 meeting.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Vermont
The Department of Vermont Health Access has published updates to the Preferred Drug List (PDL) effective January 1, 2023.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Wisconsin
The Department of Safety and Professional Services announced a new LicensE Public Application Status Lookup toll that makes it easier for employers to track the application status of current and future employees.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Alabama
On December 13, join the Alabama Pharmacy Association’s (APA’s) Year-End Continuing Education Webinar from 6:00-8:00 p.m. (CST) and earn two hours of live credit. Sessions will include “Pharmacy Law” with Stephen Brown, JD, PharmD, Assistant Professor, Samford-McWhorter, and “2023 Legislative Session Primer” with Bobby Giles, RPh, APA Government Affairs Director. Register on the APA website.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Alaska
The Board of Pharmacy adopted the following changes to proposed rules (Regulation project amending sections 12 AAC 52.020 through 12 AAC 52.990). These regulations will take effect on December 28.
Pharmacists
Removal of the transcript requirement
Delegation of examination eligibility approval to the NABP
Authorizes a pharmacist-in-charge (PIC) to serve as a PIC for more than one pharmacy upon a written request to the board
Allows the official License Transfer Application to also serve as a license verification from the reciprocating state
Removes requirement to submit separate verifications of licensure for reciprocity applicants
Clarifies patient counseling requirements
Interns
Expands the criteria to qualify for an internship license by recognizing recent graduates
Extends the duration of the license from two years to five years
Replaces the 1,500 hours education requirement for pharmacist licensure with standardized language
Removes the affidavit of moral character requirement
Technicians
Clarifies pharmacy technician duties
Removes language relating to on-the-job training for the preparation of sterile pharmaceuticals
Pharmacies
Replaces the requirement for pharmacies located outside of the state to submit a certified true copy of the home jurisdiction license with a simple copy
Replaces the inspection report requirement with an attestation that an inspection will be completed
Facilities
Removes the fingerprint and resume requirements for wholesale drug distributors, outsourcing facilities and third-party logistics providers
For wholesale drug distributors, requires a copy of the home jurisdiction license only if the state requires licensure as a wholesale drug distributor
Prescription Drug Monitoring Program (PDMP)
Adopts by reference the PDMP data dispenser submission guide
Recognizes 3rd party reporting vendors
Defines "appropriate identifier" as the provider's/pharmacist's license number
Clarifies that a provider/pharmacist must submit a zero report when no scheduled II – IV controlled substances are dispensed
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. Please note the delay in the planned resumption of retroactive adjustments and recoupment activity in "Recommencement of Pharmacy Retroactive Claim Adjustments: Status Update". Also note the MAIC notice regarding rates effective January 1, 2023 in "Maximum Allowable Ingredient Cost 30-Day Pharmacy Provider Notice".
- Recommencement of Pharmacy Retroactive Claim Adjustments: Status Update (December 8)
- Medical Supplies Update: Updates to Diabetic Testing Supplies (December 5)
- Monkeypox Vaccine as a Medi-Cal Pharmacy Benefit (December 2)
- 30-Day Countdown – Cal MediConnect Transition to Medicare Medi-Cal Plans (December 2)
- Medi-Cal Rx Weekly Wrap-Up for November 18-December 1 (December 2)
- Medi-Cal Rx Monthly Bulletin (December 1)
- Changes to Contract Drugs List (CDL) (December 1)
- Updates to the Medi-Cal Rx Provider Manual (December 1)
- Maximum Allowable Ingredient Cost 30-Day Pharmacy Provider Notice (December 1)
- Now Available: Appendix H – List of Physician Administered Drugs with Reject Code 816 (December 1)
- NCPDP Reject Code 80 and Diagnosis Documentation of Code 1 Restriction: Status Update (November 30)
- Tabloid 40 mg Update (November 21)
- Medi-Cal Rx Weekly Wrap-Up for November 11-17 (November 18)
Also in California, Medi-Cal posted the following:
- Senior Care Action Network (SCAN) Health Plan Expansion (December 7)
- CalAIM Mandatory Managed Care Enrollment Transition Phase II (December 7)
- CMC [Cal MediConnect] Plans No Longer Covered in CCI [Coordinated Care Initiative] Counties (December 5)
- UnitedHealthcare Community Plan of California no Longer a Medi-Cal MCP [Managed Care Plan] in San Diego County (December 1)
- January 2023 Medi-Cal Provider Training Webinars (November 30)
Finally in California, the Board of Pharmacy posted the agenda and meeting materials for its meeting scheduled for December 14. Please note the discussion and consideration of statutory proposals to establish a requirement for reporting medication errors to the Institute for Safe Medication Practices (ISMP) and related to working conditions (see Attachment 2).
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Colorado
When the Public Health Emergency (PHE) that the U.S. Department of Health and Human Services (HHS) declared in January of 2020 in response to the outbreak of COVID-19 ends, everyone enrolled in Health First Colorado (Medicaid) was guaranteed to keep their health coverage during the PHE. However, the Department of Health Care Policy & Financing (HCPF) will take 12 months (14 months including noticing) to complete the renewal process for each of the approximately 1.6 million people currently enrolled. Medicaid members need to pay attention to renewal notices and fill out the necessary forms to make sure they keep their Health First Colorado and CHP+ coverage, if they are still eligible.
Also in Colorado, on December 5, the HCPF sent the U.S. Food and Drug Administration (FDA) an official proposal to import lower-cost prescription drugs from Canada.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Delaware
The Office of Controlled Substances announced the 2023 meeting schedule for the Controlled Substance Advisory Committee. Meetings will be held at 9:00 a.m. on January 25, April 26, July 26 and October 25.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Florida
The following flexibilities in response to Hurricane Nicole, expired November 30:
- Waiver of prior authorization requirements for critical Medicaid services
- Waiver of service limitations to ensure a recipient requiring critical Medicaid services during the storm receives such care
- Temporary postponement of the Preadmission Screening and Resident Review processes
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Indiana
The Indiana Health Coverage Programs (IHCP) posted a provider Bulletin which includes billing guidance for pediatric vaccine counseling and pharmacy reimbursement updates for COVID vaccine administration.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Kentucky
The Kentucky Pharmacy Education & Research Foundation (KPERF), the Kentucky Pharmacists Association’s tax-exempt charitable foundation, recently announced a funding opportunity for pharmacist-led non-invasive colorectal cancer (CRC) screening for which they are seeking pharmacy applicants. They will choose six pharmacies based on their readiness, the expectation that they can see ten patients per month, their geographical location in Kentucky and the needs of their community. As a reminder, in 2021, the Board of Pharmacy approved a colorectal cancer screening protocol allowing pharmacists to initiate the dispensing of noninvasive stool-based CRC screening patients aged 45-85 years at average risk for colorectal cancer. For more information on this protocol and all pharmacy protocols approved in the state, click here.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Louisiana
The Department of Health issued a Medicaid Bulletin 22-38 with updates and requirements for the provider enrollment portal.
Also in Louisiana, Medicaid expanded its "Shot per 100,000" COVID-19 vaccine incentive program to include booster shots. Those age 5 years and older who received their first or second dose of the vaccine on or after April 5, 2022, qualify for this incentive, as do those age 6 months to age 4 years who were vaccinated with their first or second dose on or after July 5, 2022 and those age 6 months and older who received a vaccine booster dose on or after October 1, 2022, are all eligible for the $200 gift card.
Also in Louisiana, the new Preferred Drug List (PDL) update will be implemented January 1, 2023. There were no new therapeutic classes added to the PDL during the Fall 2022 Pharmaceutical & Therapeutics (P&T) Committee review.
Finally in Louisiana, Medicaid will include six health plans beginning January 1, 2023. They are Aetna Better Health, AmeriHealth Caritas, Healthy Blue Louisiana, Humana Healthy Horizons, Louisiana Healthcare Connections and UnitedHealthcare. Prior to January 1, 2023, most Medicaid members were auto-assigned to one of the Medicaid health plans. Attached is a communications toolkit.
For more information, contact NACDS’ Mary Staples at 817-442-1155.