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Illinois

This notice implements the section of Public Act 102-0103 that allows pharmacists to bill and be reimbursed for patient care services for hormonal contraceptives. This new policy is effective with dates of service on and after August 1, 2022, and applies to the Medicaid fee-for-service (FFS) program and the HealthChoice Illinois (HCI) managed care organization (MCO) plans.  

Also in Illinois, this notice provides an update on coverage of the new COVID-19 bivalent boosters. The update applies to claims for customers covered under traditional Medicaid fee-for-service (FFS) and the HealthChoice Illinois (HCI) managed care organization (MCO) plans.  

For more information, contact NACDS’ Leigh Knotts at 803-243-7207.

November 4, 2022|Illinois|

Louisiana

The Board of Pharmacy quarterly meeting is scheduled on November 15 and 16 at the Board's office in Baton Rouge. Prior to the meeting, the agenda and public meeting binder will be accessible here. 

Also in Louisiana, Gov. John Bel Edwards (D) appointed 5 members to the 17-member Board of Pharmacy.  

  • Ricky Indovina, pharmacist with Ochsner Health System to a third six-year term; 
  • Raymond Strong, PharmD, with Ascension DePaul Services to a second six-year term; 
  • Pharmacist Jennifer Elliott Dupree with Walmart, a new member to a six-year term; 
  • Richard Mannino, independent pharmacy owner to a second six-year term and 
  • Chris Melancon, a new independent staff pharmacist to a six-year term. 

Finally in Louisiana, on October 19th, the Medicaid Fee for Service (FFS) Pharmacy Program announced the implementation of an electronic drug prior authorization application to achieve a more streamlined authorization process. 

For more information, contact NACDS’ Mary Staples at 817-442-1155.

November 4, 2022|Louisiana|

Minnesota

NACDS reminds members that the mandatory Medicaid Cost of Dispensing Surveys are due back to Myers & Stauffer on November 16. Myers and Stauffer mailed and emailed the surveys to pharmacies on October 19. You can access the survey documents, download an electronic version, and find instructions for responding on behalf of multiple locations on Myers & Stauffer’s Minnesota webpage.

For more information, contact NACDS’ Jill McCormack at 717-592-8977.

November 4, 2022|Minnesota|

North Carolina

The mandate for health care organizations and providers that serve state-funded patients to connect to the state-designated HIE by January 1, 2023, is fast approaching. The legislative changes enacted in the 2022 Appropriations Act may leave organizations and providers with questions about their connection status. Our General FAQs on NC HealthConnex gives more answers about the impacts on NC HealthConnex participants and non-participants.

For more information, contact NACDS’ Leigh Knotts at 803-243-7207.

November 4, 2022|North Carolina|

Ohio

This week, ODM (Ohio Department of Medicaid) (Ohio Department of Medicaid) reversed its policy that required provider participation in the Vaccines for Children (VFC) program under the SPBM (Single Pharmacy Benefit Manager), Gainwell. To increase access to pediatric vaccines, Gainwell announced they will now cover pediatric vaccine claims by non-VFC providers, reimbursing product costs and an administration fee. NACDS worked jointly with the Ohio Council of Retail Merchants and members to advocate for this policy with both ODM and the Governor’s office.

For more information, contact NACDS’ Jill McCormack at 717-592-8977.

November 4, 2022|Ohio|

Oklahoma

The Board of Pharmacy alerted licenses that the Oklahoma Board of Medical Licensure and Supervision (OMLS) has interpreted the laws and rules for Physician Assistants (PAs) prescribing Schedule II prescriptions. OMLS interpretation is that PA's can only prescribe Schedule II drug orders for immediate or on-going administration on-stie, which they define as a hospital, emergency room, ambulatory surgery center, medical clinic, or office in cases of emergency, or state-owned VA long term care facilities with an in-house pharmacy. PAs cannot prescribe Schedule II prescriptions in an outpatient setting for dispensing by a retail pharmacy.  

Also in Oklahoma, the Board of Pharmacy will be closed November 30-December 2 so that they can move back to their newly renovated offices at 2920 N. Lincoln Blvd. Ste. A, Oklahoma City, OK 73105. 

For more information, contact NACDS’ Mary Staples at 817-442-1155.

November 4, 2022|Oklahoma|

Oregon

The Board of Pharmacy is seeking applications from persons interested in serving on a workgroup concerning pharmacy interns. For more information, including the online application, visit the “Rules Advisory Committee (RAC) & Workgroup Information” webpage.

For more information, contact NACDS’ Sandra Guckian at 703-774-4801.

November 4, 2022|Oregon|

Pennsylvania

Gov. Tom Wolf (D) signed HB 1630 last week, just one day after the bill passed the General Assembly. HB 1630 allows the Auditor General access to PBM (Pharmacy Benefit Manager) data in the Medicaid Managed Care Program to perform audits. Notably, with the intent of expanding access to drug therapies, the bill was amended in the Senate Health Committee to repeal the provision in Section 1121.53(c) of 55 Pa. Code that limits payment for prescriptions in Medical Assistance to a 34-day supply or 100 units. Additionally, the following bills of interest to pharmacy were also signed: 

  • SB (Senate Bill) 225 (Act 146 of 2022) makes changes to prior authorization procedures and requires one form of MAT to be covered by Medicaid and private insurance without prior authorization requirements, 
  • HB 1393 (Act 111 of 2022) decriminalizes the use of fentanyl test strips for personal use and 
  • SB 1201 (Act 162 of 2022) requires health insurance policies to provide coverage for prescription eye drop refills at 70% of the prescription duration 

For more information, contact NACDS’ Jill McCormack at 717-592-8977.

November 4, 2022|Pennsylvania|

South Carolina

To comply with provisions of the Families First Coronavirus Response Act, the South Carolina Department of Health, and Human Services (SCDHHS) paused the typical annual eligibility review process for the state’s Healthy Connections Medicaid members effective January 27, 2020. When the current federal COVID-19 public health emergency (PHE) ends, state Medicaid agencies will be required to resume reviewing the eligibility of all Medicaid members. For more information, click here. 

For more information, contact NACDS’ Leigh Knotts at 803-243-7207.

November 4, 2022|South Carolina|

South Dakota

The Board of Pharmacy distributed its October 2022 newsletter. Below is an outline of the content. 

  •  Board Welcomes Newly Registered Pharmacists and Pharmacies 
  • SD Hosts NABP/AACP District 5 Meeting 
  • PDMP Statistical Report 
  • Board of Pharmacy Meeting Dates, Members and Staff 

For more information, contact NACDS’ Sandra Guckian at 703-774-4801.

November 4, 2022|South Dakota|

Texas

NACDS, the Texas Federation of Drug Stores (TFDS), the Texas Pharmacy Association (TPA) and the Texas Health-Systems Pharmacists (TSHP) collaborated on November 2 for an all-day successful Pharmacy Advocacy Training Day at the Texas State Capitol. Pharmacists from around the state were briefed on the pharmacy priority issues for the 2023 legislative session, heard from legislators, regulators, on "how to advocate" effectively, and then practiced what they learned by role playing. Media pundits shared their stories on Texas politics, the November 8 elections, and the outlook for the 2023 session. Chain, independent and hospital pharmacists teamed up and spent the afternoon fanning out across the Capitol in teams putting their knowledge into practice with over 50 scheduled meetings with legislators and staff. 

Also in Texas, the Health, and Human Service Commission (HHSC) is hosting a provider online seminar at Noon on November 8 on COVID-19 updates. COVID-19 vaccine providers may also benefit from the information relating to COVID-19 vaccine updates, clinical guidance, and product ordering. Please register to receive information to participate in this event.  

Finally in Texas, the Board of Pharmacy adopted non-sterile compounding rules at its August meeting. Board rule 291.131 changes including new definitions of cleaning and sanitizing and calibrations of scales.  

For more information, contact NACDS’ Mary Staples at 817-442-1155.

November 4, 2022|Texas|

Virginia

DMAS (Department of Medical Assistance Services) has issued a memo informing pharmacy providers that DMAS fee-for-service (FFS) and the Medicaid Managed Care Organizations will provide up to five professional dispense fees per month (defined as a rolling 30-day period) for buprenorphine-based opioid use disorder (OUD) products, effective December 1, 2022.

For more information, contact NACDS’ Jill McCormack at 717-592-8977.

November 4, 2022|Virginia|

Wisconsin

The Department of Safety and Professional Services announced it earned a $1.4 million grant from the Federal Bureau of Justice Assistance for its Enhanced Prescription Drug Monitoring Program (ePDMP). The grant funds will be used to modernize the self-service functionality and provide improved data quality, better customer support and greater user satisfaction.

For more information, please contact NACDS’ Mike Sargent at 207-272-6435.

November 4, 2022|Wisconsin|

Alabama

Reminder, Alabama Administrative Rule 420-4-1-.04 requires pharmacists to report to the State Health Officer or designee the dispensing of anti-tuberculosis medications and dispensing of antiretroviral medications to an infant.

Also in Alabama, all previously published expiration dates related to the COVID-19 public health emergency (PHE) are once again extended by the Alabama Medicaid Agency. The new expiration date is the earlier of November 30, 2022, the conclusion of the COVID-19 national emergency, or any expiration date noticed by the Alabama Medicaid Agency through a subsequent ALERT.

For more information, contact NACDS’ Leigh Knotts at 803-243-7207.

October 28, 2022|Alabama|

California

The Department of Health Care Services posted the following alerts and weekly notices on the Medi-Cal Rx Web Portal.

Also in California, the Board of Pharmacy issued its Annual Notice of Availability of Precedential Decisions Index. The index and the text of the precedential decisions are available on the Board’s webpage.

For more information, contact NACDS’ Sandra Guckian at 703-774-4801.

October 28, 2022|California|

Kentucky

Patients and pharmacies in the Commonwealth took a giant leap forward this week when Anthem announced they will be enrolling pharmacists as network providers. The move is a result of the enactment of a law that provides for pharmacy payment parity; HB 48 of 2021 required Kentucky health plans to reimburse pharmacists for services within a pharmacist’s scope of practice that are otherwise covered by the plan, if provided by another healthcare provider. Coupled with a pharmacist’s current authority to provide more than a dozen clinical services under Board of Pharmacy Protocols, Anthem members will have widespread convenient access to treatment at pharmacies for ailments such as flu, strep and tobacco cessation. Pharmacies interested in enrolling in the network should contact kyprovidercontracting@anthem.com. For more information, please see the Kentucky Pharmacists Association’s (KPhA’s) latest news release. NACDS applauds KPhA for its work with Anthem and its leadership in our joint support for HB 48.

Also in Kentucky, Medicaid has proposed a rule that may make it easier for pharmacies to provide vaccine services to kids with Medicaid coverage. The rule change eliminates the requirement to use Vaccines for Children (VFC) stock and strikes current language that states Medicaid will not reimburse for the cost of any vaccine if already available through the VFC program. NACDS interprets this to mean that pharmacies do not have to be enrolled in VFC to immunize and be reimbursed for Medicaid-covered kids. NACDS is seeking member feedback to determine whether this change would be significant to your vaccination efforts. Please review this rule and send Jill McCormack your comments by November 18.

For more information, contact NACDS’ Jill McCormack at 717-592-8977.

October 28, 2022|Kentucky|

Nebraska

The Department of Health and Human Services (DHHS) posted the COVID-19 Fee Schedule Bivalent Booster Updated (revised 10.27.2022).

Also in Nebraska, the DHHS announced Medicaid’s next COVOID update call will be held on November 2 at noon (Central). To join the call, dial 408-418-9388 (access code) 2492 610 1342 or use the meeting link:
https://sonvideo.webex.com/sonvideo/j.php?MTID=m3aab184252403e62a6ff312be38e9d54

Also in Nebraska, the Board of Pharmacy posted its agenda for the November 7 meeting.

For more information, contact NACDS’ Sandra Guckian at 703-774-4801.

October 28, 2022|Nebraska|

New York

NACDS will be attending the annual meeting for the Community Pharmacy Association of New York in Albany on November 15th. At this meeting, the priorities and strategies for the 2023 legislative session will be reviewed.

Also in New York, our comments, that were reviewed by New York members will be submitted to the Department of Financial Services for the October 31st deadline. If your company is also submitting your own comment letter, please be sure to place PBM2022-06 in the subject line.

For more information, please contact NACDS’ Mike Sargent at 207-272-6435.

October 28, 2022|New York|

Ohio

This week, Ohio Medicaid announced the payment schedule for the Supplemental Managed Care Dispensing Fee and that the fee has been increased due to the compressed schedule of payments. The payment schedule is:

Payment 5 – Between November 1 – 15, 2022 (July – Sept 2022 claims)

Payment 6 – Between February 1 – 15, 2023 (Oct – Dec 2022 claims)

Payment 7 – Between May 1 – 15, 2023 (Jan – March 2023 claims)

Payment 8 – No later than August 15, 2023 (April – June 2023 claims)

Note that the November payment will be issued by the Medicaid MCOs (Managed Care Organizations) and, as in the past, will be included in your weekly claim payments. However, the balance of the payments will come from Gainwell, the SPBM (Single Pharmacy Benefit Manager), as a separate payment. The FAQ document includes more detail.

Also in Ohio, Medicaid has prepared a toolkit for providers to prepare for the expiration of the federal Public Health Emergency (PHE). The materials are focused on the “unwinding” patient eligibility that will result at the end of the PHE.

For more information, contact NACDS’ Jill McCormack at 717-592-8977.

October 28, 2022|Ohio|

Oregon

The Oregon State Pharmacy Association announced the results of its PBM study conducted by 3 Axis Advisors to review reimbursement trends between payers and retail pharmacies between 2019 and 2021.

Also in Oregon, the Board of Pharmacy posted its agenda for its Strategic Planning Meeting scheduled to be held on November 10.

For more information, contact NACDS’ Sandra Guckian at 703-774-4801.

October 28, 2022|Oregon|
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