Illinois
The Illinois D&T Advisory Board will be reviewing the Biologic Modifiers at its October 20, 2022 meeting. All clinical and financial submissions are due to the Department by 3:00pm CST September 29, 2022. Please submit to: HFS.SupplementalRebaleProgram@illinois.gov.
Also in Illinois, the Department of Healthcare and Family Services has posted a new Provider Notice regarding Sexual Assault Treatment Program Private Insurance Opt-Out Alternative Per Public Act 102-1097.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Indiana
The Family and Social Services Administration’s (FFSA) Indiana Health Coverage Programs (IHCP) Medicaid announced that effective July 1, 2023, all managed care plans will cover both preferred and nonpreferred drugs, maintain the same clinical criteria requirements and use the same format for prior authorization (PA) as the fee-for-service (FFS) program.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Iowa
The Department of Health and Human Services, Iowa Medicaid issued the following:
- INFORMATIONAL LETTER NO 2377-MC Iowa Medicaid Managed Care Town Halls September 2022
INFORMATIONAL LETTER NO 2375-MC HHS Announces Winning Bidders for IA Health Link RFP (RFP MED-23-005) - INFORMATIONAL LETTER NO 2370-MC-FFS October 2022 Iowa Medicaid Pharmacy Program Changes
- INFORMATIONAL LETTER NO 2369-MC-FFS Participation in the Federal Fiscal Year (FY) 2024 Payment Error Rate Measurement (PERM) Program
- INFORMATIONAL LETTER NO 2368-MC-FFS 2022 Iowa Medicaid Annual Provider Training
- HHS Announces New Mission, Vision and Brand
- HHS Announces Intent to Award New Managed Care Contracts
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Kentucky
The Board of Pharmacy has filed an emergency and ordinary amendment to allow pharmacists to prescribe and receive Medicaid reimbursement for Paxlovid. Specifically, the amendment removes the list of specific conditions that require a Board-approved protocol for pharmacists to be authorized to treat patients with illnesses. Instead, the regulation would allow a pharmacist to utilize any protocol approved by the board to provide treatment services. This emergency amendment will allow for any prescriber–approved protocol to be reviewed for approval by the Board of Pharmacy. If the regulation is approved, the physician Director of Medicaid Services can also sign a prescriber–approved protocol for any pharmacist to initiate the dispensing of Paxlovid for Medicaid patients. Additionally, the board approved a new board authorized protocol for Paxlovid. The emergency regulation was effective immediately, but the ordinary version must be go through the promulgation process with the Board. NACDS expects the physician community to oppose this regulation and encourages members to join us in submitting supportive comments by September 30. Further detail and contact information for comments are on the regulation webpage.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Louisiana
The Department of Health (LDH (Louisiana, the Department of Health)) Medicaid Pharmacy Facts includes detailed information on Medicaid's Fee-for-Service (FFS) Pharmacy Program and the managed care organizations (MCO) coverage and reimbursements for flu and COVID booster.
- Effective September 15, 2022, enrolled pharmacies will be reimbursed for the influenza vaccines and administration of the vaccines when given to Medicaid recipients, who are 19 years of age and older when the administering pharmacist is an enrolled Medicaid provider. The cost of the vaccine will not be reimbursed for recipients under the age of 19, only the administration fee will be reimbursed, as these vaccines are available through the Louisiana Vaccines for Children (VFC) program. The Louisiana Board of Pharmacy rules and regulations allow a vaccinating pharmacist to administer the influenza vaccine to individuals seven years of age and older.
- On September 23, 2022, with an effective date of August 31, 2022, the Louisiana Medicaid's Fee-for-Service (FFS) Pharmacy Program and the managed care organizations (MCO) are covering the bivalent COVID-19 vaccine booster, with Emergency Use Authorization (EUA). The federal government covers the cost of the COVID-19 vaccine. Therefore, Louisiana Medicaid will reimburse enrolled pharmacies the administration fee only. Coverage for the Pfizer, Janssen (Johnson & Johnson), and Moderna COVID-19 primary vaccine series will continue.
- Louisiana Medicaid is hosting a series of provider webinars regarding the upcoming Provider Enrollment deadline.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Mississippi
Effective July 1, 2022, the Mississippi Division of Medicaid (DOM) reestablished payment methods for the ingredient costs of prescription drugs that existed prior to the July 1, 2021 rate freeze. This change removed the freeze for dates of service on or after July 1, 2022. On 8/22/2022, Conduent will begin adjusting claims with dates of service of 7/1/2021 through 6/30/2022 to reflect the ingredient cost of the drug in effect on the claim's date of service.
Also in Mississippi, the Pharmacy Association will hold its 2022 Consultant Seminar on October 13, 2022, 8:00 a.m. – 5:00 p.m. Please visit their website for more information or Contact Mindy Phillips at mindy@mspharm.org if you have any questions or need assistance.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Nebraska
The Department of Health and Human Services (DHHS) announced the next COVID Medicaid Provider call will take place on October 5 at noon (Central). Call details will be posted at this website one week before the call.
Also in Nebraska, the DHHS issued a News Release, titled "Nebraska Medicaid To Interview Bidders For New Managed Care Contracts."
Finally in Nebraska, the DHHS posted the following:
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Ohio
NACDS reminds members that Gainwell, the Ohio Medicaid Managed Care Single Pharmaceutical Benefits Manager (SPBM), will being offering pharmacies training on using the web portal on September 19. Registration instructions can be found on the Single PBM page. Select the selecting the provider resources tab, then clicking on "SPBM Web Portal Training." Gainwell will be processing all Medicaid managed care claims beginning on October 1, 2022.
Also in Ohio, the Board of Pharmacy has issued draft regulations allowing registered and certified pharmacy technicians to vaccinate. The rule makes technician immunization authority consistent with Ohio's current pharmacist immunization authority as it relates to age and vaccine type, per passage of House Bill 6 of 2021. NACDS intends to comment on this rule. Please send Jill McCormack your comments by October 3.
Finally in Ohio, Medicaid and Myers & Stauffer have announced an extension of the due date for the 2022 mandatory Cost of Dispensing Study to September 21 and have stated in a letter to pharmacies that this will be the final extension of the survey due date.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Oregon
The Board of Pharmacy posted the agenda for the Public Health & Pharmacy Formulary Advisory Committee to be held on September 21. Please note agenda items related to protocol development and proposed protocol revisions.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
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.