Iowa
On June 13, Gov. Kim Reynolds (R) signed HF 2384 related to PBMs (Pharmacy Benefit Managers) including MAC (Maximum Allowable Cost) lists, claw backs and enforcement.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Massachusetts
MassHealth just released its latest edition of Medicaid Pharmacy Facts updated Drug Lists.
For more information, please contact NACDS’ Mike Sargent at 207-272-6435.
Minnesota
MDH (Minnesota Department of Health) has updated the Interim COVID-19 Vaccine Provider Guide, Template: COVID-19 Screening and Agreement and created the Pfizer-BioNTech COVID-19 Vaccine Protocol for 6 months through 4 years and Moderna COVID-19 Vaccine Protocol for 6 months through 5 years. Find these resources at COVID-19 Vaccine Providers.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
New Jersey
This week at the New Jersey Board of Pharmacy, the Board agreed to extend the remote processing pilot program for 6 months to allow time for the regulations to be finalized. The Board will be notifying New Jersey pharmacies of this extension. Today there are 124 pilot programs up and running. NACDS sent a letter last month requesting that the pilot be continued.
For more information, please contact NACDS’ Mike Sargent at 207-272-6435.
Ohio
Last week, Medicaid (ODM (Ohio Department of Medicaid)) held a pharmacy stakeholders’ online seminar where they announced pharmacy reimbursement rates under the Single PBM, “Next Generation of Managed Care Program.” The slides and a recording of the online seminar can be found on the SBPM website.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Pennsylvania
Legislation that would allow pharmacists and pharmacy interns to administer COVID and flu vaccines to children down to the age of 5 advanced in both Chambers this week. HB (House Bill) 2679 was reported from the House Professional Licensure Committee and is poised for a vote by the full House next week. The Senate Professional Licensure Committee also amended SB (Senate Bill) 511 to match the language in HB 2679 and unanimously reported it to the full Senate for consideration. The intent is to deliver one of these bills to the Governor’s desk before adjournment for summer recess. However, if the General Assembly adjourns early, we are optimistic that the process can be completed in the fall, prior to sine die.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Texas
In advance of the House and Senate health committee interim hearings this summer studying the pandemic response, NACDS and our in-state partner, the Texas Federation of Drug Stores (TFDS) provided joint letters to both the Senate Health and Human Services Committee and the House Select Committee on Health Care Reform highlighting how Texas pharmacies, empowered through federal authorizations to expand access to essential care services, were instrumental in providing millions of vaccinations, tests, and access points for antivirals. We urged lawmakers to take action to maintain critical access to care at pharmacies, allowing pharmacies/pharmacists to order and administer vaccinations approved by CDC/ACIP for ages 3 and older; initiate corresponding treatment pursuant to the result of a CLIA (Clinical Laboratory Improvement Amendments)– waived test; and permit pharmacy technicians’ to also administer the tests and vaccines.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Virginia
The Department of Health (VDH) has posted an updated COVID-19 Vaccine Standing Order to include COVID vaccines for children aged 5 and younger. You can also view the Summary of Legal Authorities for Pharmacists to Administer COVID Vaccines on their COVID-19 vaccine webpage for health professionals.
Also in Virginia. The Department of Medical Assistance Services (DMAS) will hold the Pharmacy Liaison Committee Meeting on July 14 in Richmond. The agenda has been posted. If members have any questions or comments regarding the topics on the agenda, please send them to Jill McCormack by July 12.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Alabama
All previously published expiration dates related to the COVID-19 emergency are once again extended by the Alabama Medicaid Agency. The new expiration date is the earlier of July 31, 2022, the conclusion of the COVID-19 national emergency, or any expiration date noticed by the Alabama Medicaid Agency through a subsequent ALERT. A listing of previous Provider ALERTs and notices related to the health emergency is available by selecting the Agency’s COVID-19 page.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Arkansas
Rules allowing pharmacist therapeutic substitution went into effect as of May 10, 2022. Pharmacists whose practice is located within the State of Arkansas may substitute medications for therapeutically equivalent medications unless the prescriber indicates that no substitution is to be made or if the Arkansas State Board of Pharmacy has determined that a therapeutically equivalent product should not be substituted and has notified all pharmacists of that determination.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
California
The Department of Health Care Services posted the following alerts on the Medi-Cal Rx Web Portal.
- Enteral Nutrition Updates: Interchange of Equivalent Contracted Enteral Nutrition Product and Specialty Infant Authorization Term Limit (June 18)
- Medi-Cal Rx Weekly Wrap-Up for June 3-9 (June 10)
Also in California, Medi-Cal posted the following updates.
- Respiratory Supplies: Updates to the List of Medical Supplies Billing Codes, Units and Quantity Limits
- National Correct Coding Initiative Quarterly Update for July 2022
- July 2022 Medi-Cal Provider "Coffee Break" Event
- August 2022 Medi-Cal Provider Training Webinars
- Get the Latest Medi-Cal News: Subscribe to MCSS (Medi-Cal Subscription Service) Today
- Provider Manual Revisions
- Update: Second Booster Dose for Select COVID-19 Boosters Now a Benefit
- Age Eligibility and Availability Revised for Cabenuva
- New Medi-Cal Benefit for Hepatitis B Vaccine
- Respiratory Supplies: Updates to the List of Medical Supplies Billing Codes, Units and Quantity Limits
- One Time Injection Administration Fee Update
- National Correct Coding Initiative Quarterly Update for July 2022
- July 2022 Medi-Cal Provider "Coffee Break" Event
- August 2022 Medi-Cal Provider Training Webinars
Finally in California, the Board of Pharmacy has posted the following agendas for next week's June 22 ad hoc committee meetings.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Colorado
The Board of Pharmacy is hosting a virtual Stakeholder Meeting on June 27 at 10 AM MDT to solicit feedback on multiple proposed revisions to the Board's rules on newly passed legislation. Topics include Third Party Logistics Providers, Reporting Violations, and Collaborative Pharmacy Agreements and Appendix C (Statewide Protocol for Pre-Exposure and Post-Exposure Prophylaxis of HIV). Potential considerations to revise the rules to implement new legislation concern Colorado Senate Bills 22-116, 22-173, 22-027, 22-098; and Colorado House Bills 22-1235, 22-1246, 22-1115, and 22-1122. To participate, you must register for the online seminar. If you cannot attend the meeting or want to submit comments, send your comments to: dora_dpo_rulemaking@state.co.us by June 24, 2022.
Also in Colorado, HB (House Bill) 22-1370 will pass along drug manufacturer rebates to employers and consumers – valued at more than 16% of overall drug costs for those not sharing in rebates now. This bill represented one of the policy recommendations in the Department's 2021 Reducing Prescription Drug Costs in Colorado Report.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Illinois
Governor JB Pritzker (D) signed HB4430, on June 10, 2022, effective January 1, 2023, this legislation expands the scope of practice for pharmacists to include the initiation, dispensing, or administration of drugs, laboratory tests, assessments, referrals, and consultations for HIV pre-exposure prophylaxis and HIV post-exposure prophylaxis. The measure also establishes a Medicaid reimbursement rate for all pharmacist-provided services.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Louisiana
The legislature adjourned its regular session on June 6.
Also in Louisiana, the Department of Health's (LDH) deadline for Medicaid Provider Portal enrollment is June 30, 2022. All current providers must validate their information and sign the state's provider participation agreement.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Mississippi
The Board of Pharmacy issued a proposed rule on pharmacy shared services as well as proposed amendments to the definitions found in Title 30 Part 3001, which will remove outdated definitions and add new ones to clarify the Board’s regulations. More information on these proposed rules can be found here.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Montana
This week, Gov. Greg Gianforte (R) declared a statewide disaster due to severe flooding in several counties with additional flood warnings in other areas of the state.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Nebraska
The Department of Health and Human Services posted an agenda for the Nebraska Medicaid DUR (Drug Utilization Review) Board Meeting to be held on July 12.
Also in Nebraska, a Technical Committee Meeting for the Credentialing Review (407) Pharmacy Technician is scheduled for June 28 and an agenda has been posted.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
New Mexico
Governor Michelle Lujan Grisham (D) signed an executive order creating a Prescription Drug Task Force directed to identify ways to expand access and affordable pricing for medications. The EO (Executive Order) directs its members to analyze and report solutions to manage and minimize the cost of prescriptions for New Mexicans. Membership will include a New Mexico licensed pharmacist engaged in practice at an independent pharmacy, the Superintendent of Insurance, a licensed physician in New Mexico, a patient advocate, and an individual whose profession is in the health insurance industry.
Also in New Mexico, the Medical Assistance Division (MAD) of the New Mexico Human Services Department (HSD) is now requiring ALL prescribers, including pharmacists with prescriptive authority for Centennial Care members to enroll as a Medicaid Provider to continue to receive payment for prescriptions. Failure to enroll will result in denial, rejection, or recoupment of payment for prescriptions when written for Centennial Care Members effective November 12, 2022.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
New York
On June 8, 2022, the New York State Department of Health in consultation with the Department of Environmental Conservation, announced the approval of two Drug Take-Back programs, proposed and operated by Inmar Rx Solutions, Inc. and MED-Project, LLC. Pursuant to Chapter 120 Laws of 2018, the New York State Drug Take Back Act (DTB) mandates that manufacturers establish, fund, and manage a New York State-approved drug take-back program(s) for the safe collection and disposal of unused covered drugs. Pharmacies of ten or more establishments within NYS and non-resident pharmacies that provide covered drugs to NYS residents by mail must implement such programs by providing consumers with a pre-approved method(s) of collection and disposal, free of charge to the consumer and pharmacy.
For more information on the Drug Take-Back programs to be operated by Inmar and MED-Project, visit their sites:
The press release can be found here: New York State Department of Health and Department of Environmental Conservation Announce Approval of Two Drug Take Back Programs
For more information, please contact NACDS’ Mike Sargent at 207-272-6435.
Ohio
In response to questions posed to Medicaid (ODM) at the May Joint Medicaid Operations Committee (JMOC) meeting related to the implementation of the Single Pharmaceutical Benefits Manager, ODM issued a letter that contains further detail on the implementation timeline and other issues of import to members.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Oklahoma
The Department of Insurance issued Bulletin No. 5-2022 provides information to clarify what is required regarding a new law, SB (Senate Bill) 737 was codified into Title 36 § 6962 of the Oklahoma Statutes that includes new requirements which will have a significant impact on the Pharmacy Benefits Management industry. Because the law included a declaration of emergency, it took effect immediately on April 21st when signed by Governor Kevin Stitt (R).
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Pennsylvania
The House Professional Licensure Committee will consider HB 2679 on June 20. The bill, introduced by the Majority and Minority Chairs of the Committee, represents a compromise agreement that would expand pharmacists' immunization authority by allowing the administration of influenza and COVID vaccines down to age 5. Currently, pharmacists can only vaccinate children for flu starting at the age of 9.
Also in Pennsylvania, the Board of Pharmacy has posted the agenda for the June 28 meeting. Members can access the meeting virtually and log-in instructions are included in the agenda.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Texas
The Senate Health and Human Services Committee will hold hearings on June 27 to examine the impact of state and federal pandemic policies-including agency guidance, licensing and regulatory actions, and health care industry policies-on patient care and treatment delivery.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Washington
The Care Authority (HCA) Director Sue Birch selected Dr. Charissa Fotinos, who has been the interim state Medicaid Director since August of 2021, as the new state Medicaid Director. Dr. Fotinos will also continue to serve as HCA behavioral health medical director.
Also in Washington, effective July 1, 2022, the Health Care Authority (HCA) is publishing quarterly updates to many of the Apple Health billing guides. Billing guides are located on HCA's Provider billing guides and fee schedules webpage.
Finally in Washington, the State Health Care Authority (HCA) is beginning the first step of making its Medicaid Management Information System (MMIS), known as ProviderOne, more flexible and modifiable. First, HCA is working to replace the existing Pharmacy Point of Sale (POS) system. The new Pharmacy POS solution will offer the latest functionality, features, and technologies to better meet the needs of Washington's Medicaid clients.
On the day of go‐live, fee‐for‐service pharmacy claims will no longer be billable using our current processor control number (PCN) and bank identification number (BIN). HCA will provide the new PCN/BIN as the project gets closer to go‐live. After the initial implementation, HCA will be adding functionality for pharmacies and prescribers to submit prior authorization requests through a new, secure online portal.
Sign up for the Health Care Authority's email list to receive future updates on this project, including the go‐live date and PCN/BIN changes. If you have questions, contact pharmacyposproject@hca.wa.gov.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Alabama
Effective July 1, 2022, the Alabama Medicaid Agency will:
- Remove prior authorization (PA) from dexmethylphenidate ER (generic Focalin XR). Brand Focalin XR will now require PA.
- Update the PDL (Preferred Drug List) to reflect the quarterly updates listed below:
| PDL Additions | |
| Dexmethylphenidate ER (generic) | Cerebral Stimulants/Agents Used for ADHD (attention deficit hyperactivity disorder) (Long-Acting) |
| PDL Deletions | |
| Adhansia XR | Cerebral Stimulants/ Agents Used for ADHD (Long-Acting) |
| Focalin XR | Cerebral Stimulants/ Agents Used for ADHD (Long-Acting) |
For additional PDL and coverage information, visit the drug look-up site.
The Prior Authorization (PA) request form and criteria booklet should be utilized by the prescriber or the dispensing pharmacy when requesting a PA. The PA request form can be completed and submitted electronically on the Agency’s website.
Incomplete PA requests or those failing to meet Medicaid criteria will be denied. If the prescriber believes medical justification should be considered, the prescriber must document this on the form or submit a written letter of medical justification along with the PA form to Kepro. Additional information may be requested. Staff physicians will review this information.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.