South Carolina

The Department of Health and Human Services (SCDHHS) consistently offers free training to prospective and enrolled Healthy Connections Medicaid providers. Many of these courses are available virtually. Information about the upcoming Healthy Connections Medicaid eLearning trainings for summer 2023 is listed here. These recurring virtual workshops cover a variety of topics including training on Medicaid basics, how to submit claims using the web-based tool and third-party liability (TPL). To register for a workshop, please visit the Medicaid eLearning site, www.medicaidelearning.com, or call (888) 289-0709 and select option 1. Additional training resources for providers are also available online through the Medicaid eLearning site. 

Also in South Carolina, on July 18, 2023, CVS Pharmacy reached out to the Medical University of South Carolina to authenticate a hardcopy prescription for Promethazine DM (in a 473 ml bottle) and Tessalon Perles. The medical provider listed on the prescription was Dr. Chitra Lal. During the verification process, concerns were raised regarding the signature on the prescription. It was observed that the signature was not a conventional ‘wet’ signature and appeared to deviate from Dr. Lal’s usual signature style. This discrepancy prompted a deeper investigation into the matter. Upon further examination, it was established that the prescription in question was a forgery. Rx verification should be requested by calling 864.255.5638. 

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

2023-07-21T10:42:57-04:00July 21, 2023|South Carolina|

Tennessee

The new rule from Tennessee Department of Commerce and Insurance, 0780-01-95 – Pharmacy Benefits Managers, became effective June 27, 2023. 

Also in Tennessee, beginning August 1, 2023, prior authorization requirements will be removed for the following preferred medications: Advair Diskus, Advair HFA, Dulera, Symbicort, aripiprazole, Diclegis, ezetimibe, fenofibrate and Xarelto. We encourage you to read this notice thoroughly and contact OptumRx’s Pharmacy Support Center (866-434-5520) should you have additional questions. 

Finally, TennCare is continuing the process of reviewing all covered drug classes. Changes to the PDL [Preferred Drug List] may occur as new classes are reviewed, and previously reviewed classes are revisited. As a result of these changes, some medications your patients are now taking may be considered non-preferred agents in the future. Please inform your patients who are on these medications that switching to preferred products will decrease delays in receiving their medications. We encourage you to read this notice thoroughly and contact OptumRx’s Pharmacy Support Center (866-434-5520) or tnrxeducation@optum.com should you have additional questions. For more details on Clinical Criteria, please visit https://www.optumrx.com/oe_tenncare/landing. 

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

2023-07-21T10:42:11-04:00July 21, 2023|Tennessee|

Texas

The 88th Regular Legislative Session adjourned sine die May 29. Gov. Greg Abbott (R) immediately called the first 30-day special session to address property tax cuts, which ended with no bills advancing to the Governor’s desk. The Governor called a second special session to address property tax cuts. Speaker Dade Phelan (R) and Lt. Gov. Dan Patrick (R) finally reached an agreement on a property tax relief package, it passed and was signed by the Governor.  

Also in Texas, Gov. Abbott signed into law several bills of interest to pharmacies: 

  • SB 2173 creates a voluntary prescription drug safe disposal pilot program to be developed by the Board of Pharmacy;  
  • HB 1283, legislation that makes permanent the single statewide drug formulary and preferred drug list for Medicaid managed care organizations; and 
  • HB 999, the copay accumulator bill requiring health plans and PBMs, not pharmacies, to apply any coupon or other reduction in out-of-pocket expenses made by or on behalf of an enrollee to the enrollee’s deductible copayment, cost sharing responsibility or out-of-pocket maximum applicable to prescription drug benefits. 

Also in Texas, with Attorney General Ken Paxton (R) still suspended from office as he awaits his September impeachment trial in the Senate, Gov. Abbott appointed Angela Colmenero as the new Interim Attorney General, replacing the short-term Interim Attorney General John Scott. 

Also in Texas, Vaccines for Children (TVFC) Program provider manual is now on-line. TVFC IQIP providers are responsible for understanding program policies and requirements for 2022-2023 TVFC re-enrollment. The 2023-2024 Texas Vaccines for Children (TVFC)/Adult Safety Net (ASN) Program re-enrollment will open in October 2023 and close November 2023. 

Finally in Texas, the agenda for the Drug Utilization Board July 21 meeting was posted.

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

2023-07-21T10:41:31-04:00July 21, 2023|Texas|

Vermont

Due to the current state of emergency in the state and to ensure that Medicaid beneficiaries have access to the medications they need, the Department of Vermont Health Access (DVHA) is temporarily re-activating SCC 13 as an allowable NCPDP submission clarification code in the adjudication of pharmacy claims. Changes to point-of-sale will be effective from July 13, 2023, to July 25, 2023. This code is utilized by the dispensing pharmacist when processing an early refill for the patient and indicates that an override is needed based on an emergency/disaster situation recognized by the payer. The use of SCC 13 will override a Reject 79 (Refill too soon). It will not override either Reject 75 (prior authorization required) or Reject 76 (Plan limits exceeded). DVHA will monitor claims using this submission clarification code to ensure it is used only when medically necessary. Improper use of SCC13 will subject the claim to recoupment. For questions, please contact the Change Healthcare Pharmacy Help Desk at 1-844-679-5362. Vermont providers can also send inquiries via email to PBA_VTHelpdesk@changehealthcare.com.  

On July 20, Gov. Phil Scott (R) signed the 3rd addendum to his emergency declaration. This addendum added the following relevant to pharmacies: “The Secretary of State is hereby directed to waive such rules and requirements as may be necessary to allow a pharmacist to extend a previous prescription for up to a 30-day supply for a maintenance medication for which the patient has no refills remaining or for which the authorization for refills has recently expired if it is not feasible to obtain a new prescription or refill authorization from the prescriber. “Maintenance medication” means a prescription drug taken on a regular basis over an extended period to treat a chronic or long-term condition. The term does not include a regulated drug, as defined in 18 V.S.A. § 4201.” Additionally, a pharmacist who extends a prescription for a maintenance medication pursuant to this authority shall take all reasonable measures to notify the prescriber of the prescription extension promptly. 

For more information, please contact NACDS’ Ben Pearlman at 617-515-2603.

2023-07-21T10:40:51-04:00July 21, 2023|Vermont|

Virginia

The Board of Pharmacy announced that due to the expiration of the federal public health emergency (PHE) and pursuant to the third enactment clause of HB 1323, routine childhood vaccines may be administered under the Board of Pharmacy (BOP) Vaccine Statewide Protocol for Persons Ages Three (3) through Seventeen (17). HB 1323 of 2022 made pharmacists’ authority to provide vaccines under the PREP Act permanent in the Commonwealth. 

Also in Virginia, the Department of Health sent a communication to licensees to clarify that the CDC’s COVID-19 Vaccination Program Provider Agreement is still in effect and requires that all organizations and providers participating in the CDC COVID-19 Vaccination Program continue to abide by its terms until the transition to commercialization is complete. 

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

2023-07-21T10:40:06-04:00July 21, 2023|Virginia|

Alabama

Effective October 1, 2022, the Medicaid Agency removed the requirement of absence of alcohol and illicit drug use by recipients for the prior approval of antiviral drugs used in the treatment of hepatitis C. A copy of the patient’s drug and alcohol screening lab report is no longer required. All other criteria remain, including the patient consent form with the patient’s and physician’s signature, which must be submitted with requests. 

The updated Prior Authorization (PA) request form and criteria booklet should be utilized by the prescriber or the dispensing pharmacy when requesting a PA. Updated forms and criteria can be found here.  

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

2023-06-23T10:43:39-04:00June 23, 2023|Alabama|

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