Virginia
The Board of Pharmacy has posted the Agenda for its March 15 meeting. Please note they will consider a Guidance Document on Pharmacy Working Conditions that you can find on page 101 of the agenda. Also on the agenda is a proposed rule on Pharmacist Initiation of Treatment that was a result of 2021 legislation that added authority for pharmacists to provide vaccines; Tuberculosis testing; HIV prevention medications; and paraphernalia, supplies and equipment to adults. The Board previously approved an emergency regulation on the same subject as well as protocols that were both effective in December 2021 and can be found on the Board website.
Also in Virginia, on April 4, the Department of Medical Assistance (Medicaid) will be switching from its Legacy Medicaid Management Information System (MMIS) to the Medicaid Enterprise System (MES) for fee-for-service. As a result, the MediCall and Activated Voice Response System (AVR) eligibility systems will be down from March 30 through April 3. Please see this notice for more detail. DMAS will be sending a series of Medicaid Memos detailing the impact of these system changes on the Provider community, the latest can be found here. You can find training videos and user manuals for MES here.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Washington
The 60-day legislative session ended its regular session on March 10. Prior to adjournment, NACDS chain pharmacy lobbyists, independent pharmacists, the Washington State Pharmacists Association (WSPA), the Northwest Grocers Association (NWG) and the Washington Retail Association (WRA) successfully stopped ESHB 1852 from advancing, legislation that would have required directions for use and auxiliary warnings on prescription labels in both English and at least 15 languages. Rather than have this issue defined by the Legislature, the coalition will be working with the Pharmacy Quality Assurance Commission (PQAC) to adopt rules establishing requirements for the translation of prescription drug information.
Also in Washington, on March 4, Gov. Jay Inslee (D) signed into law legislation capping insulin at $35. (Chapter 10, 2022/SSB 5546)
Also in Washington, the Health Care Authority (HCA) will submit to the Centers for Medicare & Medicaid Services by July 15th a request to renew the Section 1115 Medicaid demonstration waiver, called the Medicaid Transformation Project (MTP), which will allow the state to create and continue to develop projects, activities and services that improve Washington's health care system using federal Medicaid funding. The new proposals include: continuous Medicaid enrollment for children; extending coverage for postpartum services; re-entry services for individuals who are exiting jail, prison, or other correctional facility and enhancements to long-term services and supports (LTSS).
Finally in Washington, HCA efforts aimed at increasing health care cost transparency and controlling health care cost growth include:
- The Health Care Cost Transparency Board is focusing on reducing health care cost growth and increasing price transparency.
- Prescription drug price transparency focuses on creating an annual report on how prescription drugs affect health care costs.
- The Washington State All Payer Claims Database (WA-APCD) is a tool used to collect health care claims data for reporting and analytics and to help the public make their health care decisions. The WA-APCD supports health care and payment reform while addressing the need for cost, quality and utilization transparency.
- Value-based purchasing (VBP) helps us achieve a healthier Washington by containing costs while improving outcomes, patient and provider experience and equity.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Arizona
The Board of Pharmacy issued a Notice of Supplemental Proposed Rulemaking 4 AAC 23 related to pharmacist delegation/technician rules; see pages 339-343. A public hearing has been scheduled for March 9 at 9:00 a.m. (local time). Please note the current proposal excludes a pharmacist’s delegation of vaccine administration by a technician which was the issue of concern in the former rules package. Please recall the technician rules package was removed from the Governor’s Regulatory Review Council’s December 2021 agenda prior to the meeting by the Board of Pharmacy over concerns expressed about technician vaccine administration.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
California
The Department of Health Care Services posted the following alerts to the Medi-Cal Rx Web Portal:
- Medi-Cal Rx Weekly Wrap-Up for February 21-24 (February 25)
- Medi-Cal Rx Approved NDC List (February 25)
- Medi-Cal Rx Beneficiary Tips (February 28)
Also in California, the Board of Pharmacy published its March issue of "The Script." This issue includes the following articles about:
- New pharmacy laws in 2022.
- Pharmacy issues related to COVID-19 vaccination programs.
- Mix-ups related to COVID-19 age requirements.
- A new vendor for submitting prescription data to CURES.
- A Board policy statement on compounding requirements.
- Mitigation strategies for preventing pharmacy drug diversion.
- The important role and responsibilities for pharmacists-in-charge.
- Listening sessions for pharmacy technicians.
- New public members appointed to the Board.
- New ad hoc committees on medication errors and workforce issues and on standard of care.
- Summaries of disciplinary actions ordered July 1 through December 31, 2021.
Also in California, the Office of Administrative Law has issued a Notice of Approval for amendments to the Code of Regulations' Division 17 of Title 16, section 1715.6, related to Reporting Drug Loss, effective April 1.
Finally in California, the following Pharmacy Law waivers issued pursuant to Business and Professions Code section 4062 expired on February 28.
- Duty to Consult (Title 16, California Code of Regulations, section 1707.2(a))
- Prelicensure Inspection at Proposed Location of an Automated Drug Delivery System (ADDS) – Business and Professions Code sections 4119.11(a)(9) and BPC 4427.2(e)
- Signature Requirement for Receipt of Delivery of Drugs (BPC section 4059.5)
- Requirement for Consulting Pharmacist to Make Quarterly Visits to Clinic (BPC sections 4182(a) & (b)/BPC 4192(a) & (b))
Other waivers still in effect are posted online under Pharmacy Law Waivers.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Connecticut
The Connecticut Department of Consumer Protection adopted regulations under RCSA 20-576 to establish standards for shared pharmacy services, which are systems in which two or more licensed pharmacies process or dispense a prescription.
For more information, please contact NACDS’ Mike Sargent at 207-272-6435.
Georgia
The Georgia Department of Public Health is asking for our assistance in gathering prescription data (de-identified) for the most prescribed hepatitis C antivirals. A work group at the Department is trying to determine which physicians in Georgia routinely diagnose and treat hepatitis C. As an example, the Department would be interested in data that might show hypothetically that "Dr. Brown in Albany, Georgia prescribed Harvoni to 500 patients in Georgia in 2021." Ideally, the Department would like the data for Mavyret, Harvoni and Epclusa for 1-2 years. Please submit all data and any questions to Raybun Spelts, Clinical Pharmacist Specialist, Infectious Disease and Vaccines at the Department. His contact information is: raybun.spelts@dph.ga.gov (404)683-4949.
Of note, the Georgia Department of Public Health has personally reached out to thank chain drug pharmacy for being willing to try to assist the Department in this health initiative.
Also, the Georgia Pharmacy Association is looking for the team that will shape the future of pharmacy in Georgia and is now accepting applications for the 2022-2023 GPhA (Georgia Pharmacy Association) Board of Directors. Serving on the board is the opportunity to level the playing field and make a lasting contribution to the industry. There are two open positions: One board member at large and One Academy of Independent Pharmacy (AIP) member. If you have questions before you apply, contact Lia Andros, Governance Manager, at landros@gpha.org. The deadline for application is 11:59 p.m. EST on Saturday, March 5, 2022. Click here for more information and to submit a nomination.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Minnesota
Companion bills, SF 3154, and HF 3854, allowing pharmacists to initiate treatment for PeP (Post Exposure Prophylaxis) and PReP (Pre-Exposure Prophylaxis), have been introduced by Sen. Scott Dibble (DFL) and Rep. Athena Hollins (DFL). The language has been updated from last session, reflecting the work of a broad coalition of supporters formed by the joint efforts of NACDS, the Minnesota Retailers Association, the Minnesota Pharmacists Association, patient advocates and the bill sponsors. The bills have been referred to the appropriate committee for further consideration.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Mississippi
The Mississippi Pharmacy Association has an opening on the Executive Committee, a member-at-Large Representative, for which all current MPhA Members may apply. This position is a two-year term and qualifies one to run for Vice President in the next two years if desired. A position on the executive committee is one that helps to guide the business of our organization. Since moving to a part-time Executive Director two years ago, this position also has several responsibilities that will require you to assist with various tasks of running the organization. Please reach out to any of our current Executive Committee members, www.mspharm.org/board or our staff if you have any questions. The deadline for application is March 15, 2022.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Nebraska
The Board of Pharmacy published a REVISED meeting agenda for March 7 and draft January 10, 2022 meeting minutes.
Also in Nebraska, The Department of Health and Human Services has posted the draft minutes from the January 11, 2022, DUR Board Meeting.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
New Jersey
The New Jersey Board of Medical Examiners has proposed to amend regulations under NJAC 13:35-7 to require practitioners to identify in advance psychological co-morbidities that affect prescribing and overall treatment decisions and assess whether continued opioid therapy is working to address a patient’s treatment needs. The rule also would address treatment planning, medical records, and management of chronic pain.
For more information, please contact NACDS’ Mike Sargent at 207-272-6435.
North Carolina
NC Medicaid is receiving reports of pharmacists not utilizing the 72-hour Emergency Supply Override and the 01-No Other Coverage Identified code when applicable. Resistance to use these overrides is preventing Medicaid beneficiaries from being able to access necessary medications. As NC Medicaid providers, pharmacists are asked to please become familiar with these options and utilize them appropriately when administering the Medicaid benefit.
Pharmacists are asked to utilize the 72-Hour Emergency Supply Override when clinically appropriate for Medications pending Prior Authorization. For Medicaid members, including Medicaid Managed Care, Pharmacy providers are encouraged to use the 72-hour emergency supply allowed for drugs requiring prior approval. Federal law requires that this emergency supply be available to Medicaid beneficiaries for drugs requiring prior approval (Social Security Act, Section 1927, 42 U.S.C. 1396r-8(d)(5)(B)). Use of this emergency supply ensures access to medically necessary medications. With use of the override, the system will bypass the prior approval requirement, if an emergency supply is indicated. The pharmacist should use a "3" in the Level of Service field (418-DI) to indicate the transaction is an emergency fill. * Copayments apply to emergency fills and drug cost is reimbursed; however, a dispensing fee is not paid. There is no limit to the number of times the emergency supply can be used. *Codes may vary by managed care plan. This is the specific code for Medicaid Direct.
Pharmacists are asked to utilize the "01-No Other Coverage Identified" when a Medicaid claim rejects due to another payor on record. Medicaid is the payer of last resort, which means after any other insurance pays, Medicaid will pay. The other third-party payer must be billed as the primary payor when third party insurance exists, and then Medicaid can be billed as the secondary payor. When a claim is denied due to another payor on record being expired or terminated, the point-of-sale system will deny the claim, and the pharmacist will be prompted to submit the claim to another payer. In the event a beneficiary cannot produce another insurance or the beneficiary states they no longer have the other insurance, the pharmacy shall use the override code "01 – No Other Coverage Identified" in the Other Coverage Code claim segment 308-C8 for NCPDP D.0 transaction. * NC Medicaid will pay the pharmacy and seek payment from the third party, if appropriate. The pharmacy is not held liable for any payments made in these cases. *Codes may vary by managed care plan. This is the specific code for Medicaid Direct.
Thank you for your time and attention to this valuable information regarding the NC Medicaid Pharmacy Benefit. If you have any questions or concerns with the utilization of these override codes, please contact Angela Smith, Director NC Medicaid Pharmacy Benefit, or the Managed Care Plans directly.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Ohio
The Department of Medicaid (ODM) announced the timeline for upcoming "catch up" payments of the managed care "supplemental" dispensing fee to pharmacies along with a revised FAQ with further detail on the amount of the payments and formula for determining which payment tier your company will receive. Members will recall that these payments, which pharmacies have been receiving over the last few years, were delayed in the first quarter of 2022 while awaiting CMS approval.
Also In Ohio, on March 11 ODM is hosting an online seminar for pharmacies to give further details about the upcoming contracting process with their new SPBM (Single Pharmacy Benefit Manager), Gainwell Technology. Click here to register.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
South Carolina
Governor Henry McMaster issued Executive Order 2022-10 to suspend certain commercial vehicle regulations and provide transportation waivers to address the continued supply chain disruptions. The Governor’s executive order waives or suspends enforcement of certain state and federal regulations pertaining to registration, permitting and size. The read the full Executive Order click here
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Tennessee
Please see the updates to PDL, Clinical Criteria, and Interim Criteria below and the attached documents for March 2022. These changes went into effect on March 1st.
- Added to preferred: dimethyl fumarate, Dexilant, SPS,
- Added to non-preferred: Tecfidera, Tecfidera starter pack, dexlansoprazole, Dhivy, ciprofloxacin/dexamethasone, Epclusa pellet, Mavyret pellet
- Added to interim: Rezurock, Vuity, Voxzogo,
- BaG additions: Dexilant
- BaG removals: Tecfidera, Tecfidera starter pack
- Hepatic C Direct Acting Antivirals prior authorization criteria and PA forms: removal of restrictions surrounding prior history of substance or alcohol abuse, where applicable, removed questions related to pregnancy, concomitant ribavirin use, and renal function dosage adjustments.
Additionally, these documents can be found on the TennCare website: www.optumrx.com/tenncare
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Virginia
The Pharmacy Channel Team at the Department of Health have published a recent version of the Vaccine Standing Order, which reflects recent CDC updates on COVID-19 vaccination guidance with additional information to help vaccinators determine the optimal interval between the first and second dose of an mRNA vaccine series, based on the individual patient.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Washington
The 60-day legislative session ends on March 10th.
Also in Washington, the Health Care Authority (HCA) will submit to Centers for Medicare & Medicaid Services by July 15, 2022, a request to renew the Section 1115 Medicaid demonstration waiver, called the Medicaid Transformation Project (MTP), which will allow the state to create and continue to develop projects, activities, and services that improve Washington's health care system using federal Medicaid funding. The new proposals include:
- Continuous Medicaid enrollment for children
- Extending coverage for postpartum services
- Re-entry services for individuals who are exiting jail, prison, or other correctional facility
- Enhancements to long-term services and support (LTSS)
Finally in Washington, the Health Care Authority (HCA) aimed at increasing health care cost transparency and controlling health care cost growth include:
- The Health Care Cost Transparency Board is focusing on reducing health care cost growth and increasing price transparency.
- Prescription drug price transparency focuses on creating an annual report on how prescription drugs affect health care costs.
- The Washington State All Payer Claims Database (WA-APCD) is a tool used to collect health care claims data for reporting, analytics, and to help the public make their health care decisions. The WA-APCD supports health care and payment reform while addressing the need for cost, quality, and utilization transparency.
- Value-based purchasing (VBP) helps us achieve a healthier Washington by containing costs while improving outcomes, patient and provider experience, and equity.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Wisconsin
Wisconsin Medicaid, ForwardHealth, has released an update on coverage of at-home COVID tests for Medicaid patients. As a reminder, Pharmacies must submit a claim for these tests as a prescription. There is a standing order in place from the Department of Health Services (DHS) Chief Medical Officer Dr. Ryan Westerguard. The pharmacists may order the tests and patients may receive 8 tests per 30-day period.
For more information, please contact NACDS’ Mike Sargent at 207-272-6435.
Alaska
New rules relating to the Prescription Drug Monitoring Program (PDMP) go into effect on March 17, 2022. The regulations clarify the registration process to align with the account creation steps at alaska.pmpaware.net, replaces “registration” with “designation,” and establishes a new requirement for pharmacists and pharmacies to notify the board within 10 days of a change in dispensing/distributing status of controlled substances. The forms will be available in the coming weeks at pharmacy.alaska.gov.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
California
The Department of Health Care Services posted the following alerts to the Medi-Cal Rx Web Portal:
- Clarification of Temporary Prior Authorization (PA) Policy Change (February 21)
- Medi-Cal Rx Drug Lookup Tool and Contract Drugs List Tips (February 24)
- Medi-Cal Rx Provider Portal Troubleshooting and Support (February 24)
- Remdesivir (Veklury) for Outpatient Treatment of COVID-19 (February 24)
- Required Documentation for Claim and Prior Authorization Support (February 24)
Also in California, COVID-19 related news highlighted below:
- Governor Newsom Unveils SMARTER Plan Charting California's Path Forward on Nation-Leading Pandemic Response
- California SMARTER – The Next Phase of California's COVID-19 Response
- County of Los Angeles Department of Public Health Order of the Health Officer (Revised February 23, 2022)
Finally in California, the Department of Health Care Services is proposing a budget trailer bill language to require Medi-Cal pharmacy providers to maintain records for ten years, consistent with federal law. The current requirement in the state is three years. DHCS prepared this fact sheet about the proposal.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Colorado
Health First Colorado is paying for up to 15 COVID-19 home tests per member each month when provided by an enrolled pharmacy.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
District of Columbia
Medicaid has scheduled the virtual quarterly pharmacy forum on March 15 from 1-2pm and March 16 from 10-11:30 pm and are “highly encouraging” attendance. Click here to RSVP and receive the log in information.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Illinois
The Illinois Department of Human Services reports pharmacies and grocer/pharmacies may see an increase in demand for Neocate formula and nutritionals with the recent recall of Abbott's EleCare and EleCare Junior products. Some participants who were prescribed EleCare have had their prescriptions adjusted and will now be coming to pharmacies with requests for Neocate products.
Click here for a copy of the IDHS Notice. For ordering information click here
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Indiana
The Department of Health (IDOH) and the Health Coverage Programs (IHCP) announced that they are making changes to the Vaccines for Children (VFC) policy to allow pharmacies to easily enroll in the program, effective March 14, 2022. The maximum allowable reimbursement for the administration of a VFC vaccine will be consistent with reimbursement for vaccines administered by medical providers, which is currently $15.00.
Also in Indiana, effective February 1, 2022, IHCP began reimbursing pharmacies for dispensing FDA approved COVID19 test kits at home, with a limit of two tests per 7 days per member under a statewide standing order.
Also in Indiana, the Indiana Family and Social Services Administration's (FSSA) Office of Medicaid Policy and Planning provided updates to the opioid utilization prior authorization (PA) criteria's maximum allowable daily morphine milligram equivalent (MME) effective for claims with dates of service (DOS) on or after April 1, 2022.
Finally in Indiana, HB 1158, legislation that would allow a pharmacy technician to administer any vaccines delegated by a pharmacist, passed the House and is pending in the Senate Health and Provider Services Committee.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Iowa
The Department of Human Services published the following:
- INFORMATIONAL LETTER NO. 2314-MC-FFS-CVD: This informational letter provides guidance to providers on billing for COVID-19 OTC home testing. This policy will remain in effect for the duration of the public health emergency.
- INFORMATIONAL LETTER NO. 2315-MC-FFS-CVD: On February 3, Gov. Kim Reynolds (R) signed the final extension to the state's Public Health Disaster Emergency Proclamation that announced the Public Health Disaster Emergency would expire on February 15 at 11:59 p.m. Please note: The end of the state's Public Health Disaster Emergency does not impact Medicaid flexibilities currently in place.
Also in Iowa, the Board of Pharmacy will meet on March 1 via Zoom and in-person; the meeting agenda has been posted.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Kansas
HB 200, legislation expanding the pharmacist's scope of practice to include initiation of therapy for influenza, strep throat and urinary tract infection pursuant to a statewide protocol adopted by the collaborative drug therapy management advisory committee, passed the Senate by a vote of 37-2. It was referred to the House Health and Human Service Committee for further action.
Also in Kansas, legislation that would establish a joint committee on pharmacy workplace conditions and patient safety to conduct a study and issue a report to the legislature was referred to the House Health and Human Services Committee. HB 2698
For more information, contact NACDS’ Mary Staples at 817-442-1155.