Pennsylvania
The Department of Human Services published the following bulletins:
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Rhode Island
The June 2023 provider update can be found here. Previous issues can be found on the EOHHS [Executive Office of Health & Human Services] website at the provided link above.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Tennessee
To assist prescribers and providers, prior authorization (PA) requirements can be bypassed for certain medications when specific medical conditions exist. Those specific medications and diagnoses can be found here. Prescribers are encouraged to include the applicable diagnosis code on written prescriptions for inclusion on the electronic pharmacy claim. The submitted claim should include a Diagnosis Code Qualifier (Field # 492-WE) of “02,” indicating ICD-10, as well as the appropriate Diagnosis Code (Field # 424-DO). We encourage you to review this information thoroughly and contact the OptumRx Pharmacy Supports Center at 866-434-5520 or tnrxeducation@optum.com should you have questions.
Also in Tennessee, TennCare is continuing the process of reviewing all covered drug classes. Changes to the PDL 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.
Finally in Tennessee, effective July 1, 2023, TennCare members will be able to obtain Continuous Glucose Monitors (CGMs) and supplies from their local in network retail pharmacy. This new coverage pathway will not affect coverage under the medical plan. This update allows TennCare members to access CGMs and related supplies through either their pharmacy OR medical program. Under this new coverage pathway, prescriptions for CGMs and maintenance supplies may be sent to your patient’s in-network pharmacy of choice. 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 information, contact NACDS’ Leigh Knotts at 803-243-7207.
Texas
The legislature adjourned sine die at 6:00 p.m. on May 29. Prior to adjournment, the Senate and the House finalized the $321.3 billion state budget for the two-year cycle beginning on September 1, 2023. They also passed and sent Gov. Greg Abbott (R) several bills of interest to pharmacies, including:
- HB 25, creates the Canadian Wholesale Prescription Drug Importation Act to provide lower cost prescription drugs for consumers;
- HB 4990, establishes the Texas Pharmaceutical Initiative governing board and advisory council, a Texas State PBM;
- HB 1283, retains the single Medicaid managed care organizations formulary and preferred drug list;
- SB 2173 requires the Texas State Board of Pharmacy (TSBP) to develop and implement a prescription drug safe disposal pilot program.
Also in Texas, unfortunately on day 138 of the 140-day Texas legislative session, HB 1105, the PREP Act permanent immunization legislation that passed both houses with more than a 2/3’s vote, died at midnight because Sen. Lois Kolkhorst (R) refused to appoint Senate conferees to negotiate with House conferees on the anti-COVID mandate amendments the Senator added to the bill before it passed the Senate on May 23.
Finally in Texas, on May 24, the House General Investigating Committee released information regarding its investigation of Attorney General Ken Paxton (R). Paxton had met with legislators early in session requesting $3.3 million of taxpayer’s money in the state budget to settle a lawsuit between the Attorney General and former staff members. The lawsuit revealed the four former executives were fired in retaliation for reporting the Attorney General to authorities which violated the Texas Whistleblower Act. On May 27, the full House debated HR 2377, the 20 articles of impeachment. The resolution passed with a vote of 121 to 23 and was delivered to the Senate where the trial will begin by August 28. Gov. Greg Abbott (R) appointed John Scott to serve as the short-term interim Attorney General until a decision in the impeachment trial is reached.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Wyoming
The Board of Pharmacy adopted the following emergency rules effective April 14, 2023.
Also in Wyoming, the Board of Pharmacy announced a Notice of Intent to Adopt Rules impacting the following chapters. Comments may be submitted to bop@wyo.gov by June 21, 2023.
- Chapter 3: Pharmacy Internship Regulations
- Chapter 6: Continuing Professional Education Regulations
- Chapter 16: Immunization Regulations
- Chapter 18: Prescribing by Pharmacists
Finally in Wyoming, the Board of Pharmacy adopted the following rules effective May 24, 2023:
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Alaska
The Legislature adjourned on May 17. On the last day, legislation promoted by the Alaska Pharmacists Association (AKPhA), CS HB 112 by pharmacist Rep. Justin Ruffridge (R), passed. The bill streamlines the pharmacy practice statutes, including provisions to increase access to epinephrine auto-injectors and medication delivery devices for anaphylaxis emergencies.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
California
AB 317, legislation requiring a health care service plan or certain disability insurers that offer coverage for a service that is within a pharmacist’s scope of practice to pay or reimburse the cost of the service provided by the pharmacist at an in-network pharmacy or by a pharmacist at an out-of-network pharmacy if the health care service plan or insurer has an out-of-network pharmacy benefit, passed the Assembly on April 27 and was referred to the Senate Committee on Health on May 10.
Also in California, AB 1341, legislation authorizing a pharmacist to furnish COVID-19 oral therapeutics following a positive CLIA-waived test, passed the Assembly on April 17 and was referred to the Senate Business, Professions and Economic Development Committee on May 10. Prior to passage in the Assembly, the bill was amended to include an urgency statute meaning it will be effective immediately upon enactment.
Also in California, the Department of Health Care Services (DHCS) posted the following alerts and weekly wrap-up on the Medi-Cal Rx Web Portal:
- Medi-Cal Rx Weekly Wrap-up for May 12-18 (May 19)
- Reinstatement Spotlight (May 19)
- Billing Tips: Non-Covered Medical Supplies (May 12)
Finally in California, Medi-Cal posted the following:
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Colorado
Prior to the end of Colorado’s legislative session sine die on May 8, Gov. Jared Polis (D) signed into law the following two PBM reform bills.
- HB23- 1201, limits the amount that health insurance carriers or pharmacy benefit managers (PBMs) may charge beneficiaries of select employer-sponsored plans for prescription drugs to no more than the amount paid by the plan or PBM to a contracted pharmacy. The bill applies to select contracts issued or renewed on or after January 1, 2025. The bill grants audit authority to the Department of Health Care Policy and Financing (HCPF) for Medicaid contractors and the Department of Regulatory Agencies (DORA) for all other contracts. Failure to comply is a deceptive trade practice in the business of insurance.
- HB23-1227 enhances enforcement authority over PBMs by the Commissioner of Insurance in the Division of Insurance (DOI), Department of Regulatory Agencies (DORA). It also requires all PBMs to register with the Commissioner and pay a registration fee. These fees, credited to the DOI Cash Fund, must fund the division’s costs to enforce PBM requirements and prohibitions.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Louisiana
HB 471, sponsored by Rep. Barbara Freiberg (R), authorizes pharmacists to order and administer, and pharmacy interns and pharmacy technicians to administer immunizations to children aged 7 years and older. The bill passed the House Health and Welfare Committee by a vote of 14-2 on May 16, and it was sent to the full House to be voted on next week. Thanks to Dwana Day with Brookshire Grocery Company, and Albertsons Companies’ pharmacists Ryan LaBarbera and Brittany Tucker for a fantastic job representing their profession by testifying at the House hearing. NACDS and the Louisiana Alliance for Pharmacies strongly urge immediate action contacting all legislators where you operate pharmacies in their district.
For more information, contact NACDS’ Mary Staples at 817-442-1155.