All previously published expiration dates related to the COVID-19 emergency are once again extended by the Alabama Medicaid Agency (Medicaid). The new expiration date is the earlier of April 30, 2022, the conclusion of the COVID-19 national emergency, or any expiration date noticed by Medicaid through a subsequent alert.

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

Governor Kay Ivey (R) has signed SB102 which authorizes an approved pharmacy intern or extern to compound or dispense prescription. Authorizes the Board of Pharmacy to issue a pharmacy intern/extern permit authorizing the pharmacy intern or extern to compound or dispense prescriptions while serving under the direct supervision of a licensed pharmacist. Creates a pharmacy intern/extern permit application process that authorizes the collection of a fee and a background check. Immediate direct supervision is defined as at least one pharmacist being always present and available on the premises of the pharmacy for consultation with the intern or extern. 

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

Effective April 1, 2022, the Alabama Medicaid Agency will: 

1. Require Vascepa to be billed with a Dispense as Written (DAW) Code of 9. DAW Code of 9 indicates the following: Substitution Allowed by Prescriber but Plan Requests Brand. This value is used when the prescriber has indicated, in a manner specified by prevailing law, that generic substitution is permitted, but the Plan requests the brand product to be dispensed.
2. Require Prior Authorization (PA) for Icosapent Ethyl (generic Vascepa). Brand Vascepa will be added as preferred.
3. Require Prior Authorization (PA) for Colchicine capsules (generic Mitigare). Brand Mitigare will remain non-preferred.
4. Treatments for COVID-19 will remain accessible and available through the pharmacy benefit on an outpatient basis through the Federal Public Health Emergency (PHE) period. Approval was granted to ensure any drug with an FDA-approved or EUA-authorized indication for the treatment of COVID-19 be made available as a preferred drug through the duration of the Federal PHE.

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

The Alabama Medicaid Agency will host a virtual online seminar to provide an update to the cost-effectiveness methodology to Alabama Coordinated Health Network (ACHN) provider groups. The purpose of the online seminar is to provide an overview and answer questions on the modified cost effectiveness methodology that will take effect on April 15, 2022, check write.  

Also in Alabama, the Board of Pharmacy has issued a proposed rule regarding non-disciplinary penalties for late renewal of license, permit, registration, certification, or any similar document issued.

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

The newest Medicaid ALERT regarding COVID-19 “At Home” Tests billed through pharmacy can be found here. 

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

Effective January 1, 2022, the Alabama Medicaid Agency will have contracts with eight companies that offer Medicare Advantage coverage in Alabama: Aetna Better Health, Inc., Arcadian Health Plan, Inc. (Humana), Centene Venture Company Alabama Health Plan, Inc. (Ascension Complete), HealthSpring Life & Health Insurance Company, Inc. (CIGNA), Simpra Advantage, Inc., UnitedHealthcare of the Midlands, Inc., VIVA Health, Inc., and WellCare of Alabama, Inc. 

 Providers are encouraged to check Medicaid’s Eligibility Verification File, under the Managed Care Section, to determine if capitation payments have been made for recipients during a particular month. If a capitation payment has not been made, providers should refer to Chapter 5 of the Provider Billing Manual, Sections 5.6.1 – 5.6.2, for claims filing instructions. Questions may be directed to Shari Rudd at (334) 353-3403 or shari.rudd@medicaid.alabama.gov. 

 Also in Alabama, the Board of Pharmacy is reporting that only 35% of licensed technicians have renewed their licenses. Please be aware that the submission of a renewal by the December 31 deadline does not mean that individuals are clear to work on January 1. The renewals must be processed, not just submitted. We recommend that you renew your license NOW, with plenty of lead time to handle any issues that may come up.  

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

Changes described in the ALERT dated November 5, 2021, regarding the replacement of Claim Adjustment Reason Code (CARC) Code 45 with CARC Code (96) will not be implemented. Gainwell verified CARC Code 45 still conforms to the Payment & Remittance Uniform Use of CARCs and RARCs (835) Rule. As a result, Alabama Medicaid will continue using CARC Code 45 to indicate pricing adjustments to payments due to fee schedules/allowed amounts.

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

Pharmacy Technicians don’t forget to renew your license with the Alabama Board of Pharmacy. Technicians’ licenses expire Dec. 31, 2021. If you fail to renew your license by that date, but continue to work as a pharmacy technician, you will be subject to late fees and discipline. For more information, please contact the Board of Pharmacy directly 205-981-2280. Pharmacy permits must be renewed prior to December 31, 2021, as well. Renewals may be completed ONLINE ONLY. Visit www.albop.com for both types of renewal. 

Also in Alabama, the Alabama Medicaid Agency relocated the Birmingham District Office to the Beacon Ridge Tower (600 Beacon Parkway West, Suite 105, Homewood, Alabama) on Wednesday, December 1, 2021. 

Finally, in Alabama, Medicaid continues to monitor the COVID-19 national emergency in and is adding procedure codes for coverage of COVID-19 Monoclonal Antibody Infusion.  

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

As Alabama Medicaid continues to monitor the COVID-19 national emergency in Alabama, Medicaid is adding procedure codes for coverage. Providers may submit claims for dates of service on or after the effective dates for each procedure code as listed here. Providers may find the reimbursement rates for the COVID-19 testing procedure codes on Medicaid’s website at www.Medicaid.Alabama.gov by selecting Fee Schedules under the Providers tab.

Also in Alabama, effective January 1, 2020, all newly registered technicians are required to complete a Board approved training program within six (6) months of the registration. Technicians with Board approved training completed, PTCB or CPhT certifications, or registered prior to January 1, 2020, will be reflected as compliant with the training requirement on the technicians’ Board of Pharmacy website profile.

To view this data:

1. Go to albop.com
2. Click Online Services
3. Choose “Individual Verification” from the dropdown menu
4. Input the technician registration number or name of the technician and enter the verification code displayed and click Search
5. Identify the technician and choose the Print option to view the full license details including training information for technicians.

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