On June 27, Gov. Gavin Newsom (D) signed SB (Senate Bill) 154 (Chapter 43) which includes language allocating $114.4 million to forgive the retroactive reduction of claims reimbursement for independent pharmacies in 2022-23. Another $28.4 million will be allocated in 2023-24. This was due to an error in the implementation of the actual acquisition cost reimbursement methodology for dates of service from April 1, 2017, to February 22, 2019, inclusive. On June 30, Gov. Newsom signed AB (Assembly Bill) 178 (Chapter 45) that directs the Department of Health Care Services to forego the recoupment of overpayments from independent pharmacies and defined "independent pharmacy" as a pharmacy owned by a person or entity who owns not more than 74 pharmacies in California. Also, on June 30, the Governor signed SB 184 (Chapter 47), the health trailer bill, that expands telehealth and exempts continuous glucose monitors and medication therapy management services from a 10 percent provider cut based on 2011 legislation.  

Also in California, the Department of Consumer Affairs issued this waiver extension on July 11: DCA Waiver DCA-22-217 Order Waiving Restrictions on Pharmacists Independently Initiating and Furnishing Paxlovid to Individual Patients. The full waiver and a list of current waivers is available on the DCA website. 

Also in California, the Board of Pharmacy recently communicated the following: 

• Complaints about Pharmacy Performance Quotas 
• July 18 at 9:00 a.m. – Licensing Committee Meeting Agenda and Meeting Materials 
• July 18 at 1:00 p.m. – Legislation and Regulation Committee Meeting Agenda and Meeting Materials 
• July 19 at 9:00 a.m. – Enforcement and Compounding Committee Meeting Agenda and Meeting Materials 
• July 19 at 1:00 p.m. – Communication and Public Education Committee Meeting Agenda and Meeting Materials 

Also in California, the Department of Health Care Services posted the following alerts on the Medi-Cal Rx Web Portal. Please note this week's announcement about the postponement of implementation of NCPDP (National Council for Prescription Drug Programs) reject code 80 and the reminder about the July 31 deadline for all participating Medi-Cal Rx pharmacy providers and billers to submit a Medi-Cal Rx Telecommunications Provider and Biller Application/Agreement Form to continue submitting electronic claims without interruption. 

• Prescriber Advantages of Using CoverMyMeds® for Medi-Cal Rx Prior Authorization Requests (July 13) 
• Update: Postponement of Implementation of NCPDP Reject Code 80 (July 12) 
• Changes to Medical Supplies Reimbursement Methodology, Effective July 1, 2022 (July 8) 
• Medi-Cal Rx Weekly Wrap-up for July 1-7 (July 8)
• Second Booster Dose for Targeted Populations (July 7) 
• Medi-Cal Rx Training Catalog (July 5) 
• Medi-Cal Rx Weekly Wrap-up for June 24-30 (July 1) 
• Medi-Cal Rx Monthly Bulletin for July (July 1) 
• Changes to the Contract Drugs List (CDL) (July 1)
• Changes to the Contract Drugs List (CDL) – Authorized Drug Manufacturer Labeler Codes (July 1) 
• Updates to the Medi-Cal Rx Provider Manual (July 1) 
• 30-Day Reminder: Electronic Claims Agreement – Submission Deadline Extended to July 31, 2022 (June 30) 
• Medi-Cal Rx Office Hour – Reinstatement of Reject Codes 80 and 88 (June 29) 
• Reminder: Fiscal Year Two-week Fee-for-Service Hold for Specific Provider Payments (June 29)
• Now Available: Medi-Cal Rx Telecommunications Provider and Biller Application/Agreement Form – Supplemental Form (June 27) 
• Enteral Nutrition Updates Additions, Effective July 1, 2022 (June 24) 
• Medi-Cal Rx Weekly Wrap-up for June 17-23 (June 24) 
• Medi-Cal Rx Point-of-Sale Messaging Update (June 22) 
• Appendix A: Reject Code 88 DUR: Service Codes Scenarios (June 22)
• NDPDP Reject Code 88 DUR Reference Guide (June 22) 
• NCPDP Reject Code 80 Reference Guide (June 22) 
• 30-Day Countdown – Reinstatement of Reject Codes 80 and 88 (June 22) 
• Medi-Cal Rx Weekly Wrap-up for June 10-16 (June 17) 

Finally in California, the Department of Health Care Services posted the "August 2022 Medi-Cal Provider Training Webinars". 

For more information, contact NACDS’ Sandra Guckian at 703-774-4801.

This week, the State Health and Human Services Agency Secretary and the Director of the State Department of Public Health along with the State Public Health Officer issued a joint statement supporting the recommendation by the Western States Scientific Safety Review Workgroup, the U.S. Centers for Disease Control (CDC), the American Academy of Pediatrics and the Federal Food and Drug Administration (FDA) to grant emergency use authorization (EUA) of the Pfizer-BioNTech and Moderna COVID-19 vaccines for children as young as 6 months of age. 

Also in California, the Board of Pharmacy sent a notice about reissued pharmacy law waivers in response to Gov. Gavin Newsom's (D) declaration of emergency and the nation declaration of emergency.  

• Staffing Ratio of Pharmacists to Intern Pharmacists and General Supervision and Interprofessional Supervision – Immunizations – BPC section 4114 – The amended expiration date is December 31, 2022, or until 30 days after the emergency declaration is lifted, whichever is sooner. 
• Mass Vaccination Sites – The amended expiration date is December 31, 2022, or until 30 days following the declared disaster, whichever is sooner. 
• Prescriber Dispensing of COVID-19 Antiviral Medication to an Emergency Room Patient (including BPC sections 4068(a)(1), 4068(a)(5), 4068(a)(6), 4076.5, and 4427.2(a)) – The amended expiration date is 30 days following the end of the declared disaster. 

These waivers and all Pharmacy Law waivers are posted under COVID-19 Updates and Resources on the Board's website. 

For more information, contact NACDS’ Sandra Guckian at 703-774-4801.

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. 

• June 2022 Durable Medical Equipment and Medial Supplies Medi-Cal Update Bulletin (June 16) 

1. 1. Respiratory Supplies: Updates to the List of Medical Supplies Billing Codes, Units and Quantity Limits 
   2. National Correct Coding Initiative Quarterly Update for July 2022 
   3. July 2022 Medi-Cal Provider "Coffee Break" Event 
   4. August 2022 Medi-Cal Provider Training Webinars 
   5. Get the Latest Medi-Cal News: Subscribe to MCSS (Medi-Cal Subscription Service) Today 
   6. Provider Manual Revisions 

• June 2022 Pharmacy Medi-Cal Update Bulletin (June 16) 

• • 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 

• Part 1 – Program and Eligibility bulletin 

Finally in California, the Board of Pharmacy has posted the following agendas for next week's June 22 ad hoc committee meetings. 

• Teleconference Standard of Care Committee Meeting agenda 
• Teleconference Medication Error Reduction and Workforce Committee Meeting agenda 

For more information, contact NACDS’ Sandra Guckian at 703-774-4801.

On June 1, Legislative Leaders announced a 2022-2023 Joint Budget Agreement that contains budget priorities from the Assembly and the Senate as well as elements of the Governor's budget proposals.  The agreement provides an overall plan to provide relief to families and small businesses, including $142.8 million over two years designated to forgive recoupment of pharmacy reimbursement rate reductions in Medi-Cal from prior years for independent pharmacies. NACDS and the California Retailers Association (CRA) have been advocating in recent months for forgiveness of the Medi-Cal Recoupments for all pharmacy providers.  On June 3, NACDS and CRA submitted a joint letter to Gov. Gavin Newsom (D) urging him to allocate the $142.8 million for Medi-Cal pharmacy rate recoupment to all applicable pharmacies, including chains.   

Also in California, the Department of Health Care Services posted the following alerts and notices on the Medi-Cal Rx Web Portal.   

• Coordination of Benefits – Billing Medicare Part B and D Claims (June 6) 
• Medi-Cal Rx Coordination of Benefits (COB) Reminder (June 6) 
• Medi-Cal Rx Checkwrite Schedule – State Fiscal Year 2022-23 Available (June 3)
• Medi-Cal Rx PAVE Enrollment for ORP Providers (June 3) 
• Medi-Cal Rx Newborn Claims (June 3) 
• Medical Rx Weekly Wrap-Up for May 27-June 2 (June 3) 

Finally in California, the Board of Pharmacy has posted the following documents for its Full Board Meeting to be held on June 16. 

• Agenda 
• Meeting Materials 
• Supplemental Meeting Materials 1 
• Supplemental Meeting Materials 2 

For more information, contact NACDS’ Sandra Guckian at 703-774-4801.

The Board of Pharmacy announced its June meeting schedule.  

• June 16, 2022 – Petitioner Board Meeting
  • June 22, 2022 – Standard of Care Ad Hoc Committee Meeting
  • June 22, 2022 – Medication Error Reduction and Workforce Ad Hoc Committee Meeting 

Also in California, Gov. Gavin Newsom (D) appointed Jessica Crowley to the Board of Pharmacy. Having held a variety of positions within CVS pharmacy between 2010-2020, Dr. Crowley has been a staff pharmacist for Pavilions Pharmacy since 2020. She is a member of Lambda Kappa Sigma, United Food and Commercial Workers, the California Pharmacists Association and Phi Lambda Sigma. 

Also in California, this week, the Department of Health Care Services (DHCS) announced its plans for Medi-Cal Rx Reinstatement of Claim Edits and Prior Authorizations. DHCS along with Magellan hosted a series of webinars to provide an overview of a phased approach for reinstatement of safety edits and prior authorizations and the phasing out of the Transition Policy. Stakeholder feedback has been fundamental to the reinstatement design and will remain a critical component throughout the reinstatement process. DHCS is requesting stakeholder feedback to refine the approach to reinstatement. Stakeholders who would like to submit comments may do so through the close of business on June 10 via email to Reinstatement@dhcs.ca.gov. 

Finally in California, the Department of Health Care Services posted the following alerts and notices on the Medi-Cal Rx Web Portal.  

• Age Restrictions on Psychotropics Updated (June 1) 
• Medi-Cal Rx Monthly Bulletin for June (June 1) 
• Changes to Contract Drugs List (CDL) (June 1) 
• Changes to Contract Drugs List (CDL) – Over-the-Counter Drugs (June 1) 
• Updates to the Medi-Cal Rx Provider Manual (June 1) 
• Maximum Allowable Ingredient Cost (MAIC) 30-Day Pharmacy Provider Notice (June 1) 
• Medical Supplies Prescriber Updates (June 1) 
• Diabetic Supplies Updates (June 1) 
• Medi-Cal Rx Checkwrite Schedule – State Fiscal Year 2021-22; Hold Notation Update (May 27) 
• Reminder: Fiscal Year Two-Week Fee-For-Service Hold for Specific Provider Payments (May 27) 
• Medi-Cal Rx Weekly Wrap-Up for May 20-26 (May 27) 
• Changes to Family PACT Pharmacy Formulary (May 26) 
• Medi-Cal Rx Updated FAQs (May 23) 
• Medi-Cal Rx Weekly Wrap-Up for May 13-May 19 (May 20) 
• Submitting a Claim – Best Practices (May 19)

For more information, contact NACDS’ Sandra Guckian at 703-774-4801.

The Department of Health Care Services posted the following alerts and notices on the Medi-Cal Rx Web Portal. 

• Prior Authorization Submission Reminders (May 16) 
• Changes to the Family PACT Pharmacy Formulary (May 13)
• Medi-Cal Weekly Wrap-Up for May 6-12 (May 13) 
• Medical Supplies Update: Update to the Maximum Allowable Product Cost (MAPC) for Female Condoms, Effective, July 1, 2022 (May 12) 
• Medical Supplies Update: New Pharmacy Benefit, Blood Pressure Monitors, and Blood Pressure Cuffs, Effective July 1, 2022 (May 12) 
• Medi-Cal Weekly Wrap-Up for April 29-May 5 (May 6) 
• Medi-Cal Rx Weekly Wrap-Up for April 29-May 5 (May 6) 

Also in California, on May 6, the Department of Health Care Services hosted a Medi-Cal Rx Multi-factor Authentication (MFA) – Chain Rx Kickoff meeting to explain current MFA policy and how the exception granted for some chain pharmacies to the MFA policy expires on December 31, 2022. As indicated in the slidesDHCS will schedule bi-weekly meetings to formalize requirements and timelines. Please feel free to send questions to: 

• Rajesh Adoni Rajesh.Adoni2@dhcs.ca.gov 
• Gina Connors Gina.Connors@dhcs.ca.gov 
• Julie Cheung Julie.Cheung@dhcs.ca.gov 

Finally in California, on May 17, the Department of Health Care Services (DHCS) released the "Medi-Cal COVID-19 Public Health Emergency (PHE) Operational Unwinding Plan". This plan provides an overview of DHCS' plan to unwind COVID-19 Medi-Cal flexibilities and resume normal Medi-Cal operations.  

For more information, contact NACDS’ Sandra Guckian at 703-774-4801.

The Department of Health Care Services posted the following alerts on the Medi-Cal Rx Web Portal. Please note DUR Claims Edits were not reinstated on May 1 and the Electronic Claims Agreement Submission Deadline has been extended to July 31, 2022. Additionally, the Medi-Cal Rx 180-day prior authorization (PA) transition scheduled to go into effect July 1 will not take place.  Medi-Cal Rx will continue to utilize historical PA and claims data beyond July 1.  There is no new date for the transition.  However, providers will be notified 90 days before the PA transition takes place.  

• Diabetic Supplies – Therapeutic Continuous Glucose Monitoring (CGM) Systems (May 5) 
• Medi-Cal Rx Operational Updates (May 5) 
• Medi-Cal Rx Monthly Bulletin for May (May 1)
• Changes to Contract Drugs List (CDL) (May 1) 
• Changes to Contract Drugs List (CDL) — Over-the-Counter Drugs (May 1) 
• Updates to the Medi-Cal Rx Provider Manual (May 1) 
• Update: Drug Utilization Review Claims Edits Will Not be Reinstated on May 1, 2022 (April 29) 
• Electronic Claims Agreement – Submission Deadline Extended to July 31, 2022 (April 29)
• Medi-Cal Rx Weekly Wrap-Up for April 22-28 (April 29) 
• Diabetic Supplies Update: Disposable Insulin Delivery Devices Updates (April 28) 
• Medi-Cal Rx Compound Claims Processing Billing Tips (April 22) 
• Prescriber Training Checklist (April 22) 
• Pharmacy Training Checklist (April 22)
• Medi-Cal Rx Weekly Wrap-Up for April 15-21 (April 22) 
• Medi-Cal Rx Billing Policy for Disposable Insulin Delivery Devices (April 21) 
• Medi-Cal Rx Billing Policy for Continuous Glucose Monitoring Systems (April 21) 
• Understanding Medi-Cal Rx for Beneficiaries (April 21) 

Also in California, the Board of Pharmacy posted its agenda for the May 11 Board Meeting; see link below. 

Finally in California, the Board of Pharmacy posted its May update. 

For more information, contact NACDS’ Sandra Guckian at 703-774-4801.

The Department of Health Care Services posted the following alerts on the Medi-Cal Rx Web Portal.  

• Medi-Cal Rx Policy for Requesting Alternative Medication in Case of Supply Shortage (April 15) 
• Medi-Cal Rx Policy for Requesting Alternative Medical Supplies or Enteral Nutrition Products Due to Supply Shortages (April 15) 
• Medi-Cal Rx List of Resources (April 11) 
• Prior Authorization Status Notifications (April 11) 
• Medical Supplies Update on Pen Needles (April 11) 
• Medi-Cal Rx Coordination of Benefits (COB) Reminder (April 8) 
• Dexcom Therapeutic Continuous Glucose Monitoring (CGM) – Issue Resolved (April 7) 
• Medicare Remit Easy Print Software for EDI 835 Files (April 5) 
• Medi-Cal Rx 101 Trainings for April 2022 (April 4) 

• • Friday, April 22 – 2:00 p.m.-3:00 p.m. PST 
  • Friday, April 29 – 2:00 p.m.-3:00 p.m. PST 

• Enteral Nutrition Update: Temporary Interchange of Equivalent Contracted Enteral Nutrition Products Due to Recent Formula Recall (April 4) 
• Monoclonal Antibodies for the Outpatient Treatment of COVID-19 as a Pharmacy Benefits (April 1) 
• Changes to Pneumococcal 15 & 20 Vaccines (April 1) 
• Medi-Cal Rx Monthly Bulletin (April 1) 
• Changes to the Contract Drugs List (April 1) 
• Changes to the Contract Drugs List (CDL) – Over-the-Counter Drugs (April 1) 
• Changes to Contract Drugs List (CDL) – Authorized Drug Manufacturer Labeler Codes (April 1) 
• Updates to the Medi-Cal Rx Provider Manual (April 1) 
• How to Find Covered Drugs (March 28) 
• Deadline Reminder: Electronic Claims Agreement (March 25) 
  • By April 30, 2022, all participating Medi-Cal Rx pharmacy providers and billers need to submit a Medi-Cal Rx Telecommunications Provider and Biller Application Agreement (DHCS Form 6500) to continue submitting electronic claims without interruption. Refer to the Medi-Cal Rx Electronic Claims Agreement alert, originally posted on December 31, 2021. 

• Medi-Cal Rx Policy Updates: Consolidated Listing (March 25) 

Also in California, the Board of Pharmacy posted the following to the website: 

• Legislation and Regulation Committee Meeting Agenda – April 26 
• Communication and Public Education Committee Meeting Agenda and Meeting Materials – April 26 
• Full Board Meeting CORRECTED Agenda – April 26-27 

 Also in California, AB 852, related to e-prescribing software requirements and prescriber exceptions to e-prescribing requirements, was amended on April 18. 

Finally in California, AB 1651 was amended on April 18, creating the Workplace Technology Accountability Act. Among its various provisions, this legislation would give workers new rights with respect to their data, regulates data employers collect, regulates how employers can monitor workers, regulates the ways in which employers use algorithms to monitor workers and creates a new enforcement regime through the Department of Fair Employment and Housing. The bill is sponsored by the California Labor Federation, SEIU California, the United Food and Commercial Workers-Western and the States Council.  

For more information, contact NACDS’ Sandra Guckian at 703-774-4801.

As a reminder regarding the COVID-19 declaration of emergency, the Board of Pharmacy has a webpage dedicated to Pharmacy Law Waivers; interested parties may sign up to receive the Board’s alerts for the most up-to-date information. Also, the Department of Consumer Affairs (DCA) has a webpage dedicated to DCA Waivers and Guidance Documents..

Also in California, as a reminder, the Department of Health Care Services (DHCS) eased DUR edits in Medi-Cal Rx until May 1. NACDS and the California Retailers Association have been in communication with the DHCS staff to request advance notice be provided to pharmacy providers of the Department’s plans for these DUR edits in advance of May 1.

For more information, contact NACDS’ Sandra Guckian at 703-774-4801.