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.

The Board of Pharmacy has rescheduled April 19 Standard of Care Ad Hoc Committee meeting to June 22. The Board also announced the April 20 Medication Error Reduction and Workforce Ad Hoc Committee meeting will be rescheduled (TBD). 

Also in California, the Department of Health Care Services posted this DUR article titled “Improving the Quality of Care: Legislative Impact on the Use of Naloxone” on its Medi-Cal Rx Web Portal. Please note the Table 2 update on March 31. 

Finally in California, the Department of Health Care Services posted the following alerts on the Medi-Cal Rx Web Portal on March 24: 

• Medi-Cal Rx Finance Portal Frequently Asked Questions 
• Medical Supplies Update: Dexcom Therapeutic Continuous Glucose Monitors (CGM) 

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

The Board of Pharmacy issued an Amended Waiver: Staffing Ratio of Pharmacists to Intern Pharmacists and General Supervision and Interprofessional Supervision – Immunizations – BPC section 4114. 

Also in California, the Department of Health Care Services issued Stakeholder News that it is still accepting claims for individuals enrolled in the COVID-19 Uninsured Group Program. The COVID-19 Uninsured Group Program will end the last day of the calendar month in which the federal COVID-19 public health emergency ends. For questions or concerns, please email COVID19Apps@dhcs.ca.gov.  

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

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

• Enteral Nutrition Recall (March 14)
• Enteral Nutrition Updates: Maximum Quantity Rejections (March 15) 

Also in California, the Board of Pharmacy amended the expiration date of the following waiver: Mass Vaccination Sites – AMENDED AND REISSUED; the expiration date is June 30, 2022, or until 90 days following the declared disaster, whichever is sooner. All Pharmacy Law waivers are posted under the COVID-19 Updates and Resources. 

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