The House Commerce Committee held a hearing on January 18 and recommended passage of HSB 536, related to PBMs. This study bill, proposed by the Department of Insurance and Financial Services, expands the PBM’s duty of good faith and fair dealing to pharmacies. It also prohibits retaliation by a PBM against a pharmacy for exercising its rights or remedy or in cooperation with the commissioner. Also, a PBM is prohibited from assessing, charging or collecting any form of renumeration that passes from any pharmacist, regardless of whether the pharmacist in a pharmacy network. The bill also requires a PBM to update the maximum allowable cost (MAC) list within seven days from the date of an increase of 10 percent more in the NADAC of a prescription drug on the list. Finally, it places additional reporting requirements on PBMs. 

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

The Department of Health and Human Services, Iowa Medicaid posted INFORMATIONAL LETTER NO. 2543-MC-FFS: Amerigroup Iowa, Inc. Rebranding to Wellpoint Iowa, Inc. 

Also in Iowa, on January 3, 2024, Wellpoint released Clinical UM Guideline (Guideline #CG-DME-42) regarding the use of continuous glucose monitoring devices (CGMs). Also review the Iowa Administrative Code and Department of Human Services Medical Equipment and Supply Dealer Provider Manual for related information; see pages 39-40. Please contact the following for assistance: Angela Dillon or Joely Anderson. 

Also in Iowa, in response to complaints by Iowa pharmacies, Andria Seip, Senior Health Policy Specialist, Iowa Insurance Division, sent a memo on January 4, 2024, to PBMs (Pharmacy Benefit Managers) licensed in the state that contracts requiring reimbursement models using "effective rates" are considered prohibited under Iowa Code section 510B.8C.  

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

The Department of Health and Human Services, Iowa Medicaid posted the following:  

• INFORMATIONAL LETTER NO. 2537-MC-FFS-D: HHS New Website Launch and Content Changes 
• INFORMATIONAL LETTER NO. 2535-MC-FFS-D: January 2024 Iowa Medicaid Pharmacy Program Changes 
• INFORMATIONAL LETTER NO. 2531-MC-FFS: Member Cost Sharing Limits 
• INFORMATIONAL LETTER NO. 2528-MC-FFS-D: SUPPORT Act Section 5042(e)(I)(A) Reporting Requirements Survey for Federal Fiscal Year (FFY) 2023 
• INFORMATIONAL LETTER NO. 2522-MC-FFS: New Vaccine for Children (VFC) Program Codes 
• INFORMATIONAL LETTER NO. 2521-MC-FFS: New Respiratory Syncytial Virus (RSV) Vaccine Codes 
• INFORMATIONAL LETTER NO. 2511-MC-FFS: Date Span Billing for Durable Medical Equipment (DME) Rental and Medical Supplies; this replaces INFORMATIONAL LETTER NO. 2395 
• INFORMATIONAL LETTER NO. 2509-MC-FFS: Over-the-Counter COVID Test 

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

The Board of Pharmacy offices will move effective November 6 to 6200 Park Ave., Suite 100, in Des Moines, Iowa 50321. The move is the result of the Board now being part of the Department of Inspections, Appeals, and Licensing. The Board's goal is to have no disruption in service during the move. Online services will not be affected.  

Also in Iowa, the Board of Pharmacy posted the November 7 meeting agenda. The meeting will be held via Zoom. To access the meeting, see the details below:  

Join Zoom Meeting https://us02web.zoom.us/j/88584737545?pwd=RzdsREtyVkpkcUFUeWtNMHRmWmNxUT09  

Meeting ID: 885 8473 7545  

Passcode: 746325 

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

The Department of Health and Human Services, Iowa Medicaid posted the following: 

• INFORMATIONAL LETTER NO. 2515-MC-FFS RE: Clarification of Billing COVID-19 Vaccines and Administration, effectively immediately.
• INFORMATIONAL LETTER NO. 2507-MC-FFS RE: Request for Proposal (RFP) for Adolescent Health Pilot Projects, effective September 20, 2023 
• INFORMATIONAL LETTER NO. 2505-MC-FFS RE: Electronic Data Interchange Support Services (EDISS) Registration, effective immediately 
• INFORMATIONAL LETTER NO. 2510-MC RE: Reimbursement for Pharmacy Point-of-Care Testing – Influenza and Streptococcus A, effective immediately. 

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

The Department of Health and Human Services, Iowa Medicaid posted INFORMATION LETTER NO. 2503-MC-FFS – 2023 Annual Provider Training.

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

The Department of Health and Human Services, Iowa Medicaid posted the following:   

• INFORMATIONAL LETTER NO. 2502-MC – Your Medicaid Clients May Receive a Visit from their Managed Care Organization (MCO) – Effective Immediately 

• INFORMATIONAL LETTER NO. 2472-MC-FFS – Telehealth Services – Place of Service (POS) Codes – Effective Upon Receipt 

Also in Iowa, the Department of Health and Human Services (HHS) and the Iowa Department of Education received approval from the U.S. Department of Agriculture, Food and Nutrition Service to issue Summer 2023 Pandemic Electronic Benefits Transfer (P-EBT) for eligible school-age Iowa children.  This program provides $120 per eligible child, issued on new P-EBT cards to be received by October 4. Approximately 240,000 Iowa children are eligible for this benefit, totaling $28 million in food assistance.  

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

The Department of Health and Human Services, Iowa Medicaid posted the following:  

• INFORMATIONAL LETTER NO. 2501-MC-FFS – Iowa Medicaid Dashboard  
• INFORMATIONAL LETTER NO. 2494-MC-FFS-D – Quarterly Code Update Communication Bulletin  
• INFORMATIONAL LETTER NO. 2493-MC-FFS-D – Hope and Opportunity in Many Environments (HOME) 
• INFORMATIONAL LETTER NO. 2491-MC-FFS – Avastin® (bevacizumab) Billing for Use in Ophthalmology  
• INFORMATIONAL LETTER NO. 2489-MC-FFS – Billing for Medicaid Services  

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

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

For more information, please contact NACDS’ Mike Sargent at 207-272-6435.

For more information, contact NACDS’ Jill McCormack at 717-592-8977.

For more information, contact NACDS’ Mary Staples at 817-442-1155.

The Department of Health and Human Services, Iowa Medicaid posted the following: 

• INFORMATIONAL LETTER NO. 2501-MC-FFS – Iowa Medicaid Dashboard 
• INFORMATIONAL LETTER NO. 2494-MC-FFS-D – Quarterly Code Update Communication Bulletin 
• INFORMATIONAL LETTER NO. 2493-MC-FFS-D – Hope and Opportunity in Many Environments (HOME) 
• INFORMATIONAL LETTER NO. 2491-MC-FFS – Avastin® (bevacizumab) Billing for Use in Ophthalmology 
• INFORMATIONAL LETTER NO. 2489-MC-FFS – Billing for Medicaid Services 

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