MedImpact issued a bulletin outlining the following COVID-related coverage and policy changes, effective Oct.1 2024, pursuant to the expiration of the American Rescue Plan (ARP):

• COVID-19 OTC tests will be limited to four per member per rolling 90 days. Patients requiring more tests will be required to submit a prior authorization request for review. Kentucky’s Statewide Physician Protocol for Point of Care COVID-19 Testing will be updated to reflect the changes to allowed quantity limits.
• The COVID-19 vaccine administration fee will remain the same. Pharmacies administering COVID-19 vaccines will continue to be reimbursed at $40.
• Pharmacies may continue to bill CPT code 99401 for standalone vaccine counseling.
• COVID-19 treatments classified as EUA (Emergency Use Authorization) may be subject to additional prior authorization review for coverage.

Also in Kentucky, Medicaid issued a Statewide Physician Protocol for Point of Care COVID-19 Testing. The protocol, meant for pharmacies who do not have a medical director, applies only to testing for Medicaid patients.

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

The Department for Medicaid Services covers items such as wheelchairs, orthotic appliances and disposable medical supplies when ordered by an approved prescriber and are medically necessary. If your pharmacy is enrolled as a Medical Supplies, Equipment and Appliance (MSEA) provider (PT90), you may bill covered nutritional supplements and disposable supplies as a medical benefit under provider type 90. Reimbursement amounts are listed in the Medicaid MSEA Fee Schedule and defined in 907 KAR 1:479. Billing and enrollment instructions are available online. For children under 21 years of age, an item not listed on the MSEA fee schedule may be covered under Early Periodic Screening Diagnosis and Treatment Services (EPSDT) Special Services which requires prior authorization. For assistance, please contact the EPSDT Special Services Coordinator at ivy.sams@ky.gov.

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

MedImpact, the Medicaid Single PBM, issued a bulletin along with the statewide Naloxone protocol to clarify that the statewide protocol can be used to prescribe the drug in the absence of a physician protocol.

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

MedImpact issued an invitation and online access instructions to the 3^rd Quarter session of the KY Medicaid Pharmacy Network Provider Webinar Forum on July 31 from 10:00-11:00 am EST. The meeting is meant as an open forum to ask questions or raise issues and all pharmacy providers are invited.

Also in Kentucky, MedImpact announced that they will be reprocessing claims that were inadvertently paid at NADAC or WAC when they should have been a MAC claim.

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

MedImpact, the Commonwealth’s Single PBM, issued a Preferred Drug List update (PDL update) regarding coverage of Humulin N and Novolin N vials.

Also in Kentucky, Medicaid should now be reimbursing pharmacies both an ingredient cost and an administration fee for vaccines provided to children even if the pharmacy is not enrolled in the Vaccines for Children program. Also, due to the passage of  HB 274, effective July 15, 2024, pharmacies will be authorized to administer the full range of vaccines starting at age five years (currently age nine years) under a prescriber-approved protocol. If you are experiencing any issues with vaccine reimbursement from Medicaid Fee-for-Service (FFS) or Managed Care, please contact NACDS’ Jill McCormack.

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

Following several policy victories over the last few years, pharmacy should have a clear runway to increase children’s vaccine rates in the Commonwealth. First, effective June 1, 2024, Medicaid FFS (Fee-For-Service) implemented a new policy to allow pharmacies to bill the program for vaccines. Second, last year Medicaid adopted a final rule that removed the VFC (Vaccines for Children) enrollment requirement. This change allows providers to bill Medicaid for children’s vaccines regardless of VFC participation. Lastly, HB 274 of 2024 was signed into law, lowering the age floor. Effective July 15, 2024, pharmacies will be permitted to administer any vaccine to children 5 years of age and older (lowered from age 9 years).

Also in Kentucky, the Board of Pharmacy issued the following rules for public comment, due to the Board by August 31. They are also scheduled for a public hearing on August 28. If you have comments, please send them to Jill McCormack by August 5.

• 201 KAR 2:210. This amendment re-orders the sections of the regulation and adds sections and definitions regarding the regulation of automated filling systems and final product verification.
• 201 KAR 2:480, Telework and Electronic Supervision for Remote Prescription Processing. New Regulation. Adds KRS 315.020(5) to authorize order entry, order entry verification and drug regimen review as tasks that can be performed outside of the permitted space of the pharmacy. It also provides minimum requirements for pharmacies engaged in remote prescription processing conducted via telework and establishes rules for electronic supervision.

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

Effective June 1, 2024, the Department for Medicaid Services made changes to the vaccine coverage for Medicaid Fee-for-Service members.  

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

Gov. Andy Beshear (D) signed HB 274, sponsored by pharmacist Rep. Danny Bentley (R). The bill authorizes pharmacists to order and administer vaccines to patients aged 5 years and older under a prescriber-approved protocol. The law takes effect 90 days after the General Assembly adjourns sine die. This date will officially be set by the attorney general after April 15. 

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

MedImpact recently issued communications to pharmacies regarding the State of Emergency Override and opportunities to reverse claims affected by the migration of Medicaid fee–for–service claims.

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