MedImpact, the state Single PBM, issued a communication clarifying that the prohibition on automatic refills does not include 90-day fills.

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

MedImpact announced that they identified Managed Care and Fee-for-Service claims adjudicated between August 23 and September 11, 2024, that were inadvertently paid at an inactive National Average Drug Acquisition Cost (NADAC) rate. Most of the rates utilized were lower than the active rate, but not all. The identified claims will be adjusted within 30 days to recalculate pricing to the NADAC pricing rates effective August 21, 2024, where appropriate. They will appear on your Remittance Advice (RA) or 835 to reflect the underpayment or overpayment. Impacted claims will not be recouped in totality; instead, they will only address the difference between the inactive and active NADAC rate.

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

MedImpact issued an updated bulletin to pharmacies clarifying the coverage limits on naloxone 4 mg nasal spray. This applies to both brand and generic covered NDCs.

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

The Department for Medicaid Services (DMS) and MedImpact issued a bulletin to pharmacies promoting the administration of Human Papillomavirus (HPV) vaccines at pharmacies. Through December 1, 2024, pharmacies will receive a point-of-sale message when billing claims for Medicaid patients that DMS identified as HPV vaccine naive. Pharmacies may bill Medicaid for the product, the administration fee and counseling. NACDS serves on Medicaid’s Pharmacy Technical Advisory Committee (PTAC) that worked with DMS and the health plans to develop and advance the program. Fee-for-service and MedImpact contact information as well as the protocol have been provided to pharmacies.

Also in Kentucky, Medicaid and MedImpact issued bulletins related to MAC appeals and a reminder to pharmacies of their auto refill prohibition policy.

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

MedImpact issued a communication to pharmacies this week as a reminder about each managed care organizations (MCO) lock-in policy, including a list of each MCO’s criteria.

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

The latest Board of Pharmacy newsletter announced revisions to four statewide protocols effective July 24, 2024. The updated protocols include Acute Influenza Infection Chemoprophylaxis treatment, and three related to self-care, including diabetes testing and injections, over-the-counter (OTC) dietary supplements and OTC probiotics.

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

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.