MedImpact issued a communication to pharmacies regarding reprocessing managed care claims for Lagevrio. Prescriptions dispensed using the commercially distributed product for Managed Care members prior to February 8, 2024, may be reversed and reprocessed to include the ingredient cost in the final paid amount. They will automatically reprocess claims that pharmacies have not resubmitted within the next 60 days. This does not apply to fee-for-service claims.

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

A bill that would apply many of the PBM reforms adopted in Medicaid to commercial and state employees’ plans has been introduced. SB 188 is sponsored by Sen. Max Wise (R), a longtime advocate of PBM reform. A few of the provisions included in this comprehensive bill include: a NADAC and Medicaid Dispensing Fee rate floor, anti-steering and anti-mandatory mail order language, a broad definition of specialty pharmacy and a formula to determine network adequacy.

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

This week, the House unanimously passed HB 274, a bill that would allow pharmacies to administer ACIP (Advisory Committee on Immunization Practices) vaccines to children aged 5 years and older. The bill also removes the current vaccine prescription requirement for children. The Kentucky Medical Association stood down following negotiations that raised the age from 3 years to 5 years. The bill now goes to the Senate.

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

MedImpact will host the First Quarter 2024 pharmacy provider online seminar on January 31 from 11:00 am- 12:00 noon. The meeting topic is “provider updates and provider Q & As.” You can use one of the following options to join the online seminar:   

• Webinar URL 
• Entering Meeting ID In Microsoft Teams Meeting ID: 218 939 299 642 

Attendee Passcode: omNFva 

• Call In (audio only) 1-858-252-2734; passcode138312994# v

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

The Medicaid Advisory Committee approved several motions suggested by the Pharmacy Technical Advisory Committee (PTAC), that NACDS serves on, to improve access to pharmacy vaccines in the Medicaid program: 

• A written communication will be delivered to pharmacies clarifying that, per the rule passed last year, enrollment in VFC (Vaccines for Children) program is not required and claims will be reimbursed. 
• They will work with PTAC to change policy to allow pharmacies to bill for vaccines in Medicaid FFS (Fee-for-Service).  
• They will work with PTAC on a statewide protocol for pharmacists to administer HPV (HUMAN PAPILLOMA VIRUS) vaccines to increase adolescent vaccination rates. 

Members are encouraged to share their thoughts and suggestions on these proposed policy changes with NACDS’ Jill McCormack.  

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

NACDS reminds members that as of October 16, the MedImpact vaccine administration fee was raised to $27.49 for the first dose in a vaccine series and $9.80 for each subsequent dose in a series. Currently, pharmacies are permitted to administer all vaccines to patients 9 years of age and older (including adults) by protocol. Also notable, DMS (Department for Medicaid Services) no longer requires pharmacies to enroll in VFC (Vaccines for Children) to be reimbursed for children’s vaccines if the patient meets the age requirements in statute.  

Also in Kentucky, Medicaid issued Provider Notice #315 regarding September P&T PDL (Preferred Drug List) changes. 

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

MedImpact will host its quarterly pharmacy webinar on November. 16 from 11 to 12am Eastern. The meeting provides a forum for pharmacies to ask questions about the SPBM (Single Pharmacy Benefit Manager) program. Click here to join. 

Also in Kentucky, in preparation for the 2024 legislative session, NACDS will host a joint conference call to discuss legislative and regulatory issues with the Kentucky Retail Federation and the Kentucky Pharmacists Association on November 13 at 2:30pm Eastern. If you have not received the invitation and would like to join, please contact NACDS’ Jill McCormack. 

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

It is NACDS’ understanding that pharmacy claims for the updated Pfizer-BioNTech and Moderna COVID-19 vaccines have been rejecting under the pharmacy benefit through MedImpact. The Kentucky Pharmacy Association shared with us that Medicaid has decided to cover the new vaccines under the pharmacy benefit. MedImpact is working on system edits to accommodate pharmacy billing and will notify pharmacies when it is implemented. Additionally, managed care coverage will begin for the Abrysvo (Pfizer) and Arexvy (GSK) RSV vaccines effective October 6. For more information on Medicaid vaccine coverage, please see the updated version of MedImpact’s Vaccine Coverage Expansion.

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

The Department of Human Services announced that due to the COVID-19 pandemic and the noticeable increase in vaccinations administered by pharmacy providers in recent years, they will be increasing the current pharmacy vaccine administration fee ($3.30) effective October 16, 2023. The new administration fee will be $27.49 for the first dose in the series. Each subsequent dose will receive an administration fee of $9.80 (if applicable). The effective date of this change is October 16, 2023. Members should expect to receive more information and billing instructions from MedImpact. NACDS reminds members that Medicaid no longer requires pharmacies to enroll in the Vaccine for Children Program (VFC) to be reimbursed for vaccines. 

Also in Kentucky, the Board of Pharmacy published a final rule permitting pharmacies to provide COVID treatment to patients. NACDS encourages members to review the rule because it also makes substantive changes to the process for providing test and treat services under ALL Board-approved protocols. 

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