Patients and pharmacies in the Commonwealth took a giant leap forward this week when Anthem announced they will be enrolling pharmacists as network providers. The move is a result of the enactment of a law that provides for pharmacy payment parity; HB 48 of 2021 required Kentucky health plans to reimburse pharmacists for services within a pharmacist’s scope of practice that are otherwise covered by the plan, if provided by another healthcare provider. Coupled with a pharmacist’s current authority to provide more than a dozen clinical services under Board of Pharmacy Protocols, Anthem members will have widespread convenient access to treatment at pharmacies for ailments such as flu, strep and tobacco cessation. Pharmacies interested in enrolling in the network should contact kyprovidercontracting@anthem.com. For more information, please see the Kentucky Pharmacists Association’s (KPhA’s) latest news release. NACDS applauds KPhA for its work with Anthem and its leadership in our joint support for HB 48.

Also in Kentucky, Medicaid has proposed a rule that may make it easier for pharmacies to provide vaccine services to kids with Medicaid coverage. The rule change eliminates the requirement to use Vaccines for Children (VFC) stock and strikes current language that states Medicaid will not reimburse for the cost of any vaccine if already available through the VFC program. NACDS interprets this to mean that pharmacies do not have to be enrolled in VFC to immunize and be reimbursed for Medicaid-covered kids. NACDS is seeking member feedback to determine whether this change would be significant to your vaccination efforts. Please review this rule and send Jill McCormack your comments by November 18.

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

As a result of the adoption of an Emergency Administrative Regulation, beginning October 1, 2022, MedImpact will pay pharmacies a dispensing fee of $10.64 for each prescription of Suboxone every 7 days, as written by the prescriber. Prior to the adoption of the new regulation, Medicaid would only pay the fee every 23 days. This will be practically implemented as one dispensing fee and up to three additional professional service fees per rolling 28-day period. To receive the professional service fees, the pharmacist is required to take additional steps, including checking KASPER and providing patient counseling. Additional information as well as adjudication details are included in this Bulletin. 

Also in Kentucky, The Board of Pharmacy has issued the following proposed rules for public comment. Comments are due to the BOP on November 30 and contact details are on the last page of each rule. 

• 201 KAR 030 – amends to the license transfer regulation to establish a non-resident pharmacist license for any pharmacist located outside of Kentucky serving Kentucky patients; requires the pharmacist to have a non-resident pharmacist license and participate in NABP’s Verify program; exempts the non-resident pharmacist from continuing education requirements in the state 
• 201 KAR 2 460 -establishes an out-of-state pharmacy permit 
• 201 KAR 2 360 – amends the Naloxone regulation allowing pharmacists to dispense to emergency departments under a protocol 

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

The Board of Pharmacy has filed an emergency and ordinary amendment to allow pharmacists to prescribe and receive Medicaid reimbursement for Paxlovid. Specifically, the amendment removes the list of specific conditions that require a Board-approved protocol for pharmacists to be authorized to treat patients with illnesses. Instead, the regulation would allow a pharmacist to utilize any protocol approved by the board to provide treatment services. This emergency amendment will allow for any prescriber–approved protocol to be reviewed for approval by the Board of Pharmacy. If the regulation is approved, the physician Director of Medicaid Services can also sign a prescriber–approved protocol for any pharmacist to initiate the dispensing of Paxlovid for Medicaid patients. Additionally, the board approved a new board authorized protocol for Paxlovid. The emergency regulation was effective immediately, but the ordinary version must be go through the promulgation process with the Board. NACDS expects the physician community to oppose this regulation and encourages members to join us in submitting supportive comments by September 30. Further detail and contact information for comments are on the regulation webpage.

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

The Emergency Prescription Assistance Program (EPAP) has been authorized in areas of the state impacted by severe storms and flooding. EPAP is a federal program managed by the Department of Health and Human Services, which provides an efficient way for community pharmacies to process claims for prescription medications, vaccines, limited medical supplies and limited durable medical equipment (DME) provided to individuals who are from a disaster area declared by the President and who do not have any form of health insurance coverage. 

Also in Kentucky, The Board of Pharmacy has filed an emergency and ordinary amendment to 201 KAR 2 380, amending the board authorized protocol regulations by removing the specific conditions. Instead, a pharmacist may utilize any protocol approved by the board to provide healthcare services. Additionally, the board approved a new board authorized protocol for Paxlovid. The board list of approved protocols can be found at https://pharmacy.ky.gov/Pages/Board-Approved-Protocols.aspx 

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

On June 1, Medicaid filed concurrent emergency and ordinary regulations making changes to the 340 (B) program and increasing the frequency of permitted dispensing fees for drugs to treat substance abuse disorders to weekly.

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

On May 5, the Department of Medicaid Service (DMS) issued a statement asking pharmacies to hold off on reprocessing and rebilling TPL claims as requested by MedImpact in a recent communication to pharmacies. The statement, issued by Dr. Fatima Ali, Senior Director, Medicaid Pharmacy Services, reads: “DMS is requesting that pharmacies hold off on reversing and reprocessing claims until further guidance is provided in the upcoming days. DMS is exploring alternative solutions around the TPL issue and will provide additional updates ASAP. Thank you!” 

NACDS thanks the Kentucky Retail Federation and the Kentucky Pharmacists Association for their work on this issue and for sharing this information with us. We will keep members informed via email on any developments on this issue. 

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

Kentucky Medicaid has issued a new Standing Order to include at-home COVID-19 tests.

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

SB 25 passed the General Assembly last week and extended COVID executive orders until 4/4/22. Of interest to pharmacy, this bill continues emergency dispensing, remote work for pharmacists, and the ordering and administering vaccinations and COVID-19 testing.  

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

Rep. Steve Sheldon (R) has introduced legislation to comprehensively regulate Pharmacy Benefit Managers. House Bill 203 would regulate PBMs in commercial and self-insured plans, as well as the state employee plan. The bill includes patient choice of pharmacy protections and measures that protect pharmacy reimbursed. It would also prohibit mandatory mail order, require any rebates to reduce patients’ out-of-pocket costs and set a pharmacy reimbursement floor based on NADAC + professional dispensing fee. Additionally, it would require PBMs to treat 340B claims like other prescription claims for reimbursement purposes. 

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