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.

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.