Medicaid issued a Pharmacy Facts program update alerting pharmacies that the Single Pharmacy Benefits Manager (PBM) for Managed Care Organizations (MCO) Magellan, will contact network Pharmacy Services Administrative Organizations (PSAO), chains and independent pharmacies, to agree to the new level of effort (LOE) compound fee schedule effective April 1, 2024.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
The Department of Health’s (LDH) Informational Bulletin 24-3 providing Medicaid immunization fee schedule updates has been posted.
Also in Louisiana, providers who bill for medically necessary services for specialized mental health and substance use services for dual eligibles for Medicaid enrollees should follow the process detailed in LDH’s Informational Bulletin 15-17.
Also in Louisiana, LDH’s Informational Bulletin 24-2 provides the American Society of Addiction Medicine (ASAM) criteria updates for adult substance use services.
Finally in Louisiana, the agenda for the February 21 Board of Pharmacy meeting should be available on the website soon.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
The Department of Health (LDH) Medicaid Fee for Service (FFS) and Managed Care Organizations began reimbursing pharmacies for blood clotting factor products administered in an outpatient setting as a pharmacy benefit on February 1, 2024.
Also in Louisiana, the Board of Pharmacy’s quarterly meeting is in Baton Rouge on February 20 and 21.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
The next PBM Monitoring Advisory Council meeting, on which NACDS has a designated seat in statute, will be meeting on February 7 at 10:30 am at the Department of Insurance offices in Baton Rouge.
Also in Louisiana, the Prescription Monitoring Program (PMP) Advisory Council, on which NACDS has a designated seat in statute, will be meeting February 7 at 1:30 pm at the Board of Pharmacy office.
Finally in Louisiana, the Medicaid Fee for Service (FFS) Pharmacy Program and Managed Care Organizations (MCOs) updated the reimbursement methodology for clotting factor products effective on February 1.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Gov. Jeff Landry (R) starts his first term with a Republican supermajority in both houses. The Governor immediately convened an 8-day special session on January 15 to address three issues – congressional redistricting, reconfiguring the Supreme Court and changing the elections system.
Also in Louisiana, the Department of Health announced that effective February 1, the clotting factor reimbursement methodology will change to an average acquisition cost per unit and a dispensing fee per unit dispensed and will be limited to pharmacy claims only.
Finally in Louisiana, the Board of Pharmacy’s Regulatory Project 2023-02 ~ Temporary Closure of Pharmacy Final Rule went into effect on January 20.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
The Board of Pharmacy’s Regulation Review Committee has posted the agenda for the January 24 meeting in Baton Rouge.
Also in Louisiana, the Department of Health’s (LDH’s) vendor Magellan will approve overrides for non-preferred products when the preferred product has a manufacturer shortage. Contact the Magellan Medicaid Administration help desk at (800) 424-1664 to get the override. The prescriber does not need to fill out a prior authorization. The current list of drugs with known shortages are Sabril® 500mg powder for oral solution, generic Concerta®, generic Focalin XR®, Trileptal® suspension and generic Mydayis™.
Finally in Louisiana, LDH (Department of Health) issued Bulletin 24-1 informing providers that Medicaid is updating the Medicaid Fee-For-Service (FFS) files procedure codes.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
On January 7, Gov. Jeff Landry (R) was sworn into office, replacing former Gov. John Bel Edwards (D), who had reached his term limit. Ralph Abraham, MD, a physician, was appointed head of the Louisiana Department of Health. NACDS and our in-state partner, the Louisiana Alliance for Retail Pharmacies (LARP), have requested a meeting.
Also in Louisiana, the new Legislature elected last Fall was sworn in on January 8. Currently, Republicans hold a supermajority in both Houses.
Also in Louisiana, NACDS’ in-state partner, the Louisiana Alliance of Retail Pharmacies (LARP), submitted a comment letter to the Board of Pharmacy at the December 28, 2023, public hearing raising concerns about a proposed rule on product integrity that implements temperature control measures for shipments of prescription drugs to patients. Specifically, the proposed rule change would require ALL home delivery medications, including room temperature medications, to be sent in temperature-controlled packaging from pharmacies to patients.
Also in Louisiana, the Department of Health (LDH) issued an Informational Bulletin 23-22 to Medicaid providers reminding them that RSV vaccines that have been covered since August 3, 2023, must have the correct CPT codes 90380 and 90381.
Finally in Louisiana, in late December 2023, the Centers for Medicare & Medicaid Services (CMS) approved the state plan amendment (SPA) to increase the dispensing fee for local pharmacies only from $10.99 to $11.81. The increased fee applies to Medicaid Fee-for-Service pharmacy claims and Medicaid Managed Care local pharmacy claims, retroactive to the date of service of October 1, 2023.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
The Department of Health issued an informational bulletin on tobacco cessation counseling.
Also in Louisiana, the Department of Health (LDH) updated the available options to providers for pursuing resolution of issues with Medicaid managed care organizations (MCO) and the state’s fee-for-service (FFS) claims processor, Gainwell Technologies. Unless explicitly notated, providers should first seek resolution with the MCO or Gainwell directly, prior to engaging LDH or other third parties.
Finally in Louisiana, the Board of Pharmacy is soliciting comments and holding a Public Hearing on December 28 on three proposed rule changes:
For more information, contact NACDS’ Mary Staples at 817-442-1155.
The Department of Health (LDH) issued a report detailing the results of key initiatives and policy goals for five major categories designed to make measurable improvements:
Also in Louisiana, LDH issued a bulletin outlining the available options to providers for pursuing claims resolutions and appeals of issues with Medicaid managed care organizations (MCO) and the state’s fee-for-service claims processor, Gainwell Technologies.
Also in Louisiana, LDH issued a revised bulletin with added information on provider enrollment.
Also in Louisiana, LDH announced an 11% decline in new human immunodeficiency virus (HIV) diagnoses over the past five years. As of June 2023, the number of individuals living with HIV in Louisiana stands at 22,920.
Finally in Louisiana, LDH issued a memorandum announcing that diabetic supplies will be added to the Medicaid Single Preferred Drug List to be reimbursed as pharmacy claims only effective December 1, 2023.
For more information, contact NACDS’ Mary Staples at 817-442-1155.