On October 26, the Senate unanimously passed SB (Senate Bill) 2480 which will authorize pharmacists to prescribe, dispense and administer HIV (Human Immunodeficiency Virus) prevention drugs according to Department of Public Health and FDA (Food & Drug Administration) regulations and guidelines. The patient must prove they are HIV negative. The pharmacists may order an HIV test prior to prescribing and dispensing if the patient cannot provide proof of a negative HIV test. The pharmacist shall notify the patient that they will be required to be seen by a primary care provider to receive subsequent prescriptions for pre-exposure prophylaxis. A pharmacist shall not furnish a 60-day supply of pre-exposure prophylaxis to a single patient more than once every two years. The pharmacist shall notify the patient’s primary care provider following the dispensing of the drug and provide the patient with a list of local providers if the patient is not under the care of a provider. This bill will now be referred to the House of Representative for its consideration. As was the case last session, this bill will be referred to the Joint Committee on Health Care Financing from where it can be considered as a stand-alone bill or as part of the debate on a comprehensive healthcare reform bill which we expect to begin in the Senate soon. 

The Massachusetts Board of Pharmacy posted it’s agenda for the November 2 meeting. Three policies are on the agenda as follows:  

• Policy 14-02: Board Delegated Review (BDR): The “unknown loss protocol” was removed from the policy since the Board voted for a new “controlled substance loss protocol” at the October meeting. Also added was the ability for BDR to issue a reprimand for the loss of less than #100 units of a Schedule II controlled substance.  
• Policy 2021-04: Continuing Education (CE) Requirements for Pharmacists: Details for the required pain management training for collaborative drug therapy management (CDTM) pharmacists were added to the CE policy. With this addition, we request that the advisory titled “Pain Management Training for CDTM Pharmacists” be rescinded.  

• Policy 2023-01: Compliance Packaging and Reusable Dose Planners: The change to this policy allows Schedule II and III maintenance medications to be placed in multidrug-single-dose compliance packages. 

MassHealth posted its October monthly bulletin that announced the start dates for enforcing the ordering, referring, and prescribing (ORP) requirements. Except the information in this bulletin, all information in APB 361 and APB 376 remains in effect. Due to necessary system updates, the start date to enforce the requirement that claims processed by the Pharmacy Online Processing System (POPS) must include a prescriber who is actively enrolled with MassHealth will be delayed. This requirement will be enforced for service dates on or after May 1, 2024. Pharmacies should continue reviewing informational messages related to this requirement to avoid ORP-related denials when enforcement takes effect. 

For more information, please contact NACDS’ Ben Pearlman at 617-515-2603.

On October 19, MassHealth updated a previous notice that outlined the upcoming discontinuation of brand Flovent products and several associated changes to MassHealth’s coverage of inhaled respiratory agents. To facilitate transition from Flovent products to alternative inhalers, MassHealth has removed the PA (prior authorization) requirement from Arnuity Ellipta (fluticasone furoate inhalation powder) earlier than anticipated. Claims for Arnuity Ellipta processed through the Pharmacy Online Processing System (POPS) will be paid without PA beginning October 19, 2023. The MassHealth Drug List will be updated to reflect this change in PA status on December 4, 2023. 

The previously approved emergency regulations for pharmacists prescribing hormonal contraceptives were not published in the Friday, October 13 register by the Massachusetts Secretary of State. The next publishing date will be October 27, at which time they are expected to be published and will become effective upon publication. In the meantime, the Board of Pharmacy is developing a circular letter which will deal with all the operations issues regarding these regulations, including training and the screening risk assessment tools. These regulations come straight from the law that was signed as part of the Fiscal Year 23 Annual State Budget.  

For more information, please contact NACDS’ Ben Pearlman at 617-515-2603.

The Board of Pharmacy updated two policy positions. First regarding unfilled prescriptions, Policy 2023-10 responds to the DEA’s new rules regarding the transfer of unfilled federally controlled substance prescriptions. Second regarding vaccine administration, Policy 2023-02 allows qualified pharmacy personnel to administer routine vaccines that are not yet on the Immunization Schedule (e.g., RSV vaccine), and Collaborative Drug Therapy Management (CDTM) pharmacists may now also administer travel vaccines and other non-routine vaccines in accordance with their CDTM agreement. 

Also in Massachusetts, on September 12, the state legislature will be holding a hearing for the Joint Committee on Financial Services. This hearing will include HB 4066, an act relative to pharmacists as health care providers, making some of the test and treat language law.  

For more information, please contact NACDS’ Ben Pearlman at 617-515-2603.

On August 14, MassHealth asked all pharmacies to post the following document on display in regard to Medicaid eligibility redetermination.  

MassHealth also posted an update to COVID vaccine reimbursements and accepted codes in the August provider bulletin. 

The Board of Pharmacy updated its policy to allow for RSV (Respiratory Syncytial Virus) vaccines for adults 60 years of age and older. Qualified pharmacy personnel may administer an FDA-approved RSV vaccine if the following conditions are met:  

• it is only administered in accordance with the manufacturer’s FDA-approved labeling for the specific product; and 
• all requirements of Policy 2023-02: Vaccine Administration are met, including a prescription, or standing order. 

For more information, please contact NACDS’ Ben Pearlman at 617-515-2603.

The Board of Pharmacy has announced that Massachusetts pharmacists may provide patients of abruptly-closed Compass Medical practices with up to 30-days of certain medications even if they do not have remaining refills on their prescriptions. The southeastern Massachusetts medical clinic group shuttered suddenly last week, leaving tens of thousands of patients in the lurch and in need of alternate care arrangements. Under a policy adopted in April, state pharmacy regulators said, pharmacists are allowed to dispense Schedule VI medications that do not require a report to the state Prescription Monitoring Program without a refill order as a way of giving patients the time to find another prescriber. The board’s notice specified that federally controlled substances and gabapentin cannot be provided.

Also in Massachusetts, MassHealth announced in its Pharmacy Claims Processing Update, effective June 5, 2023, MassHealth Members who have no history of a paid MassHealth claim for an opioid in the past 90 days will be limited to a seven-day supply for their first fill with an exception. Please see details in the “Pharmacy Facts”.

For more information, please contact NACDS’ Ben Pearlman at 617-515-2603.

The Board of Pharmacy issued two notices after its May 31 board meeting. In regard to scope of practice, the first order pertains to immunizations and injections as well as from new policy 2023-08. The second order issues a new policy that consolidates previous stocking allowance orders.

For more information, please contact NACDS’ Ben Pearlman at 617-515-2603.

In advance of the May 11 Public Health Emergency ending, the Massachusetts Board of Pharmacy announced the following on May 4: 

• In response to the continued public health need for vaccinations, the Board will not be enforcing the supervisory ratios set out in 247 CMR 8.06(3) at licensed pharmacies that are providing vaccination services provided that the following conditions are met: 

• A maximum ratio of one pharmacist to six support staff is not exceeded; and 
• at least three support staff are interns and / or certified, licensed pharmacy technicians. 

• Due to continued staffing shortages, the Board does not intend to take enforcement action against pharmacies that perform and reconcile perpetual inventory counts at least every 15 days as long as back-counts are performed after each prescription is filled. 
• Pharmacists, interns and pharmacy technicians may administer vaccines to individuals who are 5 years of age and older in accordance with Policy 2023-02: Vaccine Administration. 
• COVID-19 Control Measures, including COVID-19 tests, may be dispensed or administered in accordance with Policy 2023-03: COVID-19 Control Measures. 

For more information, please contact NACDS’ Ben Pearlman at 617-515-2603.

On April 27, 2023, the MassHealth Pharmacy Program announced that “effective May 1, 2023, through March 31, 2024, MassHealth members, including those in managed care plans, do not have to pay copays for prescription drugs. This also applies to Health Safety Net (HSN) patients during this period.” 

For more information, please contact NACDS’ Ben Pearlman at 617-515-2603.

On March 22, the Massachusetts Board of Registration in Pharmacy and Department of Public Heath, in a notice, publicly reaffirmed the state’s policy that “all pharmacies located in Massachusetts and licensed by the Board must maintain a continuous, sufficient supply of all family planning medications, including mifepristone (Mifeprex® ), misoprostol (Cytotec® ), emergency contraception and contraceptive prescriptions to meet the needs of the community.”

For more information, please contact NACDS’ Ben Pearlman at 617-515-2603.