The Department of Health and Human Services (DHHS) released the presentation from the June Medicaid Pharmacy Liaison Meeting. The slides include information on performing MTM (Medication Therapy Management) for HIV (Human Immunodeficiency Virus) treatment and COVID extensions that will end on September 30, 2024.

Also in Michigan, the Board of Pharmacy has posted the minutes from the June 4 regulation workgroup meeting.

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

Pharmacy Controlled Substance Administrative Rules have been revised and changes are effective as of May 31, 2024. One amendment of note is the removal of Gabapentin, meaning it is no longer classified as a controlled substance in the state. A prescriber without a controlled substance license can now prescribe Gabapentin, and Gabapentin no longer needs to be included in reporting to the Michigan Automated Prescription System (MAPS).

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

Legislation introduced last week as HB 5435 and HB 5436 would allow pharmacists to prescribe and dispense self-administered hormonal birth control to patients. The companion bill would require insurers to reimburse pharmacies for the prescription and consultation or other ancillary services including testing. It also requires that the insurer allow the pharmacy to bill the items and services under a service code at adjudication of the prescription claim.

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

The Department of Insurance and Financial Services (DIFS) updated instructions for pharmacies to file PBM complaints on its PBM website. As a reminder, the Pharmacy Benefit Manager (PBM) Licensure and Regulation Act, PA 11 of 2022, took effect on January 1, 2024. This law introduces new licensing obligations and regulatory standards for PBMs operating in the state.  

Also in Michigan: The Department of Health and Human Services (MDHHS) is soliciting comments from the public on the Michigan Medicaid Health Plan Common Formulary, which applies to pharmacy claims paid by Medicaid managed care organizations. The public may submit comments on the drugs included or not included on the Common Formulary, new drug products, prior authorization criteria, step therapy criteria and other topics related to drug coverage under the Common Formulary. Comments should be sent to formulary analyst Linda Van Camp by March 15. 

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

The Department of Health and Human Services announced that effective December 22, 2023, Blue Cross Blue Shield of Michigan (BCBSM) is no longer a clearinghouse for Medicaid. Beginning February 2024, BCBS will no longer receive the 835/Electronic Remittance Advice (ERA). Providers who currently have BCBS associated and authorized as a billing agent in their CHAMPS provider enrollment information will need to update or modify their enrollment. To continue to receive the 835, providers will need to update their authorized billing agent in CHAMPS. For questions or assistance please

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

The Department of Health and Human Services announced that due to scheduled maintenance, the File Transfer Service (FTS) portal will be unavailable on January 14 from 10:00 am to 2:00 pm EST. They asked providers to refrain from submitting electronic files during this outage period. Billing agents or providers with additional questions can email AutomatedBilling@Michigan.gov for further assistance.

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

Gov. Gretchen Whitmer (D) signed HB 4276. The bill requires PBMs to reimburse pharmacies with no more than seven retail outlets at NADAC plus a professional dispensing fee comparable to the state Medicaid Dispensing Fee. It also prohibits the Department of Health and Human Services (department) from entering into a contract with a Medicaid managed care organization if its pharmacy benefit manager (PBM) does not do the following: reimburse for a legally valid claim at a rate not less than the rate in effect at the time the original claim adjudication was submitted at the point of sale; agree to move to a transparent pass-through pricing model, in which the PBM discloses the administrative fee as a percentage of the professional dispensing costs to the department; agree to not create new pharmacy administration fees and to not increase current fees more than the rate of inflation; and, agree to not terminate an existing contract with a pharmacy with no more than seven retail outlets for the sole reason of the additional professional dispensing fee authorized.

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

Medicaid issued a bulletin announcing prescription copay change for Healthy Michigan Plan enrollees.

Also in Michigan, The Department of Licensing and Regulatory Affairs (LARA) issued an email communication to pharmacies regarding the new Pharmacy Technician Administrative Rules that were effective on Oct. 2, 2023. They noted they are diligently working on updating relative information on their website to reflect the revision. Please send questions about the revised rules to BPLHELP@michigan.gov.

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

Medicaid issued proposed policy 2341 Documenting Beneficiary Consent Authorizing Automatic Refills of Prescribed Pharmacy Products for public comment. 

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