The Division of Medicaid has placed new requirements on the MississippiCAN Coordinated Care Organizations that will take effect Monday, October 1. The purpose of these requirements is to enable pharmacy providers to identify and separate PBM lines of business in their front-end claims processing systems.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Effective July 1, the Division of Medicaid (DOM) allowed certain physician-administered drugs to be billed and reimbursed as either a medical claim or a pharmacy point-of-sale (POS) claim. Currently, many physician-administered drugs may only be billed as a medical claim. In order to implement this change, DOM has created a new category of drugs and drug-system devices, which may be billed as either medical or pharmacy POS claims. This new category is known as Clinician Administered Drugs and Implantable Drug System Devices (CADD). The list of drugs included in the CADD category is available online. To create the current list, DOM identified the drugs where reimbursing only by medical claims has caused the greatest access issues and targeted those for the CADD category. Additional drugs may be added to the category in the future.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Legislative amendments made during the 2018 Legislative Session provided a variety of new flexibilities to the Division of Medicaid, including the removal of the statutory cap on physician visits per year and prescription drugs per month. As the agency explores these possibilities, Medicaid-enrolled providers, beneficiaries and other stakeholders should be aware the current DOM policy remains in place and will not change Sunday, July 1.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
The Board of Pharmacy issued a statewide standing order allowing pharmacists to dispense by request naloxone without a prescription. Pharmacists are required to maintain proof of completion of a board-approved training program, to maintain a copy of the standing order, to fill and file the prescription as a legend drug and to provide proper counseling on the use of naloxone.
Also in Mississippi…The Division of Medicaid was instructed by CMS to change the way it reimburses for medical supplies, equipment and appliances and subsequently published a news notice. The agency is actively working with CMS and other stakeholders to address compliance with the rule while ensuring that non-physician providers continue to serve as a vital access point for patients enrolled in the Medicaid program.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
SB 2296, sponsored by Sen. Dean Kirby(R), was signed by Gov. Phil Bryant (R) on March 5. Effective Tuesday, January 1, 2019, this bill requires any health plan that provides coverage for prescription drugs to permit and apply a pro-rated daily cost-sharing rate to prescriptions dispensed by a network pharmacy for a partial supply if the prescribing provider or pharmacist determines the fill or refill is in the best interest of the enrollee and the enrollee requests or agrees to a partial supply. The bill also prohibits health plans from denying coverage for partial fills as authorized by the measure and prohibits pro-rated dispensing fees.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
