On September 28, the Board of Pharmacy issued a statement on working conditions recommending that pharmacies review current operations and address any issues that may impede safe patient care, including pharmacy staffing and any metrics/quotas that may hinder safe patient services. The Board also recommends pharmacies provide any additional resources or protections needed to minimize any job-related stressors of pharmacy personnel.

Also in Missouri, the Board of Pharmacy posted the September newsletter which includes detailed information on pharmacists’ new immunization authority, and the recently revised statewide naloxone standing order.

Also in Missouri, the state’s Department of Social Services Division of Health published rules in the State Register (p13-15) establishing a Pharmacy Federal Reimbursement Allowance and methodologies to determine the formula for the amount of allowance each pharmacy is required to pay for the privilege of providing outpatient prescription drugs.

Finally in Missouri, the Department of Health and Senior Services’ Division of Regulation and Licensure issued an emergency regulation on Controlled Substances.

For more information, contact NACDS’ Mary Staples at 817-442-1155.

The Board of Pharmacy released emergency rules regarding pharmacist vaccine administration, effective August 28, 2023. The rules establish guidelines for independent vaccination by pharmacists, for vaccines approved as of January 1, 2023, as well as provide guidance for vaccines administered under protocols. They also clarify that pharmacists may continue to administer vaccines that are periodically/annually reformulated or updated, such as seasonal influenza vaccines, if the FDA approved the original vaccine before January 1, 2023.   

The Board issued a Supplemental Pharmacy Practice Guide summarizing the 2023 legislative changes.  

Also in Missouri, the Department of Commerce and Insurance issued emergency rules on pharmacists’ immunization procedures: 

For more information, contact NACDS’ Mary Staples at 817-442-1155.

The Missouri Board of Pharmacy released emergency rules regarding pharmacist vaccine administration, effective August 28, 2023. The rules establish guidelines for independent vaccination by pharmacists, for vaccines approved as of January 1, 2023, as well as provide guidance for vaccines administered under protocols. They also clarify that pharmacists may continue to administer vaccines that are periodically/annually reformulated or updated, such as seasonal influenza vaccines, if the FDA approved the original vaccine before January 1, 2023.  

The Board issued a Supplemental Pharmacy Practice Guide summarizing the 2023 legislative changes. 

For more information, contact NACDS’ Mary Staples at 817-442-1155.

Gov. Gov. Mike Parson (R) appointed two new pharmacists to the Board of Pharmacy, Darren Harris, and Tammy Thompson, replacing Pamela Marshall and Christina Lindsay whose terms had expired.  

Also in Missouri, the Department of Social Services (DSS) launched a public dashboard at https://dss.mo.gov/mis/clcounter/ to provide transparency regarding the resumption of eligibility determinations for MO HealthNet, Missouri’s Medicaid program. The dashboard displays data for annual renewals due at the end of June. DSS plans to update the dashboard each month. 

For more information, contact NACDS’ Mary Staples at 817-442-1155.

On July 6, Gov. Mike Parson (R) signed into law three bills enacting the largest pharmacy scope of practice expansion (HB 115 / SB 157 / SB 45 & 90). The bills allow pharmacists to independently administer all vaccines approved by the FDA as of January 1, 2023. The law also expands the services pharmacists can provide through physician protocols, and it creates framework for statewide standing orders for the testing and treatment of COVID, Flu and Strep.  

Also in Missouri, effective July 30, MO HealthNet will no longer allow automatic refills or automatic shipments of medications, devices, or supplies. MO HealthNet does not pay for any
prescription without an explicit request from a participant or the participant’s responsible party, such as a caregiver, for each refilling event. Participants and providers cannot waive the explicit refill request requirement and enroll in an automatic refill program. 

Also in Missouri, MO HealthNet also reported that due to the increase in the Missouri Pharmacy Reimbursement Allowance (Pharmacy Tax), the adjustment to account for the Professional Dispensing Fee for Medicaid-reimbursed prescriptions was increased effective July 1, 2023.  

Also in Missouri, the Department of Commerce and Insurance’s (DCI) Department of Health and Senior Services issued a revised naloxone HCL standing order that now lists the nasal spray generically, allowing pharmacists to dispense the brand name or generic product.  

Also in Missouri, starting July 17, MO HealthNet announced that the Pharmacy Help desk’s NEW hours for drug prior authorizations will be Monday through Friday, 8:00 a.m. to 7:00 p.m. Central; weekend hours will remain the same 8:00 a.m. to 6:00 p.m. 

Finally in Missouri, the MO HealthNet Division recently moved all provider forms regarding MO HealthNet benefits to a new Provider Forms page.  

For more information, contact NACDS’ Mary Staples at 817-442-1155.

Prior to the Legislature adjourning on May 12, the pharmacy practice act language pharmacies had promoted that allows pharmacists to administer all FDA authorized and approved vaccines to anyone 7years of age and older passed in two bills, SS/HCS/HBs 115 & 99 and HCS/SS/SCS/SBs 45 & 90. These bills also include language that allows pharmacists with a certificate of medication therapeutic plan authority to provide under a statewide standing order medications to treat flu, strep and COVID. Lastly, the omnibus bills included a provision amending the definition of “opioid antagonist” in a statute that is currently defined as naloxone hydrochloride; this act adds any other drug or device approved by the FDA that blocks the effect of an opioid overdose. (CCS HCS SS SCS SBs 45 & 90 and HBs 115 & 99)

For more information, contact NACDS’ Mary Staples at 817-442-1155.

Pharmacy technicians immunizing under the Board’s statutes and rules must complete an initial and annual documented competency assessment. A sample Technician Immunization Assessment Checklist template is intended for guidance purposes only to assist licensees and should be modified as appropriate for your practice setting. 

Also in Missouri, the 2023 Practice Guide contains updated compliance tips and information on recent statutory/rule changes, including, new/revised sections on Pharmacy Working Conditions, Technician Supervision & Expanded Technician Activities, Electronic Final Product Verification by Pharmacists, Technology-Assisted Product Verification by Interns & Technicians, and Quality Assurance. 

Finally in Missouri, the 2023 Missouri Pharmacy statutes and rules law book is available here. 

For more information, contact NACDS’ Mary Staples at 817-442-1155.

The Department of Commerce and Insurance (DCI) extended the COVID-19 vaccine and testing standing orders until May 11, 2023. Revised standing orders may be found at: 

• Vaccines: https://health.mo.gov/living/healthcondiseases/communicable/novel-coronavirus/statewide-orders.php 
• Testing: https://health.mo.gov/living/healthcondiseases/communicable/novel-coronavirus/testing-resources.php 

For more information, contact NACDS’ Mary Staples at 817-442-1155.

The 2023 Pharmacy Practice Guide containing updated compliance tips and information on recent statutory/rule changes, including new/revised sections on Working Conditions, Technician Supervision & Expanded Technician Activities, Electronic Final Product Verification for Pharmacists, Technology-Assisted Product Verification for Interns & Technicians and Quality Assurance is currently available.  

Also in Missouri, Section 338.013, RSMo, provides that all individuals who assist a pharmacist with the practice of pharmacy must be registered with the Board as a pharmacy technician, including anyone involved in the handling of a filled prescription that is not ready for sale or delivery to the patient without further packaging, bagging, or manipulation, including cashiers or delivery staff handling a filled prescription (patient vial/container, unit of use package, bubble card, etc.) that is not packaged/bagged for final sale or delivery to the patient are required to be registered as a technician.

For more information, contact NACDS’ Mary Staples at 817-442-1155.