The state Supreme Court unanimously ruled that the Medicaid Expansion Amendment 2 approved by voters in August of 2020 is constitutional. Previously, Gov. Mike Parson’s (R) administration announced that it would not enroll the Expansion population because the Legislature’s did not provide additional funding. As a result of the court decision, Mo HealthNet (Medicaid) will move forward on Expansion.

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

The Missouri Department of Social Services proposed to amend regulations under 13 CSR 70-20 to remove outdated provisions regarding the return of unused prescription drugs issued to a MO HealthNet (Medicaid) participant. Comments are due July 31, 2021.

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

The Board of Pharmacy met virtually on July 14 and 15 to review legislation that was approved by the Missouri General Assembly earlier this year including the new Prescription Drug Monitoring Program/Rx Cares for Missouri law SB 63 effective August 28, 2021. Also, the Board discussed several draft bills for the 2022 legislative session, including proposal to expand access to immunizations by eliminating the prescription order.

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

NACDS submitted comments opposing the inclusion of discount cards and programs in the definition of Usual and Customary that could contribute to below-cost pharmacy reimbursement.  

Also in Missouri, Gov. Mike Parson (R) signed into law legislation passed during the special session that extends the Federal Reimbursement Allowance (FRA) program, which is a provider tax on pharmacies, hospitals, nursing homes and other health-care providers that are critical to drawing down federal match to fund Missouri’s Medicaid program to 2024. The FRA is currently set to expire September 30. (SB 1) 

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

Gov. Mike Parson (R) convened a special session on June 23, 2021, to address extending Medicaid funding for the state because the Legislature adjourned last month prior to passing a renewal of the Federal Reimbursement Allowance (FRA), the tax on health care providers that draws down billions in federal matching dollars to fund the state’s Medicaid budget. To prevent a $1.4B budget gap, lawmakers only have five days to pass legislation to extend the program as the deadline for a balanced state budget is set for July 1, 2021. 

Also in Missouri, NACDS is preparing a comment letter objecting to an emergency proposed rule that would add this new definition of usual and customary (“U&C”) for purposes of reimbursement for covered drugs under the state’s Medicaid program. “U&C is defined as the provider’s charge to the general public that reflects all advertised savings, discounts, special promotions, or other programs including membership-based discounts initiated to reduce prices for product costs available to the general public, a special population, or an inclusive category of customers.” 

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

In response to a request from the State Board of Pharmacy Executive Director Kimberly Grinston, NACDS and the Missouri Retailers Association submitted several pharmacists and pharmacy technicians’ names for consideration to serve on the new task force to study working conditions.

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

Gov. Mike Parson (R) signed SB 63 into law, which makes it the 50^th state to create a statewide prescription drug monitoring program. The bill establishes the Joint Oversight Task Force of Prescription Drug Monitoring, responsible for collecting and maintaining the prescription and dispensation of prescribed controlled substances to patients within the state. It also extends the expiration date of the RX Cares for Missouri Program to August 28, 2026.

Also in Missouri, the Department of Social Services, MO HealthNet Division, issued two new proposed rules requesting comments by July 1, 2021. Both are currently in effect as emergency rules expiring February 24, 2022.

• Proposed rule removes obsolete provisions and references new provisions establishing the payment methodology for covered entities under the 340B drug pricing program that choose to carve in Medicaid.
• Proposed rule establishes the payment methodology for covered entities under the 340B drug pricing program that chooses to carve in Medicaid.

Also in Missouri, the Board of Pharmacy issued a final rule effective June 30, 2021, removing the limit on the number of intern pharmacist practice hours that may be earned per week.

Also in Missouri, the Department of Commerce and Insurance issued a proposed rule to establish the license application process and a $1,000 application fee for pharmacy benefit managers. The rule replaces a September 15, 2020, proposed rule. Comments are due on June 16^th, and a public hearing will be held on June 17, 2021.

Also in Missouri, the Board of Pharmacy is soliciting comments on two proposed rules:

• Proposed rule rescinds regulations regarding pharmacy operating procedures during declared disasters. A concurrent proposed rule would readopt the provisions to address both disasters and state/federal emergencies. Comments are due June 16, 2021.
• Proposed rule adopts regulations establishing guidelines for temporary pharmacy operations during an emergency or declared disaster. The rule would replace pharmacy disaster operation procedures that are proposed for repeal concurrently.

Also in Missouri, the Board of Pharmacy recently approved two final rules 20 CSR 2150-5.025 and 20 CSR 2220-6.050 which allows pharmacy technicians to administer vaccines under the supervision of a state-licensed pharmacist according to a written protocol with a licensed physician who is actively engaged in the practice of medicine. The rule is issued in response to the COVID-19 pandemic effective July 30, 2021.

Lastly in Missouri, the Department of Social Services, MO HealthNet Division issued three final rules effective July 30, 2021.

• Final rule adds an exception to the 31-day supply maximum restriction on medications reimbursed by the division on behalf of participants eligible for the fee-for-service programs, and an exception to allow for a 90-day supply requirement for select medications established in a concurrent rule. The rule also replaces references to “recipient” and “patient” with “participant.”
• Final rule adopts a 90-day supply requirement per dispensing on select medications reimbursed by the division on behalf of participants eligible for Medicaid fee-for-service programs.
• Final rule revises the amount of the professional dispensing fee reimbursable for MO HealthNet covered prescriptions by pharmacy providers.

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

Gov. Michael Parson (R) may soon call a special session to address one critical piece of the budget, the Federal Reimbursement Allowance (FRA) or provider tax extension. FRA is a key funding mechanism for the Missouri Medicaid program for pharmacy, hospitals, nursing homes, and ambulance districts. Failure to extend these provider taxes will create a multi-billion dollar shortfall in Medicaid funding when the new federal fiscal year begins on October 1, 2021.

Also in Missouri: before adjournment, the legislature finally passed SB 63, a Prescription Drug Monitoring Program (PDMP) bill, making it the 50^th state to adopt a statewide program.

Lastly in Missouri, unfortunately, although a PBM reform bill HB 834 by Rep. Dale Wright (R) did pass the House 126-8, it failed to advance in the Senate.

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

Last week, the Missouri Legislature passed legislation SB 63 establishing the framework for a statewide PDMP. Once operational, this new program will preempt any local PDMP program such as the one set up by St. Louis County that numerous other municipalities throughout the State of Missouri have opted to participate in. Initially, the statewide program will require pharmacies to report dispensing data for schedule II, III & IV controlled substance prescriptions into the PDMP every 24 hours, but the reporting timeframe will phase over to real-time reporting by 2024. The legislation next goes to the Governor to be signed into law. Once enacted, Missouri will become the last state in the nation to establish a PDMP.

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