Gov. Kathy Hochul (D) signed A8880A/A1010B, an Act Prohibiting Label Restrictions of Over-the-Counter (OTC) Drugs. The bill makes it illegal to knowingly alter, mutilate, destroy, obstruct or remove by means of a price sticker or otherwise the whole or any part of the label, including where applicable the expiration date displayed thereon, of any OTC drug or cosmetic.

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

On November 20, the State Department of Financial Services made final PBM market conduct regulations. The regulations will become effective on November 27, 2024. The market conduct regulations require the following:

• Allow Home Delivery. Prohibit PBMs from barring any in-network pharmacies from providing mail order or delivery services, which will increase patients’ access to home delivery from their community pharmacy;
• List Pharmacy Directories. Increase transparency to consumers and employers by requiring PBMs to list formularies and pharmacy directories online, and prohibiting PBMs from punishing a consumer who relies on said information;
• Address Consumer Inquiries. Require PBMs to post a telephone number and email address for consumers to direct their questions to, and PBMs must respond in a reasonable amount of time;
• Prohibit Steering. Prohibit anti-competitive practices that steer consumers away from their community pharmacy to larger pharmacies affiliated with the PBM;
• Treat Pharmacies Fairly. Prohibit PBMs from unfairly passing losses onto pharmacies when the PBM mistakenly approved dispensing a drug and then seeks to retroactively deny reimbursement to the pharmacy;
• Allow Electronic Submissions. Reduce administrative burdens and costs on small pharmacies by allowing them to submit information to and receive information from PBMs electronically; and
• Apply Same Standards. Prevent the abuse of audits against small pharmacies who are not affiliated with a PBM by requiring PBMs to apply the same audit standards across all in-network pharmacies.

Also in New York, on November 20, NYRx, the Medicaid Pharmacy Benefit Program, held its monthly pharmacy industry call. Two items on the agenda were (1) Non-Individual Specific Prescription for Self-Administered Hormonal Contraceptives with Pharmacy Dispensing Protocol

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

On October 25, 2024, the State Department of Health updated its “Pharmacists as Immunizers” Fact Sheet. The fact sheet includes updated billing codes, reminder that Medicaid is the payor of last resort and highlighting the change that immunizations of children ages three to 17 years will no longer be authorized as of December 31, 2024. 

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

NYRx released an updated Pharmacy Vaccine Billing Guidance, with new fees effective October 24.

Also in New York, on October 16, the State Department of Health hosted its monthly NYRx Pharmacy call. The agenda items included:

1. OMIG Restricted Recipient Program: Requirements for primary care providers and pharmacies for patients in this program including new edits taking effect in November 2024 and February 2025, and billing and referral instructions.
2. Reimbursement Changes under NYRx: Effective October 1, paying WAC for brand drugs that lack a NADAC (was WAC-3%)
3. III. New Guidance Allowing 90-Day Prescriptions and 90-Day Prescribing under NYRx
4. NYRx Coverage of OTC Progesterone-Only Contraception: With Opill available, NYRx reminder that they will only cover it for those with Medicaid if they obtain it from a pharmacist who is authorized to dispensing hormonal contraception per new law/ standing order and following patient questionnaire/counseling etc. or with a fiscal order from their prescriber.
5. NYRx Compound Policy
6. Prior Authorizations: Slides include clarification on NYRx prior authorization policies per a request for guidance.

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

On October 9, the Board of Pharmacy held its regular scheduled meeting.  The agenda included the report of the 2024 Pharmacy Workplace Survey.

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

The Office of Health Insurance Programs of the State Department of Health has approved the release of the August 2024 Medicaid Update. Included in this month’s update:

• New York State Medicaid Pharmacy Policy for Coronavirus Disease 2019 Testing
• New York State Medicaid Coverage for Coronavirus Disease 2019 Vaccines for Eligible Vaccine For Children Program Members at the Pharmacy
• Introduction to Upcoming Pharmacy and Practitioner Administered Drug Changes Due to Enacted Budget

Also in New York, on September 23, 2024, the Medicaid Program made important changes to the coverage of blood glucose testing supplies, aligning with Medicare coverage criteria. This update is designed to promote effective testing habits to support individuals managing their diabetes. Changes to the supply limits for test strips and lancets and the implications for pharmacies and healthcare providers, are explained below:

Effective October 1, 2024, the Medicaid blood glucose testing supply coverage will align with Medicare policies. The new guidelines are as follows:

• Members using insulin: Those who require insulin for blood glucose management will be eligible to receive up to 300 test strips and 300 lancets every three months.
• Members not using insulin: For individuals managing their diabetes without insulin, the allowance will be up to 100 test strips and 100 lancets every three months.

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

On September 5, Governor Hochul signed into law the Retail Workers Safety Act, which requires employers to implement policies and training programs to prevent workplace violence. It requires a retail store with 500 or more employees to install panic buttons in all New York locations. The Department of Labor would be required to create a model workplace violence prevention training program, policy, and guidance document to be utilized by employers. The law is effective March 4, 2025, however the section requiring panic buttons would take effect January 1, 2027.

On September 13, 2024, the New York Pharmacy Conference held its regular meeting. The meeting included updates from Donate Life New York State, the Comprehensive Contraceptive Coverage Act, and Expansion of Collaborative Drug Therapy Management to offsite practices, and a legislative update from Assemblyman John McDonald. The next meeting of the conference will be held on Friday December 13, 2024, at 10 AM.

On September 18, 2024, the New York Department of Health held their monthly pharmacy industry call regarding NYRx, the Medicaid Fee-For-Service Program. This month’s call included updates on Blood Glucose Test Strip Coverage Policy and Covid Tests Coverage Policy Update.

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

On August 21, the State Department of Health held its monthly pharmacy call for NYRx transition, the Medicaid Pharmacy Benefit Program. Several relevant agenda items include the following:

1. Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) order acceptance policy
2. NYRx utilizes the NADAC file which contains historical information for rate/pricing changes. The following provides information on how to read the file:
   • The “Effective Date” is the effective date for each rate change. The effective date is designed to avoid overlapping date segments for a specific NDC.
   • The “As of Date” indicates the date a rate group first appeared on the NADAC.
   • The “Posting Date” is the date in which the NADAC is posted to eMedNY.
   • EMedNY cut-off time for file updates occurs every Friday (most NADAC prices show an “As of Date” every Wednesday).
   • Information in the pricing file will post to eMedNY every Tuesday.

3. NYRx, the Medicaid Pharmacy Program, is making significant changes to the coverage of diabetic testing supplies. These changes align with Medicare coverage criteria.
4. NYRx is conducting system enhancements to accommodate vaccine billing by NDC targeted for late October:

• eMedNY systems will automatically apply the administration fee in a single transaction,
• NYRx is committed to making this transition as smooth as possible.

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

NYRx, the New York State Medicaid Pharmacy Program, provided an update to its prior authorization program, effective August 1, 2024.

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