NYRx, the New York Medicaid Pharmacy Benefit Program, issued this update regarding the NYRx BLTG (Brand Less Than Generic) Program for Flovent® and Advair®.
Also in New York, the Board of Pharmacy sent out two updates on January 2:
For more information, please contact NACDS’ Ben Pearlman at 617-515-2603.
NYRx, the State Department of Health Medicaid Pharmacy Benefit Program, released updates to the NYRx Prior Authorization Programs and updated preferred drug list, changes were effective December 14.
The State Department of Health also released a reminder regarding pharmacy providers and members out-of-pocket costs. This communication was sent to all pharmacies to remind them of their responsibility for continued enrollment, to adhere to the policies and procedures of the Medicaid Program. Specifically, it is inappropriate to allow an eligible member to pay out-of-pocket for services that are covered by NY Medicaid (NYRx) beyond copay. Please be advised that out-of-pocket expenses are only reimbursable by Medicaid for Medicaid covered services when one of these three situations applies:
If there is an eligibility issue that is corrected in a timely manner, pharmacists should resubmit the claim when the issue is resolved and reimburse the member directly if the member paid out of pocket. There is support available to pharmacists to assist with claim issues. Questions regarding this communication may be directed to NYRx@health.ny.gov.
On December 12, A6779, a bill NACDS and the Community Pharmacy Association of New York (CPANY) had been supporting to expand the 2022 law allowing pharmacists to administer long-acting injectables, was sent to the Governor’s desk by the legislature. Gov. Kathy Hochul (D) has until December 22 to act on the legislation.
For more information, please contact NACDS’ Ben Pearlman at 617-515-2603.
Effective November 29, the New York Department of Health issued updated guidance regarding dispensing of COVID-19 over-the-counter tests at the pharmacy.
NYRx, the New York State Medicaid Pharmacy Benefit Program, sent a release to pharmacy providers on December 6th. The program continues to field questions and concerns from residency program coordinators about pharmacies not able to submit claims to NYRx written by their interns and residents. NYRx asked the following shared regarding submission of claims:
For more information, please contact NACDS’ Ben Pearlman at 617-515-2603.
On November 14, NYSDOH (New York State Department of Health) hosted its monthly NYRx industry call regarding the Medicaid Fee for Service program. Following agenda items were discussed:
NYRx also published billing guidance for brand name drugs with new generic launces.
On November 15, the formal printing of the withdrawal of the PBM regulations by the Department of Financial Services was published. Within the publication are:
The New York State Board of Pharmacy held its regular meeting on November 8. Relevant to chain pharmacies, the meeting included the following:
For more information, please contact NACDS’ Ben Pearlman at 617-515-2603.
On November 1st, the New York Department of Financial Services pulled back on regulations regarding PBMs (Pharmacy Benefit Manager). This was in response to an “overwhelming” number of comments submitted in opposition to the regulation from unions, employers, and health plans. The legislative objectives driving the regulations were ‘licensing standards for PBMs, including minimum standards related to market conduct practices, conflicts of interest, deceptive, anti-competitive, and unfair claims practices in connection with the performance of pharmacy benefit management services, predatory audit practices, and actions or procedures in the PBM industry that go against the best interests of the public.’ While the full regulations were pulled back, the Department did move part of the rule-making process and fully adopted the registration requirement for PBMs.
On November 8th, the New York State Board of Pharmacy will be holding their regular scheduled meeting in person in Albany. The agenda is as follows:
Executive Session 9:30 a.m.
Public Session 1:00 p.m.
o Discussion: Online Discontinuance Form
o Discussion: Drug Price List
o Upcoming 2024 Meeting Dates
For more information, please contact NACDS’ Ben Pearlman at 617-515-2603.
Medicaid posted a COVID-19 vaccine billing guidance for this season. The Medicaid “Pharmacists as Immunizers Fact Sheet” has information on how to bill for vaccines for over and under 19 years of age and a link to the Vaccine for Children (VFC) Program. Please be advised that Medicaid does reimburse for the COVID-19 vaccine and administration at Medicaid qualified pharmacies for adults 19 years of age and older. Children under the age of 19 years are vaccinated for COVID-19 and all other ACIP–recommended vaccines at VFC enrolled providers, including their practitioner’s office, public health clinics or, in most areas, their county health department. At this time, pharmacies dually enrolled in Medicaid and VFC may also immunize children between the ages of 3 to under 19 years of age for COVID-19, and ages of 2 to under 19 years for influenza, in accordance with the federal PREP (Public Readiness and Emergency Preparedness) Act and/or state law.
For more information, please contact NACDS’ Ben Pearlman at 617-515-2603.
NACDS submitted a comment letter in support of the Proposed Rule published in the State Register by the Department of Financial Services on August 16, 2023, related to Definitions, Licensing of Pharmacy Benefit Managers (PBMs), Contracting with Network Pharmacies, Acquisition of PBMs, Consumer Protections and Audits
The Department of Health (NYSDOH (New York State Department of Health)) reported an update to the State Plan Amendment (SPA) allowing reimbursement for Medicaid covered professional services included within the pharmacist / pharmacy intern scope of practice and provided by a pharmacist / intern. For instance, once the new law on oral contraception is effective, this will apply to pharmacists dispensed oral contraception. Also, according to NYSDOH, the reimbursement will be provided to pharmacies, not to pharmacists per the New York SPA 23-0037: “This amendment proposes to allow pharmacists and pharmacy interns to provide Medicaid covered services to the limits of their scope of practice. We conducted our review of your submittal according to statutory requirements in Title XIX of the Social Security Act. This letter is to inform you that New York Medicaid SPA 23-0037 was approved on August 24, 2023, with an effective date of April 1, 2023.”
For more information, please contact NACDS’ Ben Pearlman at 617-515-2603.
Effective September 11, 2023, the State Department of Health’s NYRx, the Medicaid Pharmacy Fee-For-Service program, will provide reimbursement for qualified and enrolled pharmacies for COVID-19 vaccines and administration as approved by the FDA or authorized for emergency use. Billing codes and other guidance provided in the announcement.
Also in New York, on September 12, the State Education Department withdrew the proposed central fill pharmacy regulations. The Department and the Board of Pharmacy will convene stakeholders and restart the regulatory process. NACDS and members had been actively advocating for a change and delay in the proposed regulations, that amongst its provisions would have created a new central fill pharmacy registration class, prohibited central fill pharmacies from being open to the public, require that central fill pharmacies only prepare and fill prescriptions sent from an originating pharmacy, prohibited direct-to-patient central fill models and required the originating pharmacy to obtain consent from the patient in writing before a prescription may be prepared by a central fill pharmacy. A broad coalition of pharmacy interests are unified in opposition and pushed for support for delayed consideration. NACDS also previously submitted a letter during the public comment period.
Also in New York, on September 20, the State Department of Health held its monthly industry call for NYRx, the Medicaid fee-for-service program. The Education and Outreach team for NYRx holds virtual office hours on Tuesdays and Thursdays from 12:00 noon to 1:00 p.m. Eastern.
Finally in New York, on September 22, the State Department of Health, on behalf of NYRx, relayed to pharmacies that Medicaid patients are prohibited from paying out of pocket for covered services. The COVID vaccine is covered, and no Medicaid recipient should be asked to pay. The Department noticed that some Medicaid members were mistakenly informed that the vaccine was not covered and may have paid out of pocket. These claims should be promptly resubmitted, and the member contacted and reimbursed for all out-of-pocket costs. The State Department of Health has posted the “Medicaid Coverage Policy and Billing Guidance for the Administration of COVID-19 Vaccines.”
For more information, please contact NACDS’ Ben Pearlman at 617-515-2603.
Effective September 11, 2023, the New York State Department of Health that NYRx, the Medicaid Pharmacy Fee-For-Service program will provide reimbursement for qualified and enrolled pharmacies for COVID-19 vaccines and administration as approved by the FDA or authorized for emergency use. Billing codes and other guidance provided in the annoucement.
On September 12th, the New York State Education Department withdrew the proposed central fill pharmacy regulations. The Department and the New York Board of Pharmacy will convene stakeholders and restart the regulatory process. NACDS and members had been actively advocating for a change and delay in the proposed regulations, that amongst its provisions would have created a new central fill pharmacy registration class, prohibited central fill pharmacies from being open to the public, require that central fill pharmacies only prepare, and fill prescriptions sent from an originating pharmacy, prohibited direct-to-patient central fill models, and required the originating pharmacy to obtain consent from the patient in writing before a prescription may be prepared by a central fill pharmacy. A broad coalition of pharmacy interests are unified in opposition and pushed for support for delayed consideration. NACDS also previously submitted a letter during the public comment period.
On September 20th, the New York State Department of Health held their monthly industry call for NYRx, the Medicaid fee-for-service program. The Education and Outreach team for NYRx holds virtual office hours on Tuesdays and Thursdays, 12-1pm eastern.
For more information, please contact NACDS’ Ben Pearlman at 617-515-2603.