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.

On August 29, the New York Department of Health issued an updated policy regarding the Medicaid coverage and reimbursement of RSV vaccines.  

Also in New York, NACDS joined a coalition letter against the proposed central fill pharmacy regulations that included a broad coalition including the Business Council of New York, Food Industry Alliance of New York and two FQHC (Federally Qualified Health Centers). NACDS and members have been actively advocating for a change and delay in the proposed regulations, that amongst its provisions would: 

• Create a new central fill pharmacy registration class; 
• Prohibit central fill pharmacies from being open to the public; 
• Require that central fill pharmacies only prepare, and fill prescriptions sent from an originating pharmacy; 
• Prohibit direct-to-patient central fill models; 
• Require the originating pharmacy to obtain consent from the patient in writing before a prescription may be prepared by a central fill pharmacy; 
• Requires an originating pharmacy to be able to prepare and dispense a prescription to a patient should the prescription not be received from the central fill pharmacy, or the patient seeks to pick-up the prescription from the originating pharmacy before it has been prepared by a central fill pharmacy; and
• Requires nonresident pharmacies engaged in central fill models to comply with select provisions of the rule. 

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

On July 17, the State Department of Financial Services adopted an amendment to the final rule regarding the PBM regulations and entities filing by electronic submissions.  

On July 13, the State Department of Health’s NYRx, the Medicaid Pharmacy Benefit Program, posted a program update for providers and prescribers. On July 14, they also announced prior authorization program updates. 

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

The New York Department of Health held a webinar  on the enacted Medicaid budget including NYRx, the Medicaid Fee-for-service pharmacy benefit transition.  The scorecard highlighted in the webinar shows additional savings for the state beyond what was projected by the transiition – $410 million to $547.8 million.

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

On June 7, the State Senate approved A6779A, a bill expanding and improving last year’s long-acting-injectable law by removing the “deltoid only” location requirement. The bill now moves to the House.

Also in New York, the State Department of Health Office of Health Insurance Programs will be hosting an informational webinar on the 2023-2024 Enacted Medicaid Budget, on June 15 at 9:00 a.m., which will focus on Medicaid-specific priorities of the Governor’s 2023-24 Enacted Executive Budget. This webinar will be recorded and made available on the NYS DOH Medicaid Redesign Team (MRT) Budget Information webpage.

Finally in New York, the next Medicaid pharmacy benefit fee-for-service (NYRx) monthly all stakeholders call about the pharmacy benefit transition will be held on June 21 at 2:00 p.m. Registration is required to attend.

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

The State Department of Financial Services posted its proposed rulemaking for Pharmacy Benefit Managers regulation on May 24, 2023. The purpose is to establish rules for PBMs regarding assessments, license requirements, reporting and record keeping and to clarify definitions. Public comments are due 60 days from when this was published.

The NYRx Medicaid Pharmacy Benefit transition announced this week a 30-day countdown for transition fills. As you know, as of April 1, 2023, Medicaid members enrolled in mainstream Managed Care (MC) plans, Health and Recovery Plans (HARPs) and HIV-Special Needs (SNPs) began receiving their pharmacy benefits through NYRx, the Medicaid Pharmacy Program. 

To ensure a smooth transition for members, NYRx instituted a transition fill period from April 1, 2023, to June 30, 2023. During the transition period, members were provided a one-time transition fill for up to a 30-day supply of a drug that would normally require prior authorization (PA) under the NYRx Preferred Drug Program (PDP). The one-time transition fill does not mean that a PA will not be required for future fills. Beginning on July 1, 2023, all claims will be subject to NYRx pharmacy program criteria listed on the NYRx PDL.

PAs issued by Medicaid Managed Care plans prior to April 1, 2023 (that are active/valid after April 1, 2023) will continue to be honored by NYRx. This includes clinical PAs that may also require PA under NYRx. The state encourages members to continue to use the portal and call with any issues. The upcoming change of note is starting July 1, 2023; all claims will require a prior authorization via the IVR/Portal System (with some exceptions). 

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

On May 16, the State Department of Health held a monthly NYRx Medicaid Pharmacy Benefit transition call for pharmacies. The state encourages members to continue to use the portal and call with any issues. The upcoming change of note is starting July 1, 2023; all claims will require a prior authorization via the IVR/Portal System (with some exceptions).

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