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.

On May 2, Gov. Kathy Hochul (D) signed A 1060: pharmacists administered contraceptives into law. 

On the May 1 weekly NYRx Medicaid Pharmacy Benefit transition call, the State Department of Health reminded pharmacies that for the billing process for immunizations, there are different codes to use when billing for multiple vaccines and administration in the same day. Please see the following guidance. 

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

On April 27, 2023, Governor Hochul announced an budget agreement with the legislature that held off all efforts to repeal the NYRx, the Medicaid prescription benefit carve out for fee-for-service. As of April 1, 2023, all Medicaid members enrolled in Mainstream Managed Care now receive their prescription drugs through the program. 

On April 24, 2023, NACDS participated in a pharmacy lobby day in Albany, in collaboration with the Community Pharmacy Association of New York and the Pharmacist State Society of New York. Members and pharmacists lobbied in support of S3467: CLIA-waived testing, S6337: expanding the Long Acting Injectables law, and for final signature of A 1060: pharmacists administered contraceptives.  

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

Beginning April 1, the State Department of Public Health will be transitioning all Medicaid members to NYRx, the Medicaid Pharmacy Program.  The Department will be having a call center available for pharmacies and Medicaid recipients.  Please call 1-800-343-9000 if you experience any claims issues. The hours of operation will be Monday through Friday 7:00 am to 10:00 pm and Saturday and Sunday 8:30 am to 5:30 pm, with extended hours to 8:00 pm on April 1. The NYRx program will also be hosting calls for pharmacies regarding implementation on April 3 at 11:00 am.   

The next monthly stakeholder call for NYRx will be held April 18 at 1:00 pm. This call will be a webinar about the pharmacy benefit transition. Members, providers and all interested stakeholders are welcome to attend. Registration information will be posted one week prior. 

The State Assembly and Senate have both passed bill A1060A, an act relating to the self-dispensing of hormonal contraceptives. The legislation will authorize licensed pharmacists to provide contraceptives pursuant to a non-patient specific order from a physician or nurse practitioner. The legislation once signed by the Governor will take effect in 180 days.

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