On March 21, NACDS joined the Pharmacists Society of the State of New York (PSSNY) in a rally in support of the Medicaid transition to fee-for-service. Beginning April 1, all Medicaid members enrolled in Mainstream Managed Care will receive their prescription drugs through NYRx, the Medicaid Pharmacy Program.
For more information, please contact NACDS’ Ben Pearlman at 617-515-2603.
On March 21, 2023, NACDS will be joining the Pharmacists Society of the State of New York (PSSNY (Pharmacists Society of the State of New York)) in a rally in support of the Medicaid transition to fee-for-service. Beginning April 1, 2023, all Medicaid members enrolled in Mainstream Managed Care will receive their prescription drugs through NYRx, the Medicaid Pharmacy Program. The rally is to advocate to the legislature so no action would alter the planned transition.
On March 21 at 1:00 p.m., the New York State Department of Health will be holding its next online seminar for all stakeholders about the pharmacy benefit transition. Members, providers
and all interested stakeholders are welcome to attend regarding the transition.
The New York Deparment of Financial Services’ Pharmacy Benefits Bureau is requesting comments directly from pharmacies about the usefulness of PBM audits. Specifically, the requested comments are about whether and how the Department should exercise its authority about audits of pharmacies conducted by PBMs. New York Insurance Law §§ 2905-2906 empowers the Department to establish, by regulation, minimum standards for the issuance of a license to a PBM, including both prerequisites for the issuance of a license and requirements for maintenance of a license. Among the questions for pharmacies are: “In what way, if any, does an auditing PBM communicate its audit policies and procedures to your pharmacy?”, “What types of audits have you experienced in the past five (5) calendar years?”, “How many times per year for the past five (5) calendar years have PBM audits occurred for your pharmacy?”, “During the most recent audit conducted by a PBM for your pharmacy, was the purpose or subject of the audit identified prior to the audit occurring?”, “Was the same identified purpose or subject included as part of the PBM’s draft and/or final audit report?”, etc. Comments should be sent directly to the Department at PBM@dfs.ny.gov by March 24, 2023, with “PBM2022-07” included in the subject line.
For more information, please contact NACDS’ Ben Pearlman at 617-515-2603.
On March 14, NACDS will be joining the Pharmacists Society of the State of New York (PSSNY (Pharmacists Society of the State of New York)) in a rally in support of the Medicaid transition to fee-for-service. Beginning April 1, 2023, all Medicaid members enrolled in Mainstream Managed Care will receive their prescription drugs through NYRx, the Medicaid Pharmacy Program. The rally is to advocate to the legislature so no action would alter the planned transition.
On March 21 at 1:00 p.m., the State Department of Health will be holding its next online seminar for all stakeholders about the pharmacy benefit transition. Members, providers and all interested stakeholders are welcome to attend regarding the transition.
For more information, please contact NACDS’ Ben Pearlman at 617-515-2603.
On February 21, the State Department of Health held an online seminar to update interested parties on the latest information regarding the Medicaid Pharmacy Benefit Transition from Managed Care to NYRx effective April 1. The next presentation and meeting will be March 21 at 1:00 p.m.
Also in New York, the Department of Financial Services (Department) Pharmacy Benefits Bureau (“PBB”) announced a final request for public engagement as the Department looks to develop nation-leading regulatory standards for Pharmacy Benefit Managers (PBMs).
This request asks for information on PBM audits of pharmacies, which are meant to eliminate or reduce fraud, waste, and abuse, but often are overly burdensome and costly without meeting this intended goal. Instead, pharmacy owners are taken away from providing healthcare, requiring them to review and defend claims from years in the past at the sole direction of PBMs without justification. The information collected will inform the scope of regulations necessary to ensure audits follow a clear and transparent process and have guardrails in place to meet the goal of preventing fraud, misuse, and waste. The Department is in the process of developing a series of PBM regulations that together will form the most comprehensive regulatory framework in the country.
For more information, please contact NACDS’ Ben Pearlman at 617-515-2603.
On February 15, the Department of Financial Services published a proposed rule regarding General Duties, Accountability and Transparency Provisions for Pharmacy Benefit Managers. The proposed rule sets forth to clarify, define and limit the duties, obligations, requirements and other provisions relating to pharmacy benefit managers under Public Health Law section 280-a(2) and provides a safe harbor provision for compliance with the regulation. It also defines, limits and clarifies the requirements for pharmacy benefit managers to provide an accounting to health plans and sets forth the terms and conditions of contract relating to pharmacy benefit management services provided to health plans by the pharmacy benefit managers, including provisions related to an appeal to the bureau for a determination on disclosure.
On February 13, NACDS participated in the Community Pharmacy Association of New York State lobby day. NACDS joined with members to advocate for Gov. Kathy Hochul’s (D) budget proposal, including the Medicaid Fee-for-Service transition effective on April 1.
For more information, please contact NACDS’ Ben Pearlman at 617-515-2603.
Gov. Kathy Hochul (D) included in her budget an affirmation of the transition of Medicaid Fee-for-Service, which is set to become effective April 1. Another webinar will be held for stakeholders on February 21.
For more information, please contact NACDS’ Ben Pearlman at 617-515-2603.
On January 17, from 1:00 p.m. – 3:00 pm, the Department of Health (DOH) is hosting the next in its series of monthly stakeholder informational webinars about the transition of the pharmacy benefit from Medicaid Managed Care to Medicaid Fee for Service (NYRx). Registration is required in order to access the meeting links. Presentations from past meetings are available on the transition website.
Also in New York, the DOH issued an update to the Medicaid Fee for Service Program “Dispense Brand Name Drug When Less Expensive Than Generic” list effective January 19. Additionally, DOH published an updated standing order for Naloxone under the signature of Dr. Sharon Stancliff.
Finally in New York, as 2022 ended, Gov. Kathy Hochul (D) signed several bills important to pharmacy practice into law, including:
For more information, please contact NACDS’ Ben Pearlman at 617-515-2603.
Gov. Kathy Hochul (D) has vetoed A7889, a bill meant to reform the Medicaid audit process. In her veto message, the Governor cited concerns about the bill preventing Medicaid from recovering legitimate overpayments and any corresponding impact on the loss of federal funds.
Also in New York, on December 20, the State Department of Health is hosting an informational online seminar for all stakeholders about the transition of the pharmacy benefit from Medicaid Managed Care to NYRx, (Medicaid fee-for-service (FFS) pharmacy program). This is part of a series of recurring monthly webinars about this topic. Note that you must complete the registration form to attend. Afterward, a copy of the presentation will be posted on the transition website, where past presentations are available.
Finally in New York, Medicaid’s newsletter from November includes a section on pharmacy dispensing/prescribing of emergency contraceptives.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
The New York State Workers Compensation Board published a final rule requiring that providers be notified when a provider network exists.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.