The Department of Insurance has published rules regulating Pharmacy Benefit Managers were published this week. The reason for this proposed action is to implement statutes for the licensure of pharmacy benefits managers (PBMs) and directed the Department to adopt rules for licensure (see G.S. 5856A-2). Entities to be licensed as PBMs have previously been licensed or registered as third-party administrators (TPAs). Borrowing from the licensure requirements for TPAs, the proposed rules further set out the requirements for licensure as a PBM. Additionally, where G.S. 58-56A-2 gives the Commissioner the authority to charge an initial application fee of $2,000 and a renewal application fee of $1,500, those fees will be established by the proposed rule 11 NCAC 24 .0102. The date of the public hearing will be April 1, 2025, at 10:00 a.m., NC Department of Insurance, Hearing Room 211, 3200 Beechleaf Ct., Raleigh, NC 27604.

For more information, contact NACDS’ Leigh Knotts at 803-243-7207.

Governor Josh Stein (D) announced an executive order that directs cabinet agencies to safeguard medical privacy, ensures women receive accurate information about their pregnancies, and protects doctors providing lawful reproductive health care.

For more information, contact NACDS’ Leigh Knotts at 803-243-7207.

On October 25, the US Department of Agriculture (USDA) Food and Nutrition Service (FNS) approved the state’s Department of Health and Human Services (DHHS) extension request to waive the statutory definition of “food” under Section 3(k)(1) of the Food and Nutrition Act of 2008, as amended and accompanying regulations at 7 CFR 271.2. This extension waiver approval allows Supplemental Nutrition Assistance Program (SNAP) households statewide, including those with the Eastern Band of Cherokee Indians, to continue to purchase hot foods with SNAP benefits through December 4, in order to increase access to food after power outages as a result of Tropical Storm Helene that began on September 26. Customer questions should be directed to the EBT Call Center at 1-866-719-0141.

For more information, contact NACDS’ Leigh Knotts at 803-243-7207.

The COVID-19 Statewide Standing Orders (SWSOs) authorized under North Carolina Session Law 2022-74, Sec. 9G.7.(a)-(e) and extended under Session Law 2023-65, Sec. 9G.7, will expire on December 31, 2024. No additional extensions have been provided.

If your facility currently uses the SWSOs issued by Dr. Elizabeth Tilson, State Health Director, to facilitate COVID-19 vaccinations, action is required to prevent disruptions in vaccine administration. Coordinate with your lead physician or medical director to develop standing orders or protocols that will take effect by January 1, 2025. Action Required:

• Review and prepare to transition to facility-specific standing orders by coordinating with your medical leadership.
• Finalize and implement new standing orders or protocols by January 1, 2025.

For more information, contact NACDS’ Leigh Knotts at 803-243-7207.

The United States Department of Agriculture (USDA) has approved a request by the state to extend the hot foods waiver in response to Hurricane Helene. The hot foods waiver will now run until December 4, 2024, to allow families to purchase hot foods for the Thanksgiving holiday. Please make sure your point-of-sale (POS) systems are updated with the new expiration date. As a reminder, the hot foods waiver applies statewide to accommodate those who have been displaced by Hurricane Helene. 

For more information, contact NACDS’ Leigh Knotts at 803-243-7207.

The Office of Emergency Medical Services seeks pharmacists to assist with medical response in Western North Carolina due to Hurricane Helene. A minimum deployment of three consecutive days is preferred. If interested, sign up here and note your availability in the comments section. For questions, email OEMSSupportCell@dhhs.nc.gov.

Also in North Carolina, with Western North Carolina seeing conditions of catastrophic proportions due to Hurricane Helene, there are still many areas without power or cell service and individuals are stranded on islands due to massive road closures. If your company plans to move people, resources or equipment into western North Carolina, you must coordinate plans and movements through NCEM at BEOC@ncdps.gov and copy elizabethr@ncrma.org

Finally, the Department of Health and Human Services (DHHS) is committed to ensuring continued access to care for Medicaid beneficiaries, as well as reimbursement to qualified providers for services rendered, in good faith, throughout the period of impacts from Hurricane Helene, retroactively from September 25 through October 15 (unless otherwise communicated by DHHS).

• The Centers for Medicare & Medicaid Services (CMS) granted approval effective October 1 for DHHS to implement a temporary, expedited enrollment process for health care professionals to become a Medicaid provider due to a natural disaster. This process is not for providers who regularly see Medicaid beneficiaries.

Health care professionals who will be rendering services to Medicaid beneficiaries due to Hurricane Helene can complete and apply through the NCTracks Provider Portal. Please refer to the disaster provider enrollment job aid Disaster Relief Provider Enrollment Application Job Aid (PRV703) located under Quick Links on the NCTracks Provider Enrollment home page for necessary instructions to complete the temporary disaster provider enrollment application. Be sure to review the job aid before starting to complete the application, as several preliminary steps are necessary.

For more information, contact NACDS’ Leigh Knotts at 803-243-7207.

The Department of Health and Human Services (NCDHHS) is encouraging everyone 6-months and older to get their seasonal flu shot and COVID-19 vaccine. Both vaccines have been updated for the new flu and COVID-19 virus strains that will continue to spread this fall and winter.

For more information, contact NACDS’ Leigh Knotts at 803-243-7207.

Medicaid is committed to supporting increased adoption and utilization of the Board of Pharmacy statewide protocols authorized by legislation. As part of this commitment, effective August 1, 2024, immunizing pharmacists began to receive reimbursement for clinical services provided when utilizing the statewide Nicotine Replacement Therapy (NRT) Protocol. This bulletin applies to Medicaid Managed Care and Medicaid Direct. The claim should be submitted using a medical claim and payment will be issued to the pharmacy.

Also in North Carolina, effective September 1, 2024, Medicaid began covering condoms and spermicides as over-the-counter products, through the pharmacy benefit. This coverage applies to both Medicaid Direct and Managed Medicaid Plans. Coverage supports reproductive health care for Medicaid beneficiaries, including prevention of unintended pregnancy and sexually transmitted diseases. Medicaid beneficiaries will be able to obtain condoms and spermicides from pharmacies enrolled in Medicaid with a prescription from a Medicaid-enrolled provider, with no cost sharing responsibility.

For more information, contact NACDS’ Leigh Knotts at 803-243-7207.

Gov. Roy Cooper (D) declared a State of Emergency effective August 5, 2024, and it will remain in effect for 30 days. The Order activates the State Emergency Operations Plan and allows for the Department of Transportation and the Department of Public Safety to take the appropriate action to ensure the expeditious movement of utility vehicles to eliminate power outages, vehicles carrying essential supplies such as food, medicine and fuel or transporting livestock, poultry and crops. This order also triggers the Price Gouging Law.

Also in North Carolina, effective August 1, 2024, Medicaid beneficiaries may obtain the over the counter (OTC) oral contraceptive Opill without a prescription and at no cost. While Medicaid encourages establishing care with a medical home, coverage without a prescription allows Medicaid beneficiaries easy access to the product and reduces barriers such as having to make an appointment to get a prescription, needing transportation to the appointment or even a lack of health care providers in the community. Medicaid beneficiaries will be able to get Opill from pharmacies enrolled in Medicaid who will be able to submit the claim for reimbursement. A $5.00 fee will be included in the reimbursement amount paid to the pharmacy. A dispensing fee will not be paid. Beneficiaries are allowed to obtain up to a 3-month supply of Opill with each request, without a prescription, with a maximum of 13 packs per year. Opill is a progestin only contraceptive. Pharmacists should counsel beneficiaries that Opill is most effective when taken once a day at the same time each day.

For more information, contact NACDS’ Leigh Knotts at 803-243-7207.