State Health Director Dr. Betsey Tilson issued an updated COVID-19 Vaccine Standing Order that includes booster for patients between 5-11 years old.
You can find all the statewide standing orders for pharmacists at the Department of Public Health website provided here.
Also in North Carolina, the most recent North Carolina Medicaid Pharmacy Newsletter can be found here.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
The Board of Pharmacy has completed a rulemaking to create new Rule .2515, “Remote Work by Pharmacy Personnel.” The rule authorizes, and governs, a pharmacy’s use of its own pharmacy personnel employees to perform certain remote operations. The rule is effective May 1, 2022.
The Board’s March 17, 2020, Expanded Emergency Services Waiver, issued because of the COVID-19 public health emergency, previously authorized intra-pharmacy remote operations. New Rule .2515 does not differ materially from the waiver provisions concerning intra-pharmacy remote operations.
Accordingly, Rule .2515 (and not the waiver) will govern this practice come May 1. Detailed guidance to Rule .2515 is found here. Please note, a different rule, Rule. 1816, governs inter-pharmacy remote medication order processing arrangements. Detailed guidance to that rule is found here.
Also in North Carolina, all the respective statewide standing orders for all new therapies allowed under HB 96 can be found here.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
SPECIAL BULLETIN COVID-19 #242: Continued Reimbursement for COVID-19-Related Services for the Uninsured. Effective April 4, 2022
NC Medicaid continues to reimburse providers for COVID-19 related services for the NC Medicaid Optional Eligibility Group (which includes the uninsured (MCV) and MAFDN Family Planning Group). This program was initiated in 2020 for COVID-19 and expanded by the America Rescue Plan Act to include COVID-19 treatment and vaccination. NC Medicaid will continue to operate this program through the federal public health emergency.
It was recently announced that the Health Resources and Services Administration (HRSA) -led initiative to reimburse for COVID-19 testing and treatment will end. This program also reimbursed health care providers for delivering COVID-19 testing, treatment and vaccines to those without health insurance. As of March 22, 2022, the program stopped accepting claims for testing and treatment services. On April 5, 2022, the program will stop accepting claims for vaccine administration.
This bulletin services as a reminder that the two programs are separate entities, and that NC Medicaid will continue to reimburse providers who deliver COVID-19 treatment, testing, and vaccine administration for the uninsured in the state. To be eligible for the program, individuals must:
Detailed eligibility requirements may be found in SPECIAL BULLETIN COVID-19 #206.
Also in North Carolina, The Board of Pharmacy has completed a rulemaking to amend Rule .1816, now titled “Centralized Pharmacy Services.” The amended rule broadens the availability of remote medication order processing (“RMOP”) arrangements among pharmacies to all pharmacy practice types. The full rule is found here: 21 NCAC 46.1816
The new RMOP provisions became effective March 1, 2022. However, the Board’s Expanded Emergency Services Waiver, issued on March 17, 2020, because of the COVID-19 public health emergency, authorized expanded RMOP arrangements: Expanded Emergency Services Waiver
Pharmacies may continue to operate RMOP arrangements pursuant to the waiver until June 1, 2022. Beginning June 1, 2022, the Board will enforce the Rule .1816-based RMOP requirements. To assist pharmacies transitioning to the rule based RMOP requirements, Board staff have prepared two guidance documents.
The first, http://www.ncbop.org/PDF/GuideToInterPharmacyRMOP.pdf – provides a detailed overview of the revised rule governing inter-pharmacy RMOP arrangements. Please note, this guidance document only concerns RMOP services arranged between two pharmacies. The Board has proposed a new rule (Proposed New Rule 21 NCAC 46.2515) authorizing intra-pharmacy remote services (i.e., a pharmacy uses its own personnel to provide off-site services). Once that rulemaking is complete, the Board staff will provide a separate guidance document on that topic. In the meantime, intra-pharmacy remote services are allowed under the Expanded Emergency Services Waiver linked above.
The second, http://www.ncbop.org/PDF/HowToRegisterAsNABPVerifyHolder.pdf – provides detailed instructions on how out-of-state pharmacists who are performing RMOP services and who are not individually licensed to practice pharmacy in North Carolina may obtain an NABP Verify credential and register with the Board of Pharmacy, as required by revised Rule .1816.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Statewide standing orders issued by Dr. Betsey Tilson, State Health Director, for the administration of nicotine replacement, contraceptives, post-exposure prophylaxis medications for the prevention of human immunodeficiency virus (HIV), glucagon for the treatment of severe hypoglycemia, naloxone and COVID related treatments have been updated, organized, and can be found here.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Medicaid coverage season for Synagis will end March 31, 2022. Pharmacy providers should not submit point of sale claims with date of service after March 31, 2022, for any prior authorization granted during the eight-month extended coverage season from Aug. 15, 2021, to March 31, 2022. Physician providers should submit an EPSDT request for coverage of Synagis beyond March 31, 2022. More information can be found here.
Also in North Carolina, as indicated in the previously issued standing order, which allows qualified pharmacists’ authority to initiate hormonal contraceptive therapy, immunizing pharmacists “who provide contraception products in accordance with this standing order must also complete North Carolina Hormonal Contraception Training Program.” The North Carolina Association of Pharmacists (NCAP) has produced this training program, which is now available here. The Board of Pharmacy has agreed to fund the training program for up to 6,000 North Carolina resident pharmacists over the next 12 months. NCAP will maintain records of pharmacists who have completed this training. Board staff are adding a “Contraceptive Trained” status button to each pharmacist’s Board of Pharmacy on-line profile. Once that status button is added, pharmacists will be notified and must log on to their Board profile to record their training (just as pharmacists currently update vaccinator status and long-acting injectable trained status).. ard staff will notify pharmacists as soon as this status update option is operational.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
NC Medicaid is receiving reports of pharmacists not utilizing the 72-hour Emergency Supply Override and the 01-No Other Coverage Identified code when applicable. Resistance to use these overrides is preventing Medicaid beneficiaries from being able to access necessary medications. As NC Medicaid providers, pharmacists are asked to please become familiar with these options and utilize them appropriately when administering the Medicaid benefit.
Pharmacists are asked to utilize the 72-Hour Emergency Supply Override when clinically appropriate for Medications pending Prior Authorization. For Medicaid members, including Medicaid Managed Care, Pharmacy providers are encouraged to use the 72-hour emergency supply allowed for drugs requiring prior approval. Federal law requires that this emergency supply be available to Medicaid beneficiaries for drugs requiring prior approval (Social Security Act, Section 1927, 42 U.S.C. 1396r-8(d)(5)(B)). Use of this emergency supply ensures access to medically necessary medications. With use of the override, the system will bypass the prior approval requirement, if an emergency supply is indicated. The pharmacist should use a “3” in the Level of Service field (418-DI) to indicate the transaction is an emergency fill. * Copayments apply to emergency fills and drug cost is reimbursed; however, a dispensing fee is not paid. There is no limit to the number of times the emergency supply can be used. *Codes may vary by managed care plan. This is the specific code for Medicaid Direct.
Pharmacists are asked to utilize the “01-No Other Coverage Identified” when a Medicaid claim rejects due to another payor on record. Medicaid is the payer of last resort, which means after any other insurance pays, Medicaid will pay. The other third-party payer must be billed as the primary payor when third party insurance exists, and then Medicaid can be billed as the secondary payor. When a claim is denied due to another payor on record being expired or terminated, the point-of-sale system will deny the claim, and the pharmacist will be prompted to submit the claim to another payer. In the event a beneficiary cannot produce another insurance or the beneficiary states they no longer have the other insurance, the pharmacy shall use the override code “01 – No Other Coverage Identified” in the Other Coverage Code claim segment 308-C8 for NCPDP D.0 transaction. * NC Medicaid will pay the pharmacy and seek payment from the third party, if appropriate. The pharmacy is not held liable for any payments made in these cases. *Codes may vary by managed care plan. This is the specific code for Medicaid Direct.
Thank you for your time and attention to this valuable information regarding the NC Medicaid Pharmacy Benefit. If you have any questions or concerns with the utilization of these override codes, please contact Angela Smith, Director NC Medicaid Pharmacy Benefit, or the Managed Care Plans directly.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
The Board’s revised centralized pharmacy services rule has cleared final review. The chief change achieved by the amendments is to broaden the availability of remote medication order processing from the health-system practice setting to all pharmacy practice settings.
Even though the amended rule is effective March 1, 2022, several implementation tasks need to be completed. Chief among them: Board staff need to program a registration system for out-of-state pharmacists who are not licensed in North Carolina, but who intend to provide RMOE services to North Carolina pharmacies by obtaining an NABP (National Association of Boards of Pharmacy) Verify credential. NABP staff are implementing the NABP Verify credential application process. Board staff expect both steps to be completed by April 1, 2022.
In the meantime, North Carolina pharmacies who have implemented RMOE systems under the Board’s emergency services waiver may continue to use them. The Board will ensure that pharmacies that have deployed waiver-based RMOE operations have reasonable time and opportunity to transfer to rule-based operations. The full Board will discuss implementation at its March 8, 2022, meeting.
In the coming weeks, Board staff will also publish a detailed FAQ document on the revised centralized pharmacy services rule.
Pharmacists are reminded that the Board is proceeding with additional rulemaking to permanently authorize North Carolina pharmacy personnel to perform remote work (other than physical acts in the dispensing process) for their employing pharmacy. North Carolina pharmacies who have implemented waiver-based remote work systems in North Carolina may continue to use them while this rulemaking proceeds. More information on this proposed rule is found here.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
In response to the passage of House Bill 96 and House Bill 196, the North Carolina Board of Pharmacy has published proposed rules in the North Carolina Register to implement this legislation in three specific areas. The Board will accept written comments on these rules until May 2, 2022, and these comments can be sent to Jay Campbell by email at ncboprulemaking@ncbop.org. The Board will also hold a remote public hearing on these proposed rules on April 28, 2022, at 10:00 am.
Code of Ethics for Pharmacists (21 NCAC 46.1820) and Changes to Immunizing Pharmacists Rules (21 NCAC 46.2507) – http://www.ncbop.org/LawsRules/1820_2507ProposedCodeofEthics_AdminVaccinesPublicHearingApr282022.pdf
Administration of Long-Acting Injectables (21 NCAC 46. 2514) – http://www.ncbop.org/LawsRules/2514_ProposedRuleAdminLongActingInjectablesPublicHearingApr282022.pdf
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Dr. Betsey Tilson, State Health Director, rescinded the following Statewide Standing Orders due to the high prevalence of the Omicron variant of SARS-CoV-2 virus in North Carolina for which these therapies are not an effective treatment:
The recission orders can be accessed here: https://covid19.ncdhhs.gov/guidance#vaccination-info-for-providers
These Statewide Standing Orders may be reactivated in the future depending on the effectiveness of the therapies on circulating variants.
Also in North Carolina, reminder effective Jan. 10, 2022, NC Medicaid-enrolled pharmacies may bill for FDA approved over the counter (OTC) COVID-19 tests dispensed for use by NC Medicaid beneficiaries in a home setting, with or without a prescription issued by an NC Medicaid-enrolled provider. NC Medicaid Direct beneficiary implementation date is Jan. 10, 2022. Refer to beneficiaries’ managed care plan for guidance on the specific plan’s implementation date.
Finally, NC Medicaid will cover one kit per claim per date of service, with a maximum of four test kits every 30 days. Covered test kits are listed below. Please note that some kits will include two tests.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.