Please find here a notice from North Carolina Medicaid to permanently transition to a specific dispensing fee for North Carolina Medicaid based on the Cost-of-Dispensing Study performed every five years. This fee is currently $10.24. Also, included in this notice is North Carolina Medicaid’s decision to allow for more than one dispensing fee per month. 

Also in North Carolina, see the Medicaid Special Pharmacy Newsletter providing Revised Procedures for Prior Authorization of palivizumab (Synagis®) for Respiratory Syncytial Virus Season 2022/2023 – Coverage starts Oct. 1, 2022.  

Finally, effective with date of service Aug. 31, 2022, the NC Medicaid and NC Health Choice programs cover Pfizer-BioNTech COVID-19 Vaccine, Bivalent (Original and Omicron BA.4/BA.5) – 12 years of age and older (N/A) for use in the Physician Administered Drug Program (PADP) when billed with HCPCS code 91312 – Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, bivalent spike protein, preservative free, 30 mcg/0.3 mL dosage, tris-sucrose formulation, for intramuscular use.   

Effective with date of service Aug. 31, 2022, the NC Medicaid and NC Health Choice programs cover Moderna COVID-19 Vaccine, Bivalent (Original and Omicron BA.4/BA.5) – Booster Dose (N/A) for use in the Physician Administered Drug Program (PADP) when billed with HCPCS code 91313 – Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, bivalent, preservative free, 50 mcg/0.5 mL dosage, for intramuscular use. More information.  

Providers are encouraged to review this information. All bulletin articles, including those related to COVID-19, are available on DHB’s Medicaid Bulletin webpage.  

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

on December 1, 2022, North Carolina will launch the NC Medicaid Managed Care Behavioral Health and Intellectual/Developmental Disabilities Tailored Plans. “This plan is an integrated health plan for individuals with significant behavioral health needs and intellectual/developmental disabilities (I/DDs)” On October 12, 2022, at 8:00 am EST NC Medicaid will host an online seminar to provide valuable information about each of the contracted Tailored Plan managed care organizations, and to provide an opportunity for pharmacists to ask questions about what to expect, operational changes and processes. The target audience for the Webinar includes pharmacy owners, managers and those who submit pharmacy benefit claims for Medicaid beneficiaries. 

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

The North Carolina COVID-19 state of emergency sunsets on August 15, 2022. For more information on how it affects pharmacy practice please click here. 

Also in North Carolina, pharmacy claims processing under Behavioral Health and Intellectual/Developmental Disabilities (I/DDs) Tailored Plans. Pharmacy Point of Sale (POS) claims for members enrolled in Tailored Plans will be temporarily managed by NCTracks when the plans launch on Dec. 1, 2022, through March 31, 2023. Beginning on April 1, 2023, these claims will be managed by the Tailored Plans. This change was made due to a key Pharmacy Benefit Manager (PBM) unexpectedly leaving the NC Medicaid market in late 2021, which required some Tailored Plans to procure another PBM. 

There will be no impact to members’ pharmacy benefits during this transition period. From Dec. 1, 2022, through March 31, 2023, member ID cards will not include pharmacy information. A new card will be issued for April 1, 2023, indicating the new RxBin and PCN numbers for the Tailored Plans. 

NC Medicaid will reach out to members, pharmacists, and providers in the coming months with additional information about this transition. For more information, please see the Medicaid bulletin Pharmacy Point of Sale Process at Tailored Plan Launch.  

Finally, please see August 2022 NC Medicaid Pharmacy Newsletter which contains information on the below.  

•  NC Medicaid Pharmacy Point-of-Sale Billing for Pharmacist-Prescribed Paxlovid 
• October 2022 Drug Use Review (DUR) Board Meeting 
• Reminder Regarding the Naloxone Standing Order  
• Pharmacy Point of Sale Process at Tailored Plan Launch   

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

All immunizing pharmacists who vaccinate NC Medicaid beneficiaries, NC Medicaid wants to hear from you on how you bill for vaccine and vaccine administration to NC Medicaid. Please take 1 minute to answer three simple questions to help us determine if we can help make claims processing an easier process for you. Please respond by August 1, 2022.

Also in North Carolina, the Board of Pharmacy has been made aware that a pharmacy has implemented a policy whereby its prescription processing system will not allow an NP- or PA-issued prescription to be processed without the supervising physician’s name and other information.

A supervising physician’s information is not required on NP (Nurse Practitioners)- or PA-issued prescriptions. On February 1, 2021, the NC Medical Board amended the prescribing authority rule for physicians’ assistants by removing the supervising physician information requirement for prescriptions written by physicians’ assistants.

On August 1, 2021, the NC Medical Board amended the prescribing authority rule for nurse practitioners by removing the supervising physician information requirement for prescriptions written by nurse practitioners.

Prior to the Medical Board’s 2021 rule amendments (as detailed in long-standing Board guidance, see Item 2403), the absence of a supervising physician’s name and telephone number did not render a PA- or NP-issued prescription “invalid,” “illegal,” or otherwise ineligible for dispensing under the North Carolina Food Drug and Cosmetic Act or the North Carolina Pharmacy Practice Act.

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

Governor Roy Cooper (D) has signed the 2022/2023 budget. Of importance to NACDS (National Association of Chain Drug Stores) members, language was added to extend from June 30, 2023, to June 30, 2026, pharmacy reimbursement being tied to the fee-for-service rate of NADAC (National Average Drug Acquisition Cost) plus a $10.24 dispensing fee. Language was also added to extend the State Health Director’s authority to issue statewide standing orders for COVID tests and vaccines until December 31, 2023 and maintains all the current statewide standing orders currently in place until rescinded by the State Health Director. This will ensure Pharmacies will continue to get reimbursed for the administration of the COVID vaccination and tests by North Carolina Medicaid. Finally, a provision was added to reauthorize the dispensing of biosimilars and the requirement for pharmacists to input patient information into a system that can be accessed by prescribers for biosimilar interchangeable. This can be achieved by processing the prescription through a PBM (Pharmacy Benefit Manager) or an electronic health record.  

Also in North Carolina, the Department of Health and Human Services is establishing Community Access Points in all 100 counties where North Carolinians can find free and easy at-home tests, to meet people where they are, with the tools they need to protect themselves from COVID-19.
Community organizations interested in becoming a Community Access Point can register online. Information on where to find at-home tests is available at: covid19.ncdhhs.gov/PickUpTests. Information on how and where to find all testing locations in North Carolina is available at: covid19.ncdhhs.gov/FindTests. 

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

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:

1. Enroll in Medicaid for the uninsured (MCV) group or MAFDN Family Planning.
2. Be uninsured.
3. Be a resident of North Carolina.
4. Meet the citizenship and legal immigration status requirements of the Medicaid program.

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.