Proposed Rules from the Board of Pharmacy concerning direct-to-patient delivery systems (21 NCAC 46.1821) are slated for a public hearing on June 13 and written comments are due to the Board by June 16.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Please see the May 2023 North Carolina Medicaid Pharmacy Newsletter.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
The Board of Pharmacy announced it is pursuing administrative rulemaking concerning "direct-to-patient delivery systems" for pharmacies allowing for technologies where drugs are dispensed directly to patients. The Board will host a public hearing on this issue on June 13, and written comments are due by June 16. Below is more information on this proposed rule which the North Carolina Retail Merchants Association is in the process of analyzing.
PUBLIC HEARING AND COMMENT PERIOD — JUNE 13, 2023 — ON THE FOLLOWING PROPOSED ACTIONS:
ADOPTION OF 21 NCAC 46 .1821 DIRECT-TO-PATIENT DELIVERY SYSTEMS
AMENDMENT TO 21 NCAC 46 .1616 LIMITED SERVICE PERMITS
Reason for Proposed Action:
The Board of Pharmacy proposes to adopt a rule permitting pharmacies to employ certain direct to patient systems, which are technologies that dispense drugs directly to patients. The proposed rule contains provisions to allow pharmacies to comply with the laws governing dispensing drugs, devices, or medical equipment while using these systems. The proposed rule further contains provisions that would ensure that the systems can be used safely and securely, that required records are maintained, that the home pharmacy can adequately supervise and service these systems, and that patients may use these systems while also receiving information, safeguards and counseling that they need to use their drugs, devices, and medical equipment safely. There is an accompanying proposed change to the Board of Pharmacy's limited-service permit rules to provide for permitting of systems that a pharmacy may place in a location other than the home pharmacy's facility.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
This is advance notice of reprocessing information that will be sent to affected providers on or about January 17. Due to a system error with the generic dispensing fee, pharmacy claims were paid incorrectly. The affected claims will be reprocessed to apply the correct rate. This reprocessing notice applies to pharmacy claims that were processed and paid in NCTracks from November 1, 2013, through April 7, 2014. The affected claims will be systematically reprocessed as adjustments. No provider action is required. Applicable claims will be reprocessed in the February 7 check write. For more information, visit NCTracks here.
For more information, contact NACDS' Leigh Knotts at 803-243-7207.
Ohio: The Ohio Department of Medicaid (ODM) and Gainwell Technologies, the Single Pharmacy Benefit Manager, are continuing the re-implementation of prior authorizations (PA) based on specific drug classes. Of note, the PA reimplementation only applies to new, initial authorizations, and does not apply to those patients who have previously taken the drug supported by recent claims history prior to January 17. Phase 2 of reimplementation will begin on January 17 and encompass the following drug classes:
Please reference the Unified Preferred Drug List (UPDL) posted on the SPBM portal to see the products that require prior authorization. Prior authorizations may be submitted via phone, fax, mail and the SPBM portal. Additional prior authorizations are planned for reimplementation in a similar, incremental fashion during the first quarter of 2023. For questions, contact the Gainwell Help Desk at 1-833-491-0344.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
The mandate for health care organizations and providers that serve state-funded patients to connect to the state-designated HIE by January 1, 2023, is fast approaching. The legislative changes enacted in the 2022 Appropriations Act may leave organizations and providers with questions about their connection status. Our General FAQs on NC HealthConnex gives more answers about the impacts on NC HealthConnex participants and non-participants.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
To help providers, the Department of Health and Human Services updated its Provider Guidance on Therapeutics to include detailed up-to-date information. Providers are encouraged to read the guidance. More information is available on the Therapeutics Information for Providers webpage.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
To ensure beneficiaries can seamlessly receive care on day one, the North Carolina Department of Health and Human Services (NCDHHS) will delay the implementation of the NC Medicaid Managed Care Behavioral Health and Intellectual/Developmental Disabilities Tailored Plans until April 1, 2023.
Tailored Plans, originally scheduled to launch December 1, 2022, will provide the same services as Standard Plans in Medicaid Managed Care and will also provide additional specialized services for individuals with significant behavioral health conditions, Intellectual/Developmental Disabilities and traumatic brain injury.
The delayed start of Tailored Plans allows Local Management Entity/Managed Care Organizations, which will operate the Tailored Plans, more time to contract with additional providers to support member choice and to validate that data systems are working appropriately. The decision is supported by the leadership of the state’s six LME/MCOs.
While the start of Tailored Plans will be delayed, specific new services will still go live December 1, 2022.
More information regarding the beneficiary choice period and other key dates leading up to the April 1, 2023, launch will be shared by NCDHHS in the coming weeks. For more information about Tailored Plans, please visit NC Medicaid’s Tailored Plan website.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
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.
