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.  

1. House Bill 96 required the North Carolina Board of Pharmacy to adopt rules creating a Code of Ethics for Pharmacists. The Board has proposed 21 NCAC 46 .1820 incorporates the American Pharmacist Code of Ethics. 

1. House Bill 96 authorized pharmacy technicians and pharmacy interns to administer vaccines and immunizations allowed under N.C.G.S. 90-85.15B including COVID-19 Vaccines and Influenza vaccines for patients ten years of age and older. The Board has proposed changes to 21 NCAC 46 .2507 (Administration of Vaccines by Pharmacists) by creating a new subsection (c) to set-out the requirements for pharmacy technicians and pharmacy interns to administer these vaccines including required training, supervision, offers of counseling and continuing education. Of note the required training is a practical training program approved by the Accreditation Council of Pharmacy Education.  

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  

1. House Bill 196 and subsequently amended by House Bill 96 authorizes immunizing pharmacists to administer long-acting injectables and the proposed 21 NCAC 46 .2514 implements this new practice area by defining what constitutes a "long-acting injectable", provides training requirements and acceptable training programs, sets out a standard as far as possession of the long-acting injectable drug and creates records keeping requirements for the immunizing pharmacist.  

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:  

• Statewide Standing Order for Subcutaneous Administration of Casirivimab/ Imdevimab (REGEN-COV) Monoclonal Antibodies
• Statewide Standing Order for Intravenous Administration of Casirivimab/ Imdevimab (REGEN-COV) Monoclonal Antibodies
• Statewide Standing Order for Intravenous Administration of Bamlanivimab/ Etesevimab Monoclonal Antibodies  

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.

State Health Director Dr. Betsey Tilson has issued a statewide standing order which will allow insurance coverage to cover costs for COVID home tests, including Medicaid. The link to the order can be found here. It can also be found here under the Provider Section. 

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

The January 18th Board meeting will be conducted via Microsoft Teams. You will be able to join the meeting either by downloading the Microsoft Teams app or you may open the link in a web browser. Simply click on this link at the start of the meeting. If you prefer to attend the meeting by phone, call (336) 604-5350. The conference ID is 907 040 796#. You may view the agenda here. 

Also in North Carolina, NC Medicaid is increasing the reimbursement for COVID vaccine administration from $40 to $65. The effective date of the rate change will be retroactive to April 1, 2021. All claims previously submitted with dates of service from April 1, 2021, through the NCTracks implementation date of the rate change will be systematically reprocessed. No action will be required by providers to receive the retroactive rate increase.  

Finally in North Carolina, the Board of Pharmacy issued the following guidance regarding the role of pharmacists in oral therapeutics to treat COVID-19. 

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

Here are the links to the latest North Carolina information on COVID vaccinations including the latest statewide standing order issued by Dr. Betsey Tilson on December 22, 2021. COVID-19 Vaccine Provider Guidance Updated December 22, 2021 and Link to Summary Update.  

Dr. Tilson has also issued four updated statewide standing orders regarding the administration of the COVID-19 vaccine. These changes were in light of the CDC recommending the administration of Pfizer booster doses for 12–15-year-old. 

• Statewide Standing Order for FDA Approved Pfizer/COMIRNATY COVID-19 Vaccine Administration in Patients Ages 5-11 Years (Jan. 6, 2022) 
• Statewide Standing Order for FDA Approved Pfizer/COMIRNATY COVID-19 Vaccine Administration in Patients Ages 12 Years and Older (Jan. 6, 2022) 
• Statewide Standing Order for FDA Authorized Moderna COVID-19 Vaccine Administration (Jan. 6, 2022) 
• Statewide Standing Order for FDA Authorized Johnson and Johnson (Janssen) COVID-19 Vaccine Administration (Jan. 6, 2022) 

Also in North Carolina, the Board of Pharmacy published proposed administrative rules concerning pharmacy interns. These rules can be found beginning on Page 1049 (PDF Page 57) of the North Carolina Register at this link. The Board will hold a public hearing on these rules on February 8, 2022. The public hearing will be held remotely. The public can participate on Teams at https://tinyurl.com/jsuk4bjk or may call 336-604-5350, conference ID 903 191 899#. Written comments will be accepted by the Board until February 14, 2022, and should be submitted to Jay Campbell, 6015 Farrington Road, Suite 201, Chapel Hill, NC 27517; fax (919) 246-1056; email ncboprulemaking@ncbop.org.

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

The North Carolina Board of Pharmacy published proposed administrative rules concerning pharmacy interns. These rules can be found beginning on Page 1049 (PDF Page 57) of the North Carolina Register. 

The Board will hold a public hearing on these rules on February 8, 2022. The public hearing will be held remotely. The public can participate on Teams at https://tinyurl.com/jsuk4bjk or call 336-604-5350, conference ID 903 191 899#. The Board will accept written comments until February 14, 2022, and should be submitted to Jay Campbell, 6015 Farrington Road, Suite 201, Chapel Hill, NC 27517; fax (919) 246-1056; email ncboprulemaking@ncbop.org. 

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

In response to the U.S. Food and Drug Administration amended EUA for the Pfizer-BioNTech COVID-19 vaccine, authorizing the use of a single booster dose for administration to individuals 16 and 17 years of age at least six months after completion of primary vaccination with the Pfizer-BioNTech COVID-19 Vaccine and the CDC expanding the recommendation for boosters to include 16 and 17 year old, North Carolina has updated the  Standing Order regarding vaccine administration.    

Also in North Carolina, the Board of Pharmacy has issued new guidance concerning the application for Pharmacist-Technician Ratio of 1:6 or Greater.  

Finally in North Carolina, please see Information regarding the Administration of Long Acting Injectables in Medicaid. 

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

See the latest Statewide Standing Orders issued by State Health Director Dr. Betsey Tilson for the administration of the COVID vaccines to patients ages 5-11 and 12-17. These Statewide Standing Orders enable pharmacies to be reimbursed for programs such as Medicaid. 

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