Effective January 1, 2025, At-home COVID-19 test kits will no longer be covered under pharmacy benefits for Medicaid fee-for-service (FFS) and managed care members. Any claims received on or after January 1 will result in a rejection. Patients may obtain free At-home COVID-19 test kits and access additional resources for free testing by visiting the Department of Health and Human Services’ COVID testing page. If you have questions, please contact the Gainwell single PBM (SPBM) Customer Service Center at 833-491-0344.

Also in Ohio, the Board of Pharmacy released its 2025 meeting schedule.

For more information, contact NACDS’ Jill McCormack at 717-592-8977.

The Department of Medicaid announced the selection of four managed care plans they will contract with for the “Next Generation of MyCare,” Medicaid’s dual eligible healthcare program. The new plan contracts will begin January 1, 2026.

For more information, contact NACDS’ Jill McCormack at 717-592-8977.

The following Board of Pharmacy rules have been posted for public comment by the Commonsense Initiative:

• CSI – BIA – Sterile and Non-Sterile Drug Compounding (Comments Due 11.4.2024).pdf
• CSI – BIA – FYR 2024 (Controlled Substances) (Comments Due 11.1.24).pdf (combines existing rules into single section)
• CSI – BIA – FYR 2024 (Pharmacy Technicians) (Comments Due 11.1.24).pdf (extends training period for active-duty military)
• CSI – BIA – FYR 2024 (Prescription Drug Collection) (Comments Due 11.1.24).pdf
• CSI – BIA – FYR 2024 (Probation) (Comments Due 11.1.24).pdf
• CSI – BIA – FYR 2024 (Terminal Distributors of Dangerous Drugs) (Comments Due 11.1.24).pdf
• CSI – BIA – Zoning Requirements (Comments Due 11.1.24).pdf

For more information, contact NACDS’ Jill McCormack at 717-592-8977.

Gainwell delivered a communication this week to notify pharmacies that the 2025 Payment Error Rate Measurement (PERM) program is now in progress. The Department of Medicaid (ODM) is mandated to participate in PERM by the Centers for Medicare and Medicaid (CMS). The program will assess payment accuracy rate for the Medicaid and CHIP programs. If chosen in a random sample, your pharmacy will soon receive a Medical Records Request from the CMS review contractor, Empower AI. This cycle measurement will review Medicaid and CHIP payments made in Reporting Year (RY) 2025: July 1, 2023, through June 30, 2024.  ODM may recover payments made to providers who fail to cooperate by the established deadlines. Providers must retain recipient records for six years from the date of payment, under the terms of the Provider Agreement, even if they no longer do business with ODM. For more information about PERM, please visit the Provider link on the CMS PERM website. A video explaining the process is also available. For questions, please contact the ODM Medicaid Audit Coordination Team.

For more information, contact NACDS’ Jill McCormack at 717-592-8977.

The Board of Pharmacy published the following final rules:

• Pharmacist Duty to Report Requirements – Effective 3.1.2025.pdf
• Pharmacy Technician Duty to Report Requirements – Effective 3.1.2025.pdf
• Pharmacy Continuous Quality Improvement Programs for Dispensing Errors – Effective 3.1.2025.pdf
• Pharmacy Duty to Report Requirements – Effective 3.1.2025.pdf

For more information, contact NACDS’ Jill McCormack at 717-592-8977.

The Board of Pharmacy issued draft rules to implement SB 144, the new pharmacy immunization expansion law that passed in July. We have reviewed the rule and found no issues or concerns and intend to file a letter of support. However, if members have any concerns or comments, please share them with Jill McCormack by September 13.

For more information, contact NACDS’ Jill McCormack at 717-592-8977.

Effective August 12, 2024, OAC 4729:5-2-05 requires all outpatient pharmacies located in Ohio to submit notification to the Board of Pharmacy of the types of language translation services, hearing impairment services and vision impairment services they offer patients using the Board’s accessible services reporting webpage. Pharmacies are required to use this webpage to notify the Board of these accessible services. NOTE: The website (www.pharmacy.ohio.gov/ASreport) will go live on August 12, 2024; however, the requirement to submit notification of accessible services does not take effect until November 10, 2024. Chains can bulk report for all their locations but can only make changes moving forward by individual locations. The Board will issue a notification about the program to pharmacies on August 12. For now, only draft guidance is available.

Also in Ohio, the Department of Health is working with Innovation Horizons, a health consulting organization, to build up programs for diabetes prevention and management by increasing the number of pharmacies providing National Diabetes Prevention Program (DPP)/ Diabetes Self-Management Education and Support (DSMES) services to their patients. To better gauge the resources needed and capacities for pharmacies in the state, they created a survey for pharmacies to complete. Pharmacies are encouraged to complete the survey, if appropriate, as it may lead to further opportunities for patient care.

For more information, contact NACDS’ Jill McCormack at 717-592-8977.

Gov. Mike DeWine (R) signed SB 144, our immunization expansion bill into law at the Ohio State Fair. Early in 2024, NACDS was on the ground in Columbus to help members and partners develop the strategy that made it one of the few bills to make it to the Governor’s desk during a remarkable politically tumultuous year in the Ohio House. Sponsored and expertly championed by Sen. Mark Romanchuk (R), in clear and concise language, the bill simply deleted the age, vaccine-type and prescription restrictions and replaced it with a provision permitting pharmacists and technicians to administer “a vaccine for any disease” to patients aged 5 years and older.

For more information, contact NACDS’ Jill McCormack at 717-592-8977.

The Board of Pharmacy has published a final rule amending language prohibiting retaliation in response to requests for additional staff and reports of staffing concerns. The Rule will be effective July 25, 2024.

Also in Ohio, Medicaid and Myers and Stauffer hosted a webinar to brief pharmacy associations about the mandatory upcoming biennial Cost of Dispensing Study. Please review the slide deck and the DRAFT Cost of Dispensing study for more details. Survey forms will be sent to all pharmacies July 25 via both snail mail and email and are due back August 29. Please see pages 9-11 of the slide deck for specific information options for chain pharmacies to submit batch data for all stores.

For more information, contact NACDS’ Jill McCormack at 717-592-8977.