The Department of Human Services has released the much-anticipated Medical Assistance Bulletin for the new pharmacy payment for clinical services program which will launch on March 1.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
SB 1000, legislation to strengthen and further regulate Medicaid Managed Care PBMs was introduced by Senators Judy Ward (R) and Tina Tartaglione (D). The legislation got further momentum this week when Gov. Josh Shapiro (D) delivered his budget address and expressed the need to further regulate PBMs: “Drug companies keep raising prices, but we often don’t know why, because the middlemen negotiating those drug prices between your health insurance company and drug manufacturers don’t have to report enough information to the Insurance Department. Those middlemen are called Pharmacy Benefit Managers – or PBMs – and they have made record profits on the backs of Pennsylvanians. It’s time to reform the operation of PBMs. We’re doing our part – we need legislation to go further.” NACDS assisted in-state partners in drafting the bill and is working with them to advance it.
Also in Pennsylvania, the Department of Human Services (DHS) issued MA Bulletin 01-24-03, updating the prior authorization process for opioid use disorder treatments.
Finally in Pennsylvania, the state released an urgent bulletin stating that the Pharmacy Naloxone Copay Assistance program has been suspended due to funding issues but also indicated that it is seeking a solution.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
The Board of Pharmacy has posted the agenda for the February 6 meeting.
Also in Pennsylvania, a PACE Provider bulletin announcing benefit and corresponding billing code changes to the Pharmacy Naloxone Copay Assistance Program was published. The bulletin announces a new limit of $50 per prescription and a new policy that requires coordination of benefits for insured patients.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
The Department of Human Services (DHS) continues to work with pharmacy stakeholders on the launch of a new program that will allow pharmacists to bill for a wide variety of clinical services, including MTM (Medication Therapy Management), immunizations and patient counseling. On February 15 from 10:00 am – 12:00 noon, DHS is hosting a pharmacists enrollment training online seminar. You must register to attend. DHS will be requiring each individual pharmacist providing billable services to enroll as a provider, even those in a chain environment. They expect enrollment to open on March 1. We expect a final Bulletin to be published in the next few days with more details about the program, billing instructions and covered services.
Also in Pennsylvania, a bill to reform PBM practices in Medicaid Managed Care and set a rate floor in the state employees’ benefit program has been introduced. SB 1000, cosponsored by Senators Judy Ward (R) and Tina Tartaglione (D), has been referred to the Health and Human Services Committee for consideration. NACDS assisted in-state partners in drafting the bill and will be actively involved in advocating for its passage.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Medicaid plans to implement a system to reimburse pharmacies for a variety of services within their current scope of practice by the end of the first quarter of 2024. We understand these would include immunizations, counseling, and diabetes management and would apply to the Fee-For- Service and the Managed Care Program. We expect DHS (Department of Human Services) (Department of Human Services) to release a Bulletin announcing the new program in December. NACDS will provide updates as we receive them, including instructions on enrollment. NACDS has been supporting member and in-state efforts to develop the program.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Medicaid plans to implement a system to reimburse pharmacies for a variety of services within their current scope of practice in 2024. We understand these would include immunizations, counseling, and diabetes management; and would apply to both the Fee-For- Service and Managed Care Program. We understand a Bulletin announcing the new program will be released the first week of December. NACDS will provide updates as we receive them, including instructions on enrollment. NACDS has been supporting member and in-state efforts to develop the program.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
The Board of Pharmacy published the agenda for the June 27 meeting.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
As a reminder, the state’s Naloxone Copay Assistance Program will reimburse pharmacies up to $75.00 for Naloxone claims for any patient who appears hesitant to fill, regardless of the type of insurance they have (public or commercial), and those without coverage. Developed jointly by NACDS/PACDS members and the Governor’s Opioid Task Force, claims are billed through the PACE (Pharmaceutical Assistance Contract for the Elderly) program’s platform to make it seamless for pharmacies, with little criteria for the patient to qualify. Due to underutilization, the state recently reissued a bulletin outlining NCPDP D.0 payer specifications/billing instructions for pharmacies. It is NACDS’ understanding the $75.00 may be billed for either a copay or to offset total cost.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
The Department of Human Services published the following bulletins:
For more information, contact NACDS’ Jill McCormack at 717-592-8977.