The General Assembly’s joint Legislative Budget and Finance Committee (LBFC) finally released its study of Pharmaceutical Pricing in the Commonwealth’s Medicaid managed care program this week. The study was mandated by the passage of HB 941 of 2021, legislation that required key reforms to PBM practices in the program. These included prohibiting claw backs, increasing transparency and eliminating spread pricing. Though LBFC cited they had difficulty accessing key data from PBMs and the program, the report makes several recommendations to the General Assembly to tighten up current law, by increasing drug pricing transparency and enforcing the requirement for the release of data. NACDS is working with the Pennsylvania Association of Chain Drug Stores (PACDS), the Pennsylvania Pharmacists Association (PPA) and members to develop legislation to address these issues. 

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

The General Assembly’s joint Legislative Budget and Finance Committee (LBFC) finally released its study of Pharmaceutical Pricing in the Commonwealth’s Medicaid managed care program this week. The study was mandated by the passage of HB 941 of 2021, legislation that required key reforms to PBM practices in the program. These included prohibiting clawbacks, increasing transparency and eliminating spread pricing. Though LBFC cited they had difficulty accessing key data, the report makes several recommendations to the General Assembly to tighten up current law, increase pricing transparency and enforce the requirement for the release of data. NACDS is working with the Pennsylvania Association of Chain Drug Stores (PACDS), the Pennsylvania Pharmacists Association and other allies to advocate for legislation to address these issues.

Also in Pennsylvania, the Board of Pharmacy released its January 31 meeting agenda. Please note they will be discussing the proposed Pharmacy Technician Rules.

Finally in Pennsylvania, Medicaid issued a Bulletin with updated billing instructions for the COVID-19 bivalent booster, and Magellan announced updates and enhancements to PACE/PACENET web portal, including its embedded software applications and tools. 

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

Gov.-elect Josh Shapiro (D) has named Valerie Arkoosh, an anesthesiologist and chair of the Montgomery County Commissioners, as his Secretary of the Department of Human Services. Arkoosh led her county’s response in the early days of the coronavirus pandemic, which elevated her to the spotlight as Montgomery County was in the epicenter of the virus’ spread. She also has been a professor of anesthesiology and obstetrics and pitched an unsuccessful run for Congress in 2014 before being re-elected to the County Commission. He also named: 

• Secretary of Health: Debra Bogen, a pediatrician, and the director of the Allegheny County Health Department. 
• Secretary of Drugs and Alcohol: Latika Davis-Jones, senior director of behavioral health at Highmark Wholecare, a Medicaid managed care provider in southwest Pennsylvania. 
• Secretary of Aging: Jason Kavulich, Lackawanna County Director of Agency on Aging. 
• Insurance Commissioner: Mike Humphreys, who has held the role temporarily since last spring. 

Also in Pennsylvania, the Department of Human Services (DHS) issued a Medicaid bulletin announcing they will be reinstating pre-COVID provider enrollment requirements effective February 27, 2023; while the PACE Program announced their Part D pharmacy benefit plan partners for 2023. 

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

The Office of Medical Assistance (Medicaid) published Bulletins with updates to the Preferred Drug List effective January 9, 2023, and another about PA (Prior Authorization) instructions for Monoclonal Antibodies.

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

Gov. Tom Wolf (D) signed HB 1630 last week, just one day after the bill passed the General Assembly. HB 1630 allows the Auditor General access to PBM (Pharmacy Benefit Manager) data in the Medicaid Managed Care Program to perform audits. Notably, with the intent of expanding access to drug therapies, the bill was amended in the Senate Health Committee to repeal the provision in Section 1121.53(c) of 55 Pa. Code that limits payment for prescriptions in Medical Assistance to a 34-day supply or 100 units. Additionally, the following bills of interest to pharmacy were also signed: 

• SB (Senate Bill) 225 (Act 146 of 2022) makes changes to prior authorization procedures and requires one form of MAT to be covered by Medicaid and private insurance without prior authorization requirements, 
• HB 1393 (Act 111 of 2022) decriminalizes the use of fentanyl test strips for personal use and 
• SB 1201 (Act 162 of 2022) requires health insurance policies to provide coverage for prescription eye drop refills at 70% of the prescription duration 

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

On the last day of the 2021-22 session, a PBM transparency bill backed by NACDS and PACDS (Pennsylvania Association of Chain Drug Stores), passed the Senate unanimously and is on its way to Gov. Tom Wolf (D) for signature. HB 1630 allows the Auditor General access to PBM data in the Medicaid Managed Care Program to perform audits. Notably, the bill was amended in the Senate Health Committee to repeal the provision in Section 1121.53(c) of 55 Pa. Code that limits payment for prescriptions in Medical Assistance to a 34-day supply or 100 units.

Also in Pennsylvania, the Department of Human Services released the final regulation for IRRC No. 3308 – Interrelationship of Providers (14-549) allowing providers to co-locate. Providers who received a waiver of the previous regulation will still be operating under that waiver until the final form regulation takes effect. The regulation will be considered at the Independent Regulatory Review Commission (IRRC) meeting on December 8 and comments are accepted until 48 hours prior to the meeting.

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

Sen. Ryan Aument’s (R) bill allowing the Auditor General to conduct a full-scale audit of subcontracts with pharmacy benefit managers (PBMs) in Medicaid Managed Care unanimously passed the Senate Health and Human Services Committee this week and is expected to be considered by the full Senate next week.

Also in Pennsylvania, the Office of Medical Assistance Programs has issued a new bulletin regarding billing and payment for the Moderna SARS-CoV-2 Vaccine Booster. This bulletin as well as past bulletins can be found on DHS’ Bulletin search page.

Finally in Pennsylvania, the Board of Pharmacy has posted the agenda for the November 1 meeting.

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

Gov. Tom Wolf (D) issued a news release this week announcing that the Naloxone Standing Order has been expanded to include the 2 Dose Formulation and encouraging patients to bring a copy of the standing order to pharmacies to request the drug. NACDS reminds members that the PA Naloxone Copay Assistance Program will reimburse pharmacies up to $75 for patient copays when the patient is hesitant to pick up the prescription due to cost. For practical operational reasons, the claim must be adjudicated on the current PACE Program system. However, a claim for ANY insured patient regardless of what type of insurance they have – commercial or public – qualifies. There are no criteria to proving financial hardship on the pharmacy because access is the point of the program.

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

Due to recent technical issues with the Pennsylvania Licensing System (PALS) website, the Board of Pharmacy announced that the renewal period for Pharmacist Licenses and Authorizations to Administer Injectables for Pharmacists, has been extended to October 31, 2022. The renewal extension does apply to CE (Continuing Education) credits. However, if licensees earn CE between October 1- 31, 2022, to use for the 2022 license renewal, they cannot count those same CE credits toward the 2024 license renewal. Updates will be posted to the Board website. For general details on license renewal go to PALS. 

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