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:

• The addition of COVID-19 Antigen Laboratory Test Codes 
• Pharmacy Services for Medical Assistance Beneficiaries Related to the COVID-19 Public Health Emergency 

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 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.