The Department of Human Services released a new bulletin announcing SARS-CoV-2 Monoclonal Antibody Product Updates that includes pharmacy reimbursement rates and billing procedures.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
The Department of Human Services has issued a bulletin announcing that Chartwell Pennsylvania will be the new Specialty Preferred Pharmacy Provider for Fee-For-Service beginning July 1, 2022. Further details are included in the bulletin.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
The Department of Human Services Office of Medical Assistance Programs has issued a new bulletin with billing instructions for COVID-19 at-home test kits.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
The state has reissued billing guidance for the Pharmacy Naloxone Copay Assistance Program, because of claims – otherwise eligible- but rejected due solely to coding errors. The claims are eligible for correction for payment. NACDS reminds members that naloxone claims from any patient, regardless of type of insurance coverage, are eligible for the copay to be reimbursed to the pharmacy. The program, which NACDS and PACDS helped the Governor’s Opioid Taskforce develop with member input, is funded through federal grants and meant to incentivize greater naloxone access to all Pennsylvanians. It is run on the PACE program system merely to streamline the adjudication process for pharmacies.
Also in Pennsylvania, The Department of Human Services published a Bulletin for COVID Oral Antiviral Treatments billing procedures and codes for pharmacies.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
The Office of Medical Assistance Programs (OMAP) has announced by bulletin that they will now reimburse pharmacies a $10 administration fee for any vaccine provided to adult Medicaid patients consistent with the Pharmacy Practice Act, retroactive to Nov. 1, 2021, in both FFS and MC. Historically OMAP has only paid for ingredient costs. Billing codes are in the bulletin. Pharmacies cannot bill for vaccines covered under the VFC program.
Also in Pennsylvania: The Pennsylvania Prescription Drug Monitoring Program (PDMP) will be transitioning PDMP system vendors. This change will bring new enhancements to the PDMP that are based on feedback from PDMP users, including a single platform for pharmacists to search patients, and upload and edit data. Starting on January 10, 2022, PDMP users will need to transfer their accounts to create new login credentials and establish their SFTP credentials (if applicable) within the LogiCoy PDMP platform. Pharmacies using a third party for data submission must ensure their vendor also transfers their accounts. Transitioning accounts takes an average user less than two minutes, as registration has been streamlined to pre-populate information based on the user’s license information. The transfer account period begins on January 10. During this time all PDMP users must, by February 14:
Pharmacists (or their data submission vendor) will be able to test their data submission during this time. Please note, before February 14, PDMP users will continue to use PMP Aware to search patients and PMP Clearinghouse to upload data. On February 14, PDMP users will begin using the LogiCoy PDMP to search patients and upload data. Users who search patients through their organization’s pharmacy management system will not need to change how they search patients and will not experience any changes to their pharmacy management system’s connection to the PDMP. For more information about the PDMP, please visit: www.doh.pa.gov/pdmp. For assistance with account transfer, please contact LogiCoy technical support at 844-939-0999 or email papdmp@logicoy.com.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
The Office of Medical Assistance Programs (OMAP) has issued a Bulletin with updates to the Statewide Preferred Drug List clarifying when an MCO can require prior authorization for certain drugs. The PACE Prescription Drug Program has also issued a Bulletin clarifying the claims submission code for “other coverage” claims. The Bulletin applies to all prescription programs administered by PACE.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
NACDS reminds members that a new program is available that will reimburse pharmacies for naloxone copays when the pharmacist believes the patient will be hesitant to pick up the prescription due to cost. The Naloxone Copay Assistance Program is funded through federal grants and began October 1, 2021. The program runs on the existing PACE adjudication platform and will reimburse a pharmacy up to $75 per claim for any patient regardless of their insurance plan. In the interest of making the program as seamless as possible for pharmacies to increase access to naloxone, there is no ID patient card or patient criteria to meet. For more details, see the program bulletin and detailed adjudication specifications. It is our understanding that only a handful of claims were submitted in October; if you are experiencing any barriers to utilizing the program or have suggestions to increase uptake, please contact NACDS’ Jill McCormack at 717-525-8962 or jmccormack@nacds.org.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Gov. Wolf (D) has signed a bill that extends COVID-19 related pharmacy waivers due to expire on September 30 until March 31, 2022. It does not extend the waivers that were already terminated by the Department of State prior to September 30th. Since this was a blanket extension of the current waivers, the bill did not go further than the state waivers to fill in the gaps to match the PREP Act allowances. We will continue advocating for the passage of bills that match the PREP Act.
Also in Pennsylvania, NACDS reminds members that beginning October 1, the state will cover copays for Naloxone prescriptions for patients hesitant to pick up the prescription due to cost, regardless of the type of insurance coverage. Please refer to the submission specifications and program bulletin for more information.
Also in Pennsylvania, the Board of Pharmacy has published proposed regulations providing for pharmacy technician registration based on Act 140 of 2020. Keeping in mind that any substantive changes will require legislation, please send any comments you may have to Jill McCormack by October 11.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
The state has announced a new program that will reimburse pharmacies for Naloxone copays when the pharmacist believes the patient will be hesitant to pick up the prescription due to cost. The Naloxone Copay Assistance Program is funded through federal grants and will begin October 1, 2021. The program will run on the PACE platform; however, the program will reimburse a pharmacy up to $75 per claim for any patient regardless of their insurance plan. There are adjudication testing opportunities available prior to Oct 1. Should you wish to run test claims, please contact NACDS’ Jill McCormack. For more detail, see the program bulletin and detailed adjudication specifications. NACDS thanks Governor Wolf, the Governor’s Opioid Command Center, PACE, and our members that helped advocate for this important lifesaving program over the last few years.
Also in Pennsylvania, Acting Secretary of Health Alison Beam signed an order this week with guidance on administering COVID-19 booster shots once they are available. It requires vaccine providers, as possible, to:
For more information, contact NACDS’ Jill McCormack at 717-592-8977.