See the April 2026 provider update, which includes Medicaid’s new policy which reinforces its role as payer of last resort by denying pharmacy claims when a primary insurer rejects a claim due to lack of prior authorization (PA). Pharmacies must now resolve PA requirements with the primary payer before billing Medicaid and include valid NCPDP reject codes to demonstrate coordination of benefits. Additional provider updates can also be found on the Executive Office of Health and Human Services (EOHHS) website. 

For more information, contact NACDS’ Leigh Knotts at 803-243-7207.

The Board of Pharmacy implemented a new Pharmacy Law Test effective April 1, as part of updates to pharmacy initial licensing and renewal requirements. The changes are being administered through the National Association of Boards of Pharmacy’s (NABP’s) Electronic Licensure Transfer Program.

For more information, contact NACDS’ Leigh Knotts at 803-243-7207.

See the August 2025 provider update, which includes information on upcoming Pharmacy & Therapeutics (P&T) Committee and Drug Utilization Review (DUR) Board meetings scheduled for September 9 at the Executive Office of Health and Human Services (EOHHS) office in Cranston as well as upcoming payment and processing schedules. Additional provider updates can also be found on the EOHHS website.

For more information, contact NACDS’ Leigh Knotts at 803-243-7207.

The 2025 legislative session has wrapped up. Notably, SB 114 was enacted which would prohibit discriminatory practices in the reimbursement of 340B covered entities and their contract pharmacies. Additionally, SB 314 was enacted to limit pharmacies to no more than one on-site audit per carrier within a twelve-month period, unless there is a reasonable suspicion of fraud or misrepresentation. The State Attorney General will have the authority to enforce compliance with this measure.

For more information, contact NACDS’ Leigh Knotts at 803-243-7207.

Medicaid posted its April 2025 Provider Update. Please note the “Pharmacy Spotlight” with information about the Medicaid Fee-for-Service program’s Stand Along Vaccine Counseling project in Spring 2025. This project allows pharmacies to be reimbursed for vaccine counseling services using the Service Billing (SI) and Service Reversals (S2) Transactions on the NCPDP transaction standard. See the update for additional details. All previous provider updates may be found online. 

For more information, contact NACDS’ Leigh Knotts at 803-243-7207.

The Medicaid Program posted its December 2024 Provider Update. All previous provider updates may be found here.

For more information, contact NACDS’ Leigh Knotts at 803-243-7207.

Please see the October 2024 Provider Update from Medicaid. All previous provider updates may also be found online.

For more information, contact NACDS’ Leigh Knotts at 803-243-7207.

Please see the June 2024 Provider Update from Medicaid. All previous provider updates are available online. 

For more information, contact NACDS’ Leigh Knotts at 803-243-7207.

Please see the April 2024 Provider Update from Medicaid. All previous provider updates may also be on this webpage.

For more information, contact NACDS’ Leigh Knotts at 803-243-7207.