State Senator Dr. Dawn Buckingham (R) toured an HEB pharmacy in her district this week where she observed first-hand why the pharmacy technician ratio needs to be increased and witnessed how pharmacies are stepping up to fill gaps in health care by administering more immunizations. Dr. Buckingham expressed appreciation for NACDS’ support for her reelection campaign.

Also in Texas. The Health and Human Services Commission Department of State Health Care Services (DSHS) issued detailed guidance on how to become a COVD-19 Vaccinator in Texas. Pharmacists can register by visiting the following website. https://enrolltexasiz.dshs.texas.gov/eregister1.asp

Lastly in Texas.  On Tuesday, November 3, 2020, at 9 am CST, the Board of Pharmacy will meet virtually to discuss the final adoption of proposed rules expanding pharmacy technician duties and increasing ratios. Please visit the links below for the agenda, live stream, and for information on how to provide oral comments during the meeting for which pre-registration must be completed by 5 pm CST October 31, 2020.

• Agenda
• Watch/listen only mode to livestream meeting
• From for providing oral comments during the meeting

For more information, contact NACDS’ Mary Staples at 817-442-1155.

The Prescription Monitoring Program Advisory Committee will hold its virtual quarterly meeting at 9 AM on October 20, 2020.  The meeting agenda can be found here. More information about the PMP is available here.

Also in Texas. The Board of Pharmacy requested comments be submitted by October 31, 2020, on sixteen proposed rules, including the expansion of pharmacy technician duties and expanding ratios. NACDS strongly urges members to submit letters of support and participate in the November 3, 2020 Board of Pharmacy zoom meeting. Links to the proposed rules and brief summaries are below.

1. Proposed rule amending regulations under 22 TAC 283 to clarify course work requirements for reciprocity applicants retaking the state pharmacy jurisprudence exam.
2. Proposed rule amending regulations under 22 TAC 283 to remove an outdated reference to pharmacist intern-trainees.
3. Proposed rule amending regulations under 22 TAC 283 to remove the ratio of pharmacists to pharmacist-interns.
4. Proposed rule amending regulations under 22 TAC 283 to remove an outdated reference to a change of name fee.
5. Proposed rule amending regulations under 22 TAC 291 to expand the nonjudgmental duties that may be performed by pharmacy technicians to include receiving and transferring prescriptions for dangerous drugs. The rule also would remove the ratio of on-site pharmacists to pharmacy technicians.
6. Proposed rule amending regulations under 22 TAC 291 to update the definition of “original prescription.”
7. Proposed rule amending regulations under 22 TAC 291 to expand the nonjudgmental duties that may be performed by pharmacy technicians to include receiving, transferring, or contacting a prescriber regarding prescriptions for dangerous drugs.
8. Proposed rule amending regulations under 22 TAC 291 to expand the nonjudgmental duties that may be performed by pharmacy technicians to include receiving, transferring, or contacting a prescriber regarding prescriptions for dangerous drugs. The rule also would increase the ratio of pharmacists to pharmacy technicians and pharmacy technician trainees to 1:6.
9. Proposed rule amending regulations under 22 TAC 291 to expand the nonjudgmental duties that may be performed by pharmacy technicians to include the transfer of prescriptions for dangerous drugs and documentation of consultation.
10. Proposed rule amending regulations under 22 TAC 291 to require non-pharmacist individual owners or managing officers of a Class A pharmacy license applicant to attend a pharmacy ownership training course.
11. Proposed rule amending regulations under 22 TAC 291 to require non-pharmacist individual owners or managing officers of Class A pharmacies to take ownership training within 90 days of notifying the board of a change of managing officer. The rule also would revise the change of ownership notification requirements.
12. Proposed rule amending regulations under 22 TAC 291 to expand the nonjudgmental duties that may be performed by pharmacy technicians to include receipt of oral prescription drug orders for dangerous drugs.
13. Proposed rule amending regulations under 22 TAC 291 to expand the nonjudgmental duties that may be performed by pharmacy technicians to include receiving and transferring prescriptions for dangerous drugs. The rule also would remove the ratio of pharmacists to pharmacy technicians and pharmacy technician trainees.
14. Proposed rule of the State Board of Pharmacy would amend regulations under 22 TAC 315 to clarify when a controlled substance prescription is not required to be issued electronically. The rule also would add procedures for requesting a waiver of the electronic prescribing requirement.
15. Proposed rule amending regulations under 22 TAC 309 to update the definition of “original prescription.”
16. Proposed rule amending regulations under 22 TAC 309 to update provisions on oral prescriptions to allow for expanded pharmacy technician duties.

Lastly in Texas. The Department of State Health Services’ (DSHS) Immunization Program is urging pharmacies and other health care providers interested in administering the COVID-19 vaccines once they are available to enroll as vaccine providers at EnrollTexasIZ.dshs.texas.gov. For more information on the DSHS Immunization Program, visit EnrollTexasIZ.dshs.texas.gov.

For more information, contact NACDS’ Mary Staples at 817-442-1155.

NACDS and the Texas Federation of Drug Stores submitted three joint letters to the House Select Committee on Statewide Health Care Costs providing extensive comments on all three issues: (1) primary drivers of increased health care costs in Texas, (2) opportunities to better coordinate how public dollars are spent on health care, and (3) identify emerging and proven delivery system improvements and sustainable financing models that could reduce the cost of health care.

Also in Texas. The Board of Pharmacy, partnering with the Drug Enforcement Administration (DEA) Diversion Control Division, is hosting a virtual opioid symposium on both October 11 and 12, 2020. For information about speakers, program details, and registration information, visit here. The symposium offers three (3) hours (0.3 CEUs) of CE approved by the Texas State Board of Pharmacy for license renewal. This program may be counted toward the requirement of prescribing and monitoring controlled substances as outlined by Board rule 295.8 for pharmacists and toward Texas-specific pharmacy laws or rules for pharmacy technicians per Board rule 297.8

For more information, contact NACDS’ Mary Staples at 817-442-1155.

The Board of Pharmacy has posted a final rule that took effect on September 9, which to adopted provisions to add a $500 administrative penalty for failure to access the Prescription Monitoring Program for a patient’s information before dispensing opioids, benzodiazepines, barbiturates, or carisoprodol.

Also in Texas. The Health and Human Services Commission’s (HHSC) Vendor Drug Program’s (VDP) Drug Utilization Review (DUR) Board will be soliciting public comments at their October meeting on the new drug classes anticonvulsants, antihemophilic, antineoplastic (i.e., anti-cancer), antiretroviral (i.e., anti-HIV), and medications used to treat multiple sclerosis. These drug classes are not currently reviewed on the Texas Medicaid Preferred Drug List (PDL). All medications within these newly reviewed drug classes will be preferred and continue to be available without PDL prior authorization. More information can be found here.

Also in Texas. Effective September 21, 2020, the Health and Human Services Commission will require the “Quantity Prescribed” field (460–ET) on all pharmacy claims for Schedule II drugs. Pharmacies should refer to the payer sheet addendum for more information on how this change impacts claim processing.

For more information, contact NACDS’ Mary Staples at 817-442-1155.

In response to Secretary Azar’s PREP Act declaration, the Board of Pharmacy posted on their website a guidance document confirming the conditions under which pharmacists and pharmacist-interns acting under the supervision of a pharmacist are allowed to order and administer immunizations to children 3-18 years of age.

Also in Texas. According to the Louisiana Department of Health, pharmacies serving Louisiana patients that evacuated because of Hurricane Laura must enroll with Louisiana Medicaid for reimbursement of prescriptions. Please refer to the “Hurricane Laura Provider Assistance FAQs” in the Louisiana Department of Health Informational Bulletin 20-17 (Aug. 30)  for more information.

For more information, contact NACDS’ Mary Staples at 817-442-1155.

As two hurricanes headed for the Texas Gulf coast, earlier this week Governor Greg Abbott declared a disaster in multiple counties which automatically triggered emergency procedures for dispensing of medications. Additional information on the declared state of emergency can be found here.

Also in Texas.  The Department of Insurance, Division of Workers’ Compensation issued an emergency rule waiving certain CMS distant site practitioner requirements during the COVID-19 outbreak that would allow health care providers licensed to perform physical medicine and rehabilitation services to bill and receive reimbursement for services allowed under current CMS telemedicine and telehealth billing codes.  Under this emergency rule, these waivers will be extended until October 9, 2020.

Also in Texas. The Health and Human Services Vendor Drug Program (VDP) issued three announcements:

1. Opioid-Related Clinical Prior Authorization Criteria Updates – VDP regularly updates clinical prior authorization criteria to better align drug policies and prior authorization approval criteria with the latest information available on drug information packets, the federal or state regulations. Opioid-related prior authorizations are scheduled for revision on September 1, 2020, to align with the uniform opioid policy.
2. Insulin Products Return to Non-Preferred Status – VDP temporarily removed the non-preferred status on April 1 in response to reported drug shortages for insulin products in the “Hypoglycemics, Insulins” drug class. VDP will reverse this change in status because of sufficient availability in the market. Beginning September 18, 2020, the Medicaid formulary will reflect the Preferred Drug List status changes for all non-preferred insulin products.
3. Inhaled Glucocorticoids Products Return to Non-Preferred Status – VDP temporarily removed the non-preferred status on April 1 in response to reported drug shortages for medications in the “Glucocorticoids, Inhaled” drug class. VDP will reverse this change in status because of sufficient availability in the market. Beginning September 18, 2020, the formulary will reflect the Preferred Drug List status changes for all non-preferred inhaled glucocorticoid products.

Also in Texas. On September 1, 2020, the Health and Human Services Commission (HHSC) will expand the Medicaid and CHIP benefit to allow and reimburse pharmacists for administering certain medications in a pharmacy setting, including the administration of certain long-acting anti-psychotics, opiate dependence treatments and emergency treatment for known or suspected opioid overdoses, and flu vaccines.  Under this benefit, pharmacies must be reimbursed for the ingredient cost, administration fee, and applicable dispensing fee for each claim processed. Pharmacies will also be reimbursed for the administration of flu vaccines for ingredient cost and the administration fee. To prepare pharmacies for changes to the claims submission process an addendum (PDF) to the NCPDP B1 Transaction Billing Request Payer Sheet is available showing changes to three existing fields in the Drug Use Review/Professional Pharmacy Service segment and addition of one new field to the Pricing segment. Pharmacies should refer to the addendum for more information on how this change impact claims processing. VDP will revise the full B1 payer sheet upon implementation. More information can be found here.

For more information, contact NACDS’ Mary Staples at 817-442-1155.

To advance our 2021 legislative agenda, NACDS and the Texas Federation of Drug Stores continue to schedule virtual meetings with lawmakers, advocating for increased access to immunizations (including the future COVID-19 vaccine), expanded pharmacists scope of practice, and fair Medicaid reimbursement. In support of these initiatives, NACDS and pharmacists from HEB and Walgreens that live and work key districts recently met with Senator Kelly Hancock (R) (Chair of the Business and Commerce Committee), Representative Geanie Morrison (R), Representative Julie Johnson (D), Representative John Kuempel (R), and Representative Eddie Lucio III (D).

Also in Texas. On September 15^th , the Health and Human Service Commission Vendor Drug Program will extend the non-preferred prior authorization duration for macrolides from 30 days to 90 days for people with a diagnosis of Gastroparesis, Cerebral Palsy Gastroparesis, or GERD Gastrostomy complications. Managed Care Organizations are required to comply with this PDL prior authorization criteria, including duration. More information can be found here.

For more information, contact NACDS’ Mary Staples at 817-442-1155.