On January 11, the Department of Health released the following notice regarding increased RSV cases and its strain on the health system. Reports have been sent to the Department that pregnant patients have been turned away from pharmacies. The Department asked that pharmacies are aware that: 

• Pregnant individuals are eligible for Abrysvo.  

• • If a particular pharmacy does not have Abrysvo, please refer the pregnant individual to a location that does have it.  
  • We have Immunization Registry (IMR) data showing that pharmacies are administering Abrysvo to women of childbearing age. The IMR does not collect pregnancy status.  

• Adults 60 years of age and older are eligible and encouraged to receive either Arexvy or Abrysvo vaccine.  

• • IMR data shows that pharmacies are giving doses to older adults.        

For more information, please contact NACDS’ Ben Pearlman at 617-515-2603.

The Board of Pharmacy is scheduled to hold its regular meeting on December 20; the agenda has been posted.

For more information, please contact NACDS’ Ben Pearlman at 617-515-2603.

On October 5, the Department of Vermont Health Access (DVHA) updated the administration fee for the 2023-2024 commercial COVID-19 vaccines to $40.00, to align with Medicare reimbursement. This change is retroactive to September 11, 2023. DVHA-enrolled pharmacies may be reimbursed for injectable COVID-19 vaccinations administered to adults 19 years and older who are enrolled in Vermont’s Medicaid. Pharmacists must be enrolled with Vermont Medicaid, certified to administer vaccines in the State of Vermont and compliant with all Vermont laws governing vaccine administration. Failure to comply with all Vermont immunization regulations will subject these claims to recoupment. Participation in the Vermont Child Vaccine Program (VCVP) is mandatory for providers who wish to provide vaccinations to children under age 19 years insured by Vermont Medicaid.  If the pharmacy is not enrolled in VCVP please refer members through age 18 years presenting for vaccinations at pharmacies to their health care provider for State-supplied vaccines at no cost to the member.  Under the DVHA General Provider Agreement (Conditions 4.2), providers shall not bill a member for any covered service.

Also in Vermont, regarding currently covered COVID-19 vaccines:  Comirnaty® (Pfizer), Novavax®, Spikevax® (Moderna), pharmacies are reimbursed for the ingredient cost and administration fee for COVID-19 vaccines. No dispensing fee is paid for vaccine claims. Basis of Cost and Submission Clarification Codes are no longer required. Through the pharmacy POS system, the pharmacy must submit the code “MA” in the Professional Service Code field for the COVID-19 vaccine claim to document the administration of the vaccine and receive full reimbursement. There is no member copay for vaccines.

For questions regarding this benefit, please contact the Change Healthcare Pharmacy Help Desk at 1-844-679-5362. Vermont providers can also send inquiries via email to PBA_VTHelpdesk@changehealthcare.com.

Also in Vermont, the Board of Pharmacy held its regular meeting on September 27. The board accepted the state pharmacist prescribing protocols for emergency contraception (limited to medications, not IUDs) and the ACIP-recommended vaccines. Those two protocols will be posted on the state OPR (Office of Professional Regulation) website soon.

The Board clarified the language regarding Rule 10.26 in the Board’s 2014 “Policy on Hydrocodone Combination Products as Schedule II Drugs” that limits future fill prescriptions to two. The Board chose to remove the 2014 policy and follow the DEA (Drug Enforcement Administration) policy instead.

Additionally, the Board, in response to a request from the Department of Vermont Health Access to clarify blood pressure monitors qualifying as “accessory devices” and pharmacists prescribing authority as described in described in 26 V.S.A. § 2023(b)(3), decided that it is considered over the counter as defined in section 5 in regard to insurance coverage.

Finally in Vermont, on September 18, the Department of Vermont Health Access (DVHA) made changes to the Pharmacy Manual regarding automatic refills for Medicaid members. Vermont Medicaid does not pay for prescriptions that are not medically necessary or for individuals who are no longer eligible for Vermont Medicaid. Providers may not use automatic refill systems to deliver or provide prescriptions to members. Members and providers may not agree to waive the requirements of this section. Providers may contact members to initiate a refill, but members must choose to fill each prescription, and providers must determine that the member remains eligible for Vermont Medicaid before providers deliver or dispense the prescription. Providers may not assume that, because a member’s prescription authorizes refills, the member has implicitly requested that the provider refill the prescription. For questions, please contact the Change Healthcare Pharmacy Help Desk at 1-844-679-5362. Vermont providers can also send inquiries via email to PBA_VTHelpdesk@changehealthcare.com.

For more information, please contact NACDS’ Ben Pearlman at 617-515-2603.

The Vermont Board of Pharmacy posted the agenda for the September 27th meeting.  The agenda includes drafts for state pharmacists prescribing protocols for emergency contraception and ACIP-recommended vaccines which are included in the agenda posting.    

On September 18th, the Department of Vermont Health Access (DVHA) made changes to the Pharmacy Manual regarding automatic refills for Medicaid members. Vermont Medicaid does not pay for prescriptions that are not medically necessary or for individuals who are no longer eligible for Vermont Medicaid. Providers may not use automatic refill systems to deliver or provide prescriptions to members. Members and providers may not agree to waive the requirements of this section. Providers may contact members to initiate a refill, but members must choose to fill each prescription, and providers must determine that the member remains eligible for Vermont Medicaid before providers deliver or dispense the prescription. Providers may not assume that, because a member’s prescription authorizes refills, the member has implicitly requested that the provider refill the prescription. For questions, please contact the Change Healthcare Pharmacy Help Desk at 1-844-679-5362. Vermont providers can also send inquiries via email to PBA_VTHelpdesk@changehealthcare.com. 

For more information, please contact NACDS’ Ben Pearlman at 617-515-2603.

On August 23, the Board of Pharmacy held its monthly meeting.  On the agenda was a request for input regarding draft proposals for prescribing emergency contraceptives and Advisory Committee on Immunization Practices (ACIP) recommended vaccines.

For more information, please contact NACDS’ Ben Pearlman at 617-515-2603.

NACDS joined its members, in-state partners, and representatives from the state medical community to discuss pharmacist and technician scope with members from the Department of Health. Stakeholders also met on July 27 to discuss test and treat legislation for 2024.  

Also in Vermont, on July 26, the Board of Pharmacy held its regular meeting, during which it reviewed the emergency declarations and the Executive Order regarding pharmacies. Link to the agenda 

Finally in Vermont, the Executive Order allows a one-time 30-day maintenance prescription to be filled, as well as emergency licensing for pharmacists and pharmacy technicians from out-of-state to fill any staffing gaps. This Executive Order lasts for 90 days or if there is a State of Emergency, whichever is shorter. There will be updates to come as things change. The next board meeting is August 23. 

For more information, please contact NACDS’ Ben Pearlman at 617-515-2603.

Due to the current state of emergency in the state and to ensure that Medicaid beneficiaries have access to the medications they need, the Department of Vermont Health Access (DVHA) is temporarily re-activating SCC 13 as an allowable NCPDP submission clarification code in the adjudication of pharmacy claims. Changes to point-of-sale will be effective from July 13, 2023, to July 25, 2023. This code is utilized by the dispensing pharmacist when processing an early refill for the patient and indicates that an override is needed based on an emergency/disaster situation recognized by the payer. The use of SCC 13 will override a Reject 79 (Refill too soon). It will not override either Reject 75 (prior authorization required) or Reject 76 (Plan limits exceeded). DVHA will monitor claims using this submission clarification code to ensure it is used only when medically necessary. Improper use of SCC13 will subject the claim to recoupment. For questions, please contact the Change Healthcare Pharmacy Help Desk at 1-844-679-5362. Vermont providers can also send inquiries via email to PBA_VTHelpdesk@changehealthcare.com.  

On July 20, Gov. Phil Scott (R) signed the 3rd addendum to his emergency declaration. This addendum added the following relevant to pharmacies: “The Secretary of State is hereby directed to waive such rules and requirements as may be necessary to allow a pharmacist to extend a previous prescription for up to a 30-day supply for a maintenance medication for which the patient has no refills remaining or for which the authorization for refills has recently expired if it is not feasible to obtain a new prescription or refill authorization from the prescriber. “Maintenance medication” means a prescription drug taken on a regular basis over an extended period to treat a chronic or long-term condition. The term does not include a regulated drug, as defined in 18 V.S.A. § 4201.” Additionally, a pharmacist who extends a prescription for a maintenance medication pursuant to this authority shall take all reasonable measures to notify the prescriber of the prescription extension promptly. 

For more information, please contact NACDS’ Ben Pearlman at 617-515-2603.

This week, the legislature returned to override the Governor’s veto of H. 305, a bill that will, among its provisions, clarifies the definition of pharmacy technician, allows technicians to perform tests and vaccinations for Covid and other immunizations, allows pharmacists and technicians to administer vaccines for flu and covid for children ages 5 and up, allows a pharmacist to prescribe, order, or administer self-administered hormonal contraceptives for patients 18 years of age or older, vaccinations recommended by the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices (ACIP) and administered consistently with the ACIP-approved immunization schedules, and finally exempts persons dispensing over-the-counter hearing aids from provisions for audiologists and hearing aid dispensers.

For more information, please contact NACDS’ Ben Pearlman at 617-515-2603.

On May 12, the Vermont legislature approved HB 305, which would revise the definition of pharmacy technician to mean an individual who, only while assisting and under the supervision of a licensed pharmacist, performs tasks relative to dispensing prescription drugs, administering immunizations and performing tests for SARS-CoV. Pharmacy technicians may administer immunizations and perform tests for SARS-CoV. This measure also outlines requirements for pharmacy technicians in order to administer immunizations. They may only administer immunizations to individuals 18 years of age and older. Regarding patients five years old and older for flu and COVID-19 vaccines, a licensed pharmacist must be present to assist as needed. Pharmacy technicians may only administer immunizations that: (1) are recommended by the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices; and (2) licensed pharmacists are permitted to administer under the State clinical pharmacy protocol. This measure allows a pharmacist to prescribe, order or administer self-administered hormonal contraceptives, including subcutaneous depot medroxyprogesterone acetate as well as, for patients 18 years of age or older, vaccinations recommended by the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices (ACIP) and administered consistently with the ACIP-approved immunization schedules, as may be amended from time to time. Lastly, this measure exempts persons dispensing over-the-counter hearing aids from provisions for audiologists and hearing aid dispensers. The bill now awaits signature from the Governor.

For more information, please contact NACDS’ Ben Pearlman at 617-515-2603.