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.

The Department of Vermont Health Access has published updates to the Preferred Drug List (PDL) effective January 1, 2023.

For more information, contact NACDS’ Sandra Guckian at 703-774-4801.

The Department of Vermont Health Access (DVHA) is implementing changes to its prescription drug benefits programs to ensure Medicaid patients continue to have access to the medications they need for conditions related to COVID-19. The changes center around copayments, prescription instructions, and approved medication treatments. 

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

The Vermont Office of Boards, Commissions & Public Service announced that there was a vacancy on the Board of Pharmacy. If a Vermont pharmacist is interested in filling the vacant spot the application for filling the new position can be found here. The next Board of Pharmacy meeting is April 27.

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

The Department of Vermont Health Access recently released its March 2022 Pharmacy Newsletter. It contains information on: 

• Pharmacy Benefit Provider Satisfaction Survey 
• Hypertension Management Initiative  
• Team Care Program 
• Important Changes to Administration Fees for Vaccines  
• Update on Pharmacy COVID-19 Antigen Test Coverage  
• Preferred Drug List (PDL) 
• New DURB Board Member 
• Drug Utilization Review Board (DURB) Meeting 
• Website Updates 

Also in Vermont, the Department of Vermont Health Access issued a communication that Synagis® prophylaxis is of unproven value when administered outside of the RSV season as defined by the CDC surveillance reports. Therefore, no further shipments will be authorized after March 11. 

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

On January 1, 2022, the Medicaid pharmacy administration fee for vaccines changed from $13.97 to $13.87. This is to align with changes to the physician fee schedule and does not apply to COVID-19 administration fees. There is further guidance around POS submission, administration fees added to adult ACIP (Advisory Committee on Immunization Practices) recommended vaccines, and enrollment in the Vermont Child Vaccine Program (VCVP). 

Also in Vermont, the Department of Vermont Health Access (DVHA) contracts with Change Healthcare to support Vermont’s publicly funded pharmacy benefit programs. The Change Healthcare help desk supports all pharmacies and prescribers enrolled in Vermont’s pharmacy benefit programs. It is the first point of contact for pharmacy and medical providers for drug prior authorization requests, drug claims processing issues, and other drug-related questions, concerns, and complaints.  

Change Healthcare is conducting a provider satisfaction survey of pharmacies and prescribers and your participation in this survey is particularly important to DVHA as responses from this survey will be used for quality improvement efforts. The entire survey should take less than 5 minutes to complete. Comments are dure by March 15.  

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

The Vermont Department of Financial Regulations has issued draft guidance for commercial insurance coverage of COVID-19 at-home rapid antigen testing. The Department contemplates requiring commercial health insurers to cover at-home rapid antigen testing listed as “preferred” by Vermont Medicaid without member cost sharing. Under the draft emergency rule, the tests would be fully covered when prescribed, in which case the claim would process exactly like any other prescription medication, or if the member submits a claim form. This guidance, once finalized, will be effective December 1, 2021.

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