Legislation that would require Medicaid to hire a single PBM to manage the pharmacy benefit has advanced. Both HB 2610 and SB 875 passed their respective chambers and advanced significantly in the opposite chamber. They are now poised to go to the Conference Committee to work out the remaining details, including the implementation date. NACDS cautions that the Department of Medical Assistance Services (DMAS) has been resistant to the legislation, though Gov. Glenn Youngkin (R) has not officially taken a stance. We will continue to work with in-state partners and members over the next month to advocate for the bill or bills to become law.

Also in Virginia, Gov. Glenn Youngkin (R) issued Executive Order 45  on February 16, declaring a state of emergency due to winter weather and flooding. In response, the Board of Pharmacy has implemented emergency waivers. They will remain in effect for the duration of Executive Order 45, which is effective for 30 days from February 10, unless sooner amended or rescinded. Existing emergency regulations plus those implemented because of the declaration waivers are as follows:

• Pursuant to 18VAC110-20-320, an authorized refill may be dispensed early provided the pharmacist documents a valid reason for the necessity of the early refill.
• Emergency Waiver: a prescription for a drug controlled by Schedule III-V with no remaining refills may be refilled one time without authorization from the prescriber, if after reasonable effort has been made to contact him, the pharmacist ascertains that he is not available and the patient’s health would be in imminent danger without the benefits of the drug. Authorization to refill under this subdivision also exists when the pharmacist only has access to the label on a prescription container. The pharmacist shall inform the patient of the prescriber’s unavailability and that the refill is being made without his authorization.
• A prescription for a drug controlled by Schedule II may be dispensed pursuant to the emergency allowance in 18VAC110-20-290.
• Emergency Waiver: A one-time early dispensing of a Schedule II prescription for a chronic condition that is due for dispensing within the next 7 days is authorized. Dispensers must document the reason for the early refill.

For more information, contact NACDS’ Jill McCormack at 717-592-8977.

Two bills that would require DMAS (Department of Medical Assistance Services) to contract directly with a SPBM to manage the Medicaid managed care pharmacy benefit are quickly advancing this session. NACDS testified in favor of SB 875, sponsored by Sen. Aaron Rouse (D), that was later approved by both the Education and Health Committee and the Finance Committee. The bill now heads to the Senate Floor for a vote. In the House, The Health and Human Services Committee approved HB 2610 and advanced it to the Appropriation Committee. Identical fiscal notes were issued for the bills and they include cost savings estimates. NACDS is working with members, in-state partners and DMAS to support this effort.

For more information, contact NACDS’ Jill McCormack at 717-592-8977.

The Department of Health (VDH) issued a clinician’s letter related to an increase in pneumonia and pertussis cases in the Commonwealth. This and other provider communications are also available on the VDH webpage.

Also in Virginia, the Department of Health and Human Services issued a report to the Governor and General Assembly recommending that the state not move forward with a Drug Importation Program. The report is the result of a legislatively mandated workgroup on “The Feasibility of a Wholesale Prescription Drug Importation Program” that found that there was no guarantee of cost savings by implementing an importation program and that the better course of action was to wait and see if other states’ programs move forward with any positive outcomes.

For more information, contact NACDS’ Jill McCormack at 717-592-8977.

The Department of Medical Assistance Services (DMAS) is currently conducting a pharmacy cost of dispensing study. Surveys were delivered to pharmacies on September 12 and are due back to Myers & Stauffer on October 17. The statute requires that the Medicaid Fee-For-Service (FFS) Professional Dispensing Fee be determined by a study completed “at least every five years”. DMAS’ slide deck has more detail. The current FFS Professional Dispensing Fee is $10.65.

For more information, contact NACDS’ Jill McCormack at 717-592-8977.

The Department of Medical Assistance Services (DMAS) held an initial virtual meeting with pharmacy associations to discuss the upcoming pharmacy cost-of-dispensing survey (slide deck). The survey instrument has not been finalized; however, Myers & Stauffer intends to send it to pharmacies on September 12. Additional informational webinars for all pharmacy stakeholders are tentatively scheduled for September 24 and September 26.

For more information, contact NACDS’ Jill McCormack at 717-592-8977.

State Health Commissioner Karen Shelton, MD, distributed a clinician letter to practitioners across the Commonwealth with updates on the national shortage of penicillin G benzathine (Bicillin L–A®) and the ongoing syphilis statewide outbreak trends and clinical manifestations in the state.

For more information, contact NACDS’ Jill McCormack at 717-592-8977.

The Board of Pharmacy issued the following communication to licensees:

“In response to House Bill 2147, passed during the 2023 General Assembly Session, the Board of Pharmacy is reminding pharmacy personnel that federal laws require minimum standards in certain situations regarding patient translation services for prescription drugs. Specifically, pharmacy personnel are encouraged to review and consult with their management regarding the pharmacy’s compliance with the following federal laws: Title VI of the Civil Rights Act 1964 (42 U.S.C. 2000d) regarding discrimination based on race, color, or national origin by any program or activity receiving federal financial assistance; Section 504 of the Rehabilitation Act (29 U.S.C. § 794) regarding discrimination based on a disability from any program or activity receiving federal financial assistance; and Title III of the American with Disabilities Act (42 U.S.C. §§ 12181 to 12189; 28 C.F.R. Pt. 36) regarding discrimination at a place of public accommodation which includes a pharmacy. Please note the Board is unable to provide legal advice on this matter. However, additional information may be found in the Board of Pharmacy Report Regarding the Provision of Translated Directions for Use of Prescriptions submitted to the Virginia General Assembly on December 7, 2023.Please also be aware that the Board will adopt regulations and guidance by December 31, 2024, for accessible prescription labels to assist the blind, visually impaired, or otherwise print disabled as required by House Bill 516, passed during the 2024 General Assembly Session.”

For more information, contact NACDS’ Jill McCormack at 717-592-8977.

The Board of Pharmacy posted the agenda for its June 25 meeting. Please note they intend to discuss the emergency regulations for central fill/remote processing, the final regulations updating the 2022 test and treat law and current pharmacy workforce conditions in preparation for a new workforce survey.

For more information, contact NACDS’ Jill McCormack at 717-592-8977.

Gov. Glenn Youngkin (R) vetoed companion bills (HB 570 / SB 274) that would have created a Prescription Drug Affordability Board (PDAB) in the state. This move comes as three other states actively conduct affordability reviews of prescription drugs nationwide. NACDS will be monitoring the final outcome of the bill when the Legislature returns later this spring for its veto session. NACDS joined other organizations in expressing opposition to the bill to Gov. Youngkin.

For more information, contact NACDS’ Jill McCormack at 717-592-8977.