The Health Care Authority issued a final rule effective May 1, 2021, requiring providers to agree that all claims for Apple Health clients in fee-for-service and managed care are subject to 340B standards as part of participation in the 340B drug pricing program.

Also in Washington, the Office of the Insurance Commissioner extended two emergency orders until May 16, 2021, that are of interest to pharmacies.

• Notice extending the Emergency Order 20-01 requiring health insurers to waive copays and deductibles for coronavirus (Covid-19) testing. The order also requires insurers to allow a one-time early refill for prescription drugs; suspend any prior authorization requirement for treatment or testing of Covid-19 and allows enrollees to be treated by out-of-network providers within a reasonable distance at no additional cost when the insurer does not have enough in-network medical providers.
• Notice extending Emergency Order 20-06 concerning insurance coverage for COVID-19 diagnostic testing prohibits all health carriers from balance billing for COVID-19 diagnostic testing processed by out-of-network laboratories, when determined to be medically necessary. The order also requests that insurers notify the agency if out-of-network laboratories submit claims but have not published a cash price or fail to accept such a price.

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

The Pharmacy Quality Assurance Commission issued an emergency rule effective until July 3^rd increasing the amount of time to 15 days that a practitioner has to deliver a signed prescription when authorizing an emergency prescription of a Schedule II substance to the pharmacy. The rule also defines “signed prescription” and allows practitioners to fulfill signature requirements through paper, electronic transmission, facsimile, photograph, or scanned copy. The rule extends August 5, 2020, emergency rule is issued in response to the COVID pandemic.

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

The Health Care Authority submitted a Medicaid state plan amendment (SPA 21-0012) providing the state flexibility to automatically enroll COVID-19 vaccine administration providers that have already completed Medicare application processes for participation. It also allows the Medicaid program the flexibility to not require NPIs for the administration of vaccines to Medicaid recipients during the public health emergency.

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

The Washington Health Care Authority (Medicaid) has added the following optional benefits to their state plan: Allow pharmacists practicing within their scope of practice to order, collect specimens, conduct and interpret necessary tests, initiate treatment when appropriate, and administer vaccines for the diagnosis, treatment and prevention of COVID-19; and allow pharmacists practicing within their scope of practice to administer any prescribed injectable, covered, outpatient drug during the COVID-19 pandemic. 

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

This week, Washington State joined California and Oregon in a Western States Pact to coordinate the regional reopening of the economy as the COVID-19 pandemic progresses. 

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

The WA Pharmacy Quality Assurance Commission is holding two calls per week during the COVID crisis, Wednesdays and Fridays at 7:30 a.m. PACIFIC.  They are discussing actions that may be needed to take the strain off pharmacists, interns, techs and assistants as they provide access to patients.  To participate you can register at: https://register.gotowebinar.com/rt/6130868446164549132.  If you have questions you would like the Commission to consider, please address them to COVID19.PQAC@doh.wa.gov 

Also in Washington...  Gov. Jay Inslee (D) signed 2SSB 5601 relating to health care benefit managers into law. This “landmark” bill creates a new statute in Washington law specific to the regulation and registration of Health Care Benefit Managers (HCBM) and includes PBMs. Due to the lack of funding available, the Governor vetoed Section 22, the creation of the pharmacy contract work group.  Rulemaking will begin this summer under the direction of the Office of the Insurance Commissioner (OIC). 

Also in Washington...  Gov. Jay Inslee (D) signed SHB 2464, protecting patients from excessive medication charges.  Beginning January 1, 2021, the maximum amount a PBM or health carrier may require a person to pay at the point of sale for a covered prescription medication is: the lesser of the applicable cost sharing (co-payment/co-insurance); or the amount the person would pay for the medication if purchased (cash) without using a health plan.

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

The Senate unanimously passed 2nd Substitute Senate Bill 5601 – Health Care Benefit Manager reform. Requiring registration with the Office of the Insurance Commissioner and transparency. The Bill now goes to the House.

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

Mid-way through the 2020 Legislative Session there are a number of pharmacy-related bills still making their way through the process: House Bill 2251 extends the reporting requirement when dispensing biosimilars to 2025; Substitute House Bill 2438 imposes a 1 cent per MME on manufacturers if more than 100,000 MME’s are dispensed within a quarter; 2nd Substitute Senate Bill 5601 address health care benefit managers including PBM’s; Substitute Senate Bill 6086 addresses pharmacy remote dispensing; 2nd Substitute Senate Bill 6087 limits co-payments and cost-sharing to patients on insulin to $100 per month; and Substitute Senate Bill 6113 creates a central insulin purchasing program which includes among others an independent and a chain pharmacist on the work group.

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