The Health Care Authority (HCA) is hosting a webinar on June 25 at 11 :00 am Pacific time to educate providers on Apple Health (Medicaid) eligibility, benefits and expansion.

Also in Washington, Apple Health’s new point-of-sale system is live and processing claims. Providers are reminded to update to the new billing information for fee-for-service (FFS) clients:

• New BIN = 024822
• New PCN = DRWAPROD
• New Group = CAID

Also In Washington, Apple Health’s new fax number is 833-991-0704.

Also in Washington, the Chief Science Officer signed an updated standing order that allows pharmacies to dispense the naloxone products to eligible persons and entities.

Also in Washington, HCA (Health Care Authority) published a revised Prescription Drug Program Billing Guide.

Finally in Washington, the Pharmacy Quality Assurance Commission (PQAC) is accepting applications to fill current and upcoming public member and pharmacist member vacancies. To qualify for a public member position, an individual must be a resident of Washington State and not affiliated with any aspect of pharmacy. To qualify for a pharmacist member position, an individual must be a resident of Washington State and, at the time of their appointment, have been a licensed pharmacist in Washington State for at least five consecutive years immediately preceding appointment.

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

The Health Care Authority (HCA) will change to a new pharmacy point-of-sale system on June 8. The system will be off from midnight until 3:30 pm on June 8-9. HCA will notify providers once the new system is running and can adjudicate claims. At 5:00 pm on June 6, pharmacy prior authorization faxes will cease being accepted. HCA will start accepting prior authorization faxes again on June 10. HCA’s ProviderOne Point of Sale (POS) Replacement Project provided an updated payer sheet.

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

The Health Care Authority (HCA) is extending the April 27 implementation of the Pharmacy Point of Sale (POS) Replacement system. The new targeted go live date is June 8. 

Also in Washington, the Pharmacy Quality Assurance Commission (PQAC) revised its Ancillary Utilization Plans and the Administration of Drugs and Devices guidance document to include pharmacy assistants with a technician in training endorsement that are enrolled in a commission-approved Pharmacy Technician Education and Training Program. 

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

NACDS was alerted that an error has occurred when the Health Care Authority (HCA) made the Retroactive Time Period payments to the pharmacies under Section 4(b) of the Washington State Medicaid lawsuit Settlement Agreement, and that HCA is taking steps to correct the error which will impact some pharmacies’ reimbursement. HCA discovered that it had overpaid 197 pharmacies while underpaying 334 pharmacies and will be correcting the erroneous payments.   

Also in Washington, the Pharmacy Quality Assurance Commission (PQAC) filed a CR-103E Emergency Rulemaking order codifying in rule the Food and Drug Administration’s (FDA) approval of certain naloxone hydrochloride nasal sprays as over the counter. PQAC considers the ongoing opioid epidemic to be a public health emergency in Washington state. This rule, filed on April 5, 2024, took effect immediately and will remain in effect for 120 days but will be refiled as needed while permanent rulemaking is in progress. 

Also in Washington, the Health Care Authority Apple Health (Medicaid) added the new over the counter (OTC) birth control pill – Norgestrel oral tablets (Opill) – to the list of covered drugs that also includes family planning supplies without a prescription, such as condoms, emergency contraception and spermicides. 

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

NACDS applauds the enactment of ESSB 5213, a new law signed by Gov. Jay Inslee (D) on March 25 that will hold PBMs accountable. Although the law exempts the Employment Retirement and Security Act (ERISA) plans, it enhances the Insurance Commissioner’s enforcement authority, establishes an appeals process, opens the network, includes anti-steering and mail order provisions, prohibits spread pricing and expands Maximum Allowable Cost appeals to all prescriptions, not just generic drugs. The bill sponsor, Sen. Patty Kurderer (D), who is running for the office of Insurance Commissioner in November, plans to enforce this new law and actively seek further PBM reforms, if elected. 

Also in Washington, the Heath Care Authority asked NACDS to alert pharmacies that recently they have seen delays from its switch vendors and/or software vendors in applying changes for testing. Sarah Stewart said these changes to the BIN number and other information on the payer sheet for its POS (point of sale) replacement system are going live on April 27, 2024.  

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

NACDS applauds the enactment of ESSB 5213, a new law signed by Gov. Jay Inslee (D) on March 25 that will hold PBMs accountable. Although the law exempts the Employment Retirement and Security Act (ERISA) plans, it enhances the Insurance Commissioner’s enforcement authority, establishes an appeals process, opens the network, includes anti-steering and mail order provisions, prohibits spread pricing, and expands Maximum Allowable Cost appeals to all prescriptions, not just generic drugs. The bill sponsor, Sen. Patty Kurderer (D) who is running for the office of Insurance Commissioner in November, plans to enforce this new law and actively seek further PBM reforms if elected.

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

The Pharmacy Quality Assurance Commission (PQAC) will hold a rules workshop during the May 2-3 business meeting on draft rule language regarding prescription transfers. The draft rule language discussed at the March 7 meeting was amended (WAC 246-945-345) to clarify noncontrolled prescription transfers, and language was added (WAC 246-945-346) relating to controlled substance prescription transfers. The PQAC is soliciting written comments on the draft rule language through April 5. Submit comments to PharmacyRules@doh.wa.gov; oral comments may be provided at the May rules workshop.  

Also in Washington, the Health Care Authority (HCA) hosted a Prescription Drug Affordability Board (PDAB) meeting on March 20. More information about the PDAB is available on the website.  

Finally in Washington, the 2024 Regular Session adjourned sine die on March 7. Our #1 priority bill in the state, a PBM reform bill filed by Sen. Patty Kurderer (D), ESSSB 5213, passed both houses and was delivered to Gov. Jay Inslee (D). Although the bill exempts ERISA plans, it enhances the Insurance Commissioner’s enforcement authority, establishes an appeals process, opens the network, includes anti-steering and mail order provisions, prohibits spread pricing, and expands MAC appeals to all prescriptions, not just generic drugs. 

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

Prior to the March 7th adjournment date, pharmacies priority legislation, the PBM reform bill E2SSB 5213, passed both houses and was sent to Gov. Jay Inslee (D) to be signed into law. 

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

The PBM reform bill that passed the Senate earlier this month was amended in the House and continues to advance E2SSB 5213 through the legislative process despite the false claims that this bill would cost the state of Washington almost $239 million in excess drug spending in year one, and as high over $2.7 billion over the next 10 years. The bill is on the House calendar and must be voted out by 5:00 pm on March 1. If that occurs, the bill will be returned to the Senate for concurrence with amendments added in the House Health and Wellness Committee last week. 

Also in Washington, the Pharmacy Quality Assurance Commission (PQAC) posted the agenda for the March 7 meeting. 

Also in Washington, register now for the Apple Health quarterly online seminar on March 7 aimed at providing HCA (Health Care Authority) partners with information about current Apple Health (Medicaid) programs and program updates. 

Also, in Washington, responsible pharmacy managers or equivalent managers of pharmaceutical firms must conduct an annual self-inspection in March and within 30 days of naming a new responsible pharmacy manager. The self-inspections are to be completed on Pharmacy Quality Assurance Commission provided worksheets. 

Finally in Washington, the Department of Health Prescription Monitoring Program is hosting a rulemaking workshop on March 19 to clarify the rules defining the concepts of “sold”, “dispense”, “filled” and “distributed”. 

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