Vermont

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.