The Health Care Authority (HCA) requires Apple Health providers to dispense a full 12-month supply of contraceptives per WAC 182-530-2000; therefore we are asking CMS to waive the NCCI edit to avoid administrative burden to our providers and maintain access to adequate contraception for our clients. We most likely will not receive a response before January 1.

Providers should continue to dispense the required amount of contraceptive based on HCA requirements and the client’s needs.

Until HCA receives an answer from CMS, you may:

• Delay billing for these two contraceptives until we notify you of our resolution with CMS; or
• Provide a prescription for the client to take to a pharmacy, as this edit does not apply to pharmacy dispensed contraceptives; or
• Bill either HCA or the client’s MCO by entering 1 unit per line on the claim for as many lines as the number of units dispensed.

For questions or concerns by email contact HCA Family Planning.
Click here to go the WAHCA webpage.

See more Washington Apple Health announcements and additional pharmacy resources at: https://www.wsparx.org/page/Law

ALEXANDRIA, Va. (Jan. 17, 2018) – In comments submitted in support of the Centers for Medicare & Medicaid Services’ proposed 2019 Medicare Part D rule, the National Community Pharmacists Association has endorsed CMS’ plan to consider assessing pharmacy DIR fees at point of sale.  The association offered input on several other provisions in the rule as well.

“We commend CMS for addressing in this proposed rule troublesome practices in the Part D program and encourage the agency to implement these provisions to produce greater convenience and savings for Medicare beneficiaries and greater transparency and fairness for pharmacies,” said NCPA CEO B. Douglas Hoey, Pharmacist, MBA.

“NCPA and its allies urge CMS to stand firm against pushback from PBMs, who oppose having pharmacy price concessions rolled into the initial adjudication process for prescription drugs, even though doing so is in the interest of patients who need the Part D benefit the most.”

NCPA’s comments included the following points:

• NCPA fully supports CMS’ recommendation that PBMs be required to account for pharmacy price concessions at the point of sale, rather than retrospectively.
• NCPA backs the revised definition of mail order pharmacy and retail pharmacy, which allows patients to continue getting their prescription drugs from the same pharmacy.
• NCPA endorses CMS’ proposal that PBMs may not require onerous pharmacy accreditation and credentialing requirements that go beyond state laws.
• NCPA supports CMS’ proposal to mandate the timeline for when Part D standard terms and conditions are given to pharmacies.
• NCPA is concerned that revisions to communications materials and activities could create loopholes where incomplete or misleading information is provided to patients.  

In addition to NCPA’s comments, approximately 1,000 independent community pharmacist owners each submitted their own comments to CMS before the Jan. 16 deadline.

On May 6, CMS held a short information session with national pharmacy groups on the agency’s newly published interim final rule allowing Medicare Part D plans to continue covering pharmacy claims for prescriptions written by “other authorized prescribers,” such as pharmacists........(Read article posted by APhA)