I am excited to announce a new webinar that I will be presenting with Marina Plotkin, Harrison Beach. The American Society for Pharmacy Law is hosting the webinar on March 10 at 12pm (Central) (10am PST). The presentation will focus on pharmacy operation during the times of natural and man-made disasters, local/state/national emergencies, and other catastrophic situations. We will present information on:
(1) state and federal waivers of certain regulatory compliance, such as prior…
The announced Medi-Cal Rx implementation date, which was initially set for April 1, 2021, is postponed. (See a related Blog Post).
Magellan Haelth, Inc – a PBM that will administer the program – is in the process of being acquired by Centene Corporation. Centene operates managed care plans and pharmacies that participate in the Medi-Cal program. As a result, the Department of Health Care Services (DHCS) is analyzing potential conflicts with Centene managing Medi-Cal…
The California Department of Healthcare Service (DHCS) has just posted an update regarding Medi-Cal Rx transition (See Related Blog Post). In anticipation of this transition, there are some early cutoff activities that California pharmacies should note:
Pharmacy Paper Claim Submitters: The cutoff for claims processing for paper claim submissions to the current FI is March 14, 2021. Paper claim submissions received after this date will be routed to Medi-Cal Rx for processing on…
If you are into pharmacy technology, you might have heard of a new pharmacy software designed to optimize profitability – UGO. It was built by pharmacy owners who know the industry and day-to-day problems that independent pharmacies face. For example, the platform integrates and functions with most existing pharmacy operating systems and provides “Key Performance Indicators” highlighting what the pharmacy is currently doing and ways it could improve its profitability. It also provides a…
I am starting a series of posts consisting of mini-topics that I covered during my December webinar. I had many questions regarding the information presented and will try to address some of the issues in this series.
Today I will be talking about manufacturer coupons, which is a common cause of significant PBM recoupments.
Let’s review when a pharmacy can safely apply manufacturer coupons. According to PBM manuals, coupons may be applied when a pharmacy:…
The transition date of Medi-Cal managed care claims to fee-for-service is still set for April 1, 2021.
Medi-Cal Rx – the name of the new program – will apply to all pharmacy services billed on pharmacy claims. However, most DME claims are exempt. For a complete list of exempt products, visit Medi-Cal Rx website.
The existing Medi-Cal managed care pharmacy carve-outs will continue to be reimbursed in the same manner (e.g., blood factor, HIV/AIDS…
The SUPPORT Act (Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act) requires that controlled substances prescriptions covered under Medicare Part D be transmitted electronically. The effective date for compliance was set for January 1, 2021. Does this mean that pharmacies can no longer accept paper/faxed prescriptions?
First of all, the Act only applies to prescribers (not pharmacies) and requires them to have technology that supports e-prescribing. There are a…
The news are full of excitement regarding a recent US Supreme court decision in Rutledge v PCMA. But there is still lots of confusion what this decision means for independent pharmacies.
So let’s look at what the case is really about.
It all started in Arkansas when the state passed Act 900, which provided that:
PBMs are to tie reimbursement rates to pharmacies’ acquisition costs by timely updating their MAC lists when drug prices increase…
Due to extremely high demand, we created a second webinar on regulatory compliance. So, if you have not registered for our November 24th, 2020 webinar, we encourage you to register for this one, which will take place on December 2, 2020 at 6:30 pm PST. Both seminars have the same agenda. But we want to make sure everyone has an opportunity to ask questions and participate.
This webinar is geared towards pharmacy owners, managers, and…
In the most recent Script newsletter, the California State Board of Pharmacy explained that it received multiple complaints and observed practices where non-pharmacist staff were initiating the immunization process. It reminded that the authority to independently initiate and administer a vaccination extends only to pharmacists. The Board strongly encouraged pharmacies, designated pharmacists-in-charge, and pharmacists to evaluate their practices of initiating and administering vaccinations and take immediate corrective actions. Based on some of our cases, the…