New Mexico
Pharmacists Association


Pharmacy Benefits Manager Regulation 59A-61

Click here to see the statute


Audit of pharmacy records 61-11-18.2.

Click here to see the statute


Pharmacies billing Medicaid when providing vaccinations!

Xerox has  implemented this in the system, so pharmacies can now bill Medicaid for vaccine  administration.

Click here to see the updated payer sheet

with instructions on how  to bill for vaccine administration (see segments 438-E3 and 440-E5).

There is no specific limitation on the vaccines eligible for the administration fee. Vaccine administration may be billed for any vaccine that the pharmacist is certified to administer and that is covered under the Medicaid recipient’s category of eligibility.

It is important to note that only one vaccine administration fee is allowed for each “poke” regardless of how many components are in the vaccine.


There are two Supplements on the topic available at:

http://www.hsd.state.nm.us/mad/pdf_files/Registers/Registers2013/1301%20Primary%20Care%20Increase%20Revised%20Feb%202013.pdf

and

http://www.hsd.state.nm.us/mad/pdf_files/Registers/Registers2013/1303%20Primary%20Care%20Increase%20Feb%202013.pdf


59A-Prompt Payment requirements


Billing Medicaid for OTC Emergency Contraception


Link to the Medicaid Supplement authorizing OTC billing - click here
Link to payment flow chart and billing mechanism


Other Resources:


CMS - Medicare/Medicaid Resources


Two New Electronic Prescribing Section Pages Now Available 

The Centers for Medicare & Medicaid Services (CMS) is pleased to announce that two (2) new section pages have been created on the 2009 Electronic Prescribing (E-Prescribing) Incentive Program web page on the CMS website.

E-Prescribing Measure Section page - This page contains several resources including: Measure Specifications; new Claims-Based Reporting Principles and a Sample E-Prescribing Claim.   To access these resources, visit http://www.cms.hhs.gov/ERxIncentive/06_E-Prescribing_Measure.asp on the CMS website.  

Educational Resources Section Page – This page contains MLN Matters articles; E-Prescribing Incentive Program fact sheets; a link to Medicare’s Practical Guide to the E-Prescribing Incentive Program, and information on how to receive continuing education credit related to the E-Prescribing Incentive Program. To access these resources and information, visit http://www.cms.hhs.gov/ERxIncentive/09_Educational_Resources.asp on the CMS website. 

New and updated information will continually be added, so please visit the E-Prescribing Incentive Program web page at http://www.cms.hhs.gov/ERXIncentive on the CMS website on a frequent basis.


CLIA Waiver Process Information

CLINICAL LABORATORY IMPROVEMENT AMENDMENTS (CLIA)

Linked below are documents from the CDC that discusses best practices for CLIA waived testing that is very helpful and describes proper policies and procedures for anyone wanting to provide testing.

It is highly recommend that any pharmacy that provides CLIA waived testing develop a policy and procedures manual so that proper testing can be performed for each patient.  The policy and procedures manual needs to include procedures for each test and should include documentation of quality control (testing of new lots of test cassettes or reagents, testing the device, documenting proper storage, etc).

Q & A:

Answers from Joe Anderson at UNM College of Pharmacy.

How difficult is it to get a CLIA Waiver?  

It is not hard at all.  Those interested should contact the New Mexico Department of Health for specific information.  A power point slide show is linked below that I think will help folks to understand better.

Do you have to register the pharmacy as a lab?

You can register as a pharmacy or as a lab or several other categories (see slide show).  A Pharmacy should register as a mobile laboratory if you plan to do screenings at a variety of locations.

What does a CLIA waiver allow you to do?  

It allows you to offer laboratory testing to patients for tests that are CLIA-waived.  Click the link for a list of CLIA-Waived tests.

Joe R. Anderson, PharmD, PhC, BCPS

Associate Professor
UNM College of Pharmacy


Pharmacies must have quality improvement programs in place to comply with CMS requirements for Part D programs.

Click either link below for program information:

APMS
Copy of pqc01

Summary of DEA Final Rule Disposal of Controlled Substances

On September 8, 2014, the Drug Enforcement Administration published the final rule on the disposal of controlled substances. The rule becomes effective on October 9, 2014.

OVERVIEW

The final rule sets requirements for DEA registrants (including pharmacies) that voluntarily decide to establish disposal programs to collect unwanted controlled substances from ultimate users. The final rule expressly states that disposal programs are voluntary and no person is required to establish or operate a disposal program. The rule allows numerous DEA registrants to become authorized to establish disposal programs including manufacturers, distributors, reverse distributors, narcotic treatment programs, hospitals/clinics with an on-site pharmacy, and retail pharmacies. These persons may become authorized to have disposal programs by modifying their DEA registrations.

Click here to download the NACDS summary!


FDA publishes the Purple Book

Lists of Licensed Biological Products with Reference Product Exclusivity and Biosimilarity or Interchangeability Evaluations.

Get the FDA Purple Book on the FDA website


The Purple Book lists biological products, including any biosimilar and interchangeable biological products, licensed by FDA. The lists include the date a biological product was licensed under 351(a) of the PHS Act and whether FDA evaluated the biological product for reference product exclusivity under section 351(k)(7) of the PHS Act.

The disposal summary and the Purple Book information were provided by the National Association of Chain Drug Stores.


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