Member Pharmacy Resources
Department of Health Standing Orders for contraception:
New Mexico Statewide Standing Order for Registered Pharmacist to Dispense:
Medicaid Community Pharmacy list - updated July 2, 2023
Click here to see the list of Community Based Pharmacies through the NM Medicaid Program! FYI - Medicaid wants to make sure all independent community pharmacy providers for NM patients, in New Mexico and surrounding states, are included in their list.
Reimbursement by Medicaid MCO's for Pharmacist Clinical Services as required by HB 42 - 7/15/2022
Blue Cross Blue Shield - Prime Therapeutics
Presbyterian - OptumRx
Western Sky Community Care - CVS Caremark - updated document 8/8/22
Western Sky Community Care created - special instructions just for Vaccines for HB42
document - posted 11/16/22
Medicaid Supplement issued March 2022 regarding reimbursement for Pharmacists clinical services (HB 42 implementation)
Superintendent of Insurance information This is a bulleting from our Superintendent regarding the requirement for health plans to comply with the pharmacists reimbursement parity law (HB 42).
Health Plan Resources:
The following information is posted at the request
Donna Williams
Virtual Care Advocate
MedicarePlans.com
MEDICARE AND MEDICAID GUIDE FOR LOW-INCOME RECIPIENTS
If you have low income, you may qualify for help with Medicare costs.
I’m sure you know that navigating the healthcare system for you and your family can feel like an impossible task. For those with lower income, it can feel even more daunting with all the costs involved. As a Medicare resource center (Note: we do not sell or provide healthcare plans), we’ve made it our mission to tackle these complicated issues to empower those with the right to affordable healthcare.
Our new resource, reviewed by experts, helps inform seniors and people with disabilities about how Medicaid works with Medicare. We cover the dual eligibility standards, how to apply, and most importantly, the associated costs.
You can view the guide here:
Virtual Care Advocate
MedicarePlans.com
Pharmacist Survey - September 15 - from NM Human Services Department
COVID Treatment Trials and Increased Access to COVID Testing Come to Northern NM
COVID-19 Vaccine Billing Guidance - information from PAAS National.
BUY PAAS TODAY - member promotion from PAAS National
Provider Referral COVID-19 Monoclonal Antibody Therapy - Presbyterian
Abundant Love Health Care LLC,
I am glad to inform the New Mexico Pharmacist Association about the establishment of my new pharmacy practice, which would have been open by now but for the COVID -19. I just got my Masters in Public Health with concentration in Nutrition.
The name of my parent company is Abundant Love Health Care LLC, but my pharmacy practice is called Public health Pharmacist clinic. As a public health official we work in collaboration with other organizations, as a pharmacist and a member, I would like to link the NMPA website to Public Health Pharmacist Clinic. Please visit www.publichealthpharmacistclinic.com.
Ifeoma Achusim RN, PharmD, MPH.
Public Health Pharmacist Clinic
2921 Carlisle Blvd NE
Albuquerque, NM 87110
1 (505) 832-7162
https://www.publichealthpharmacistclinic.com
Immunization Resources
Frequently Asked Questions about Routine Vaccinations due to COVID-19 Current as of May 5, 2020—clinic priorities will likely change in the future. Call your provider for more information
New Medicaid Contractor Information from Western Skies Community Care:
Flyer for Western Skies and the CVS/Caremark PBM!
New Mexico Department of Health - Tobacco Use Prevention and Control (TUPAC)
CMS Information Update: New information September 27, 2018
How Medicare Drug Plans Use Pharmacies, Formularies, & Common Coverage Rules
Finding NADAC pricing information:
The NADAC (and the ACA FUL) are found on the links on the following website:
https://www.medicaid.gov/medicaid/prescription-drugs/pharmacy-pricing/index.html
You enter the NDC code in the search function once you have gone to the time period you want. It seems to work well.
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
During the 2021 Legislative Session, the prompt pay/clean claims requirement for pharmacy reimbursement was modified to require payment within 15 days of the pharmacy filing a prescription drug claim with a health plan or PBM. We hope to get the appropriate document on line in this location soon.
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.Â
Educational Resources Section Page â“ This page contains MLN Matters articles; E-Prescribing Incentive Program fact sheets; a link to Medicareâ™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:
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.
