Pharmacy News

AL Medicaid

H1N1

Need to Know

Legislative News Relative to Pharmacy

Alabama Medicaid 

Alabama Medicaid ALERT - Oil Spill

ALERT Letter 

PDL Update

DME Program Updates

H1N1 News (Click here for more information on the topics listed below)

  Pharmacist's Pandemic Preparedness Guide (download pdf)

  Business Pandemic Influenza Checklist (download pdf)

CDC Health Advisory - Seasonal Influenza A (H3N2) Virus Infections

FDA Approves Vaccines for the 2010-2011 Influenza Season

Need to Know

FDA News

For product safety information, please visit the MedWatch website.

To review MedWatch Drug Safety Labeling Changes please click here.

To view current drug shortages click here.

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Legislative News Relative to Pharmacy

Pharmacy Legislative Outcomes 2010
2010 Alabama Bills Impacting Pharmacy (view)

Congressional Topics of Interest to Pharmacy

Senate and House Pass Bill with Extension of Increased Funding to State Medicaid Programs 

The August 10 House passage follows Senate passage of the funding bill last week. The bill will now proceed to President Obama for enactment.

Bill Authorizing Secure Controlled Substance Disposal Methods Passes Senate

Financial Reform Bill
This legislation signed into law on July 28, 2010 includes a provision which would allow the Federal Reserve to set reasonable transaction fees for credit and debit card transactions. Now that the law has passed, pharmacies can apply  two of the amendment’s provisions right away: 1)  Establishing a minimum transaction amount (up to $10) for the use of a credit card; 2)  Offering discounts to customers for using a lower cost payment method (i.e., cash vs. credit card).

PBM Reform: H.R. 5234
The PBM Audit Reform and Transparency Act of 2010 recently introduced by Reps. Weiner (D-NY) and Moran (R-KS) expands the new PBM transparency requirements included in the health care reform bill to all plans both public and private. The legislation is also the first to try and reform PBM’s auditing practices.

DME Accreditation Exemption and Competitive Bidding: H.R. 5235
The Medicare Access to Diabetes Supplies Act was recently introduced by Reps. Welch (D-VT) and Rogers (R-MI). This legislation would not require competitive bidding on diabetic supplies provided by small pharmacies, defined as pharmacies with $7 million or less in annual sales.

2010 Resolution SJR78 passed

Creating an Educational Program for the Safe Disposal of Home Generated SHARPS

(Read the resolution)

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Alabama Medicaid

Alabama Medicaid ALERT - Oil Spill

Please click here for an ALERT regarding identification of oil-related illnesses.  Additional questions may be directed to the Provider Assistance Center at 1-800-688-7989.

Alabama Medicaid Pharmacy AAC/COD Submitted Rule Changes Now on Agency Website

Alabama Medicaid reimbursement modification submitted rule change and submitted State Plan Amendment is posted on the Agency website. Click here to review.

Medicaid ALERT Letter – Identifying Oil-Spill Related Illnesses

To: All Providers

RE: Identifying Oil-Spill Related Illnesses/Injuries for Medicaid Recipients

In order to track and evaluate health outcomes and costs related to the BP Oil Spill, the Alabama Medicaid Agency will begin use of claims billing indicators to identify services provided to Alabama Medicaid recipients when treated for an oil-spill related illness or injury.

Effective immediately, providers are asked to use the following indicators on applicable claims submitted to Alabama Medicaid:

• Professional Claims (837P, other electronic methods, or CMS-1500) – Enter Modifier “U9” (Disaster-Related Service or Illness) with all appropriate procedure codes. This modifier should follow any other modifiers currently required for claims payment.

• Institutional Claims (837I, other electronic methods, or UB-04) – Enter the Condition Code“DR” (Disaster-Related Service or Illness) as the first condition code with all appropriate services.

• Pharmacy POS Transactions – Enter the NCPDP Field Reason for Service Code

Providers should begin immediately to use these indicators on claims submitted for Medicaid payment. Please contact the Provider Assistance Center at 1-800-688-7989 with any related questions.

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Medicaid PDL Update

Effective July 1, 2010, the Alabama Medicaid Agency updated the Preferred Drug List (PDL) to reflect the recent Pharmacy and Therapeutics (P&T) Committee recommendations as well as quarterly updates.

The updates are listed below:

PDL Additions                                                                  

Besivance—EENT Preparations/ Antibactericals

PDL Deletions *

Pramox—Skin and Mucous Membrane Agent

Optivar—EENT Preparations/ Antiallergic Agents

*denotes that these brands will no longer be preferred but are still covered by Alabama Medicaid and will require Prior Authorization (PA). Available covered generic equivalents (unless otherwise specified) will remain preferred.

Also effective July 1, the Alabama Medicaid Agency added the First Generation Antihistamines to the Preferred Drug List (PDL).

Non-preferred brands in this class require prior authorization (PA) for payment. The Preferred Drug List (PDL) has been updated to reflect these changes. The criteria for the First Generation Antihistamines can be found on the Agency’s website at www.medicaid.alabama.gov and should be utilized by the prescribing physician or the dispensing pharmacy when requesting a PA.

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Updated Information from the Medicaid DME Program

Attention DME Providers

Correction to the information in the April 2010 Provider Insider Newsletter and information sent to DME providers from webwork@medicaid.ala regarding Medicaid’s coverage of procedure code E0140 (walker with trunk support, adjustable or fixed height, any type). The information that the Alabama Medicaid initially sent out stated that effective March 1, 2010 Alabama Medicaid would be covering specialty walkers for children up to the age of 21 through the EPSDT Program with procedure code E0140 using modifier U8. Medicaid will still be covering specialty walkers using procedure code E0140 but modifier U8 will no longer be required.

Effective May 1, 2010, Alabama Medicaid began reimbursing DME providers the amounts listed for the following procedure codes:

Reimbursement

E0149 - Walker, heavy duty without wheels, rigid or folding any type, each           $161.00 

Recipient’s weight, width and height must be submitted with prior authorization requests.

E0168 - Commode chair, extra wide and/or heavy duty, stationary or mobile, with or without arms, any type, each                 $191.50

Recipient’s weight, width and depth must be submitted with the prior authorization requests for these codes.

E0303 - Hospital bed, heavy duty extra wide, with weight capacity greater than 350 pounds, but less than or equal to 600 pounds, with any type side rails, with mattresses             $2,037.00

E0304 - Hospital bed, extra heavy duty, extra wide, with weight capacity greater than 600 pounds, with any type side rails, with mattresses

Medicaid will reimburse for this code based on provider’s invoice price plus 20%.

Recipient’s weight must be submitted with prior authorization requests for these codes.

E0911 - Trapeze bar, heavy duty, for patient weight capacity greater than 250 pounds, attached to bed, with grab bar                  $523.40

E0912 - Trapeze bar, heavy duty, for patient weight capacity greater than 250 pounds, free standing, complete with grab bar

Medicaid will reimburse for this code based on provider’s invoice price plus 20%.

Recipient’s weight must be submitted with prior authorization for these codes.

Effective June 1, 2010, The National Registry of Rehabilitation Technology Supplier (NRRTS) or the Rehabilitation Engineering Assistive Technology Society of North America (RESNA) certified professional must have direct, in person involvement in the wheelchair selection for the recipient. RESNA certifications must be updated every two years. NRRTS certification must be updated annually. Prior authorization requests will be denied if the NRRTS or RESNA professional’s certification is not current; the contractor will deny the PA request.

The Occupational Therapist (OT) or the Physical Therapist (PT) performing the wheelchair assessment may not be employed by the DME company or contracted with the DME company requesting the physical therapy evaluation.

Effective July 1, 2010, the current blood glucose test strips and lancets policy for non-insulin dependent recipients were changed as follows:

The number of blood glucose test strips were changed from two boxes each month to one box each month and lancets from one box per month to one box every two months for non-insulin dependent diabetics. If more than one box of blood glucose test strips or lancets is needed, the provider should submit the request for the additional strips or lancets with medical documentation from the primary physician to the LTC Medical Quality and Review Unit for review and approval.

Clarification for non-oxygen DME repairs (K0739, E1399)

Alabama does not require a PA for K0739 (repair or non-routine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes), however, a maximum of four units (1unit = 15 minutes) for non-oxygen related repairs requiring the skill of a technician is allowed.  Any repair request that requires labor exceeding the four units must be submitted to the LTC Medical Quality and Review Unit for review and approval.

Replacement parts are reimbursed based on the procedure code and fee schedule pricing.  In situations where there are no procedure codes or fee schedule reimbursement for the repair item(s), the provider must submit procedure code E1399 (durable medical equipment, miscellaneous) with an itemized list of the needed repair items with invoice pricing for each item.  Alabama Medicaid will reimburse for these repair items based on provider’s invoice price plus 20%.

Revised policy criteria for coverage of Adult (age -21-64) Prosthetic, Orthotic and Perdorthic Devices

Effective June 1, 2010, the procedure codes used for the billing of Prosthetic, Orthotic and Perdorthic Devices for Adults age 21-64 no longer require prior authorization.

Consignment Closets

Durable Medical Equipment (DME) will not be reimbursed if it is consigned. DME should be provided in accordance with Medicaid policy governing participation in the Alabama Medicaid Durable Medical Equipment (DME) Program (see page 14-2 of the Medicaid DME Provider Manual.) You will note that “DME providers must have a physical location in the state of Alabama or within a 30-mile radius of the Alabama State line.  Additionally, there must be one person to conduct business at the physical location.  Answering machine and/or answering services are not acceptable as personal coverage during normal business hours. Satellite businesses affiliated with a provider are not covered under the provider contract; therefore, no reimbursement will be made to a provider doing business at a satellite location, however the satellite could enroll with a separate NPI”. It is the position of the Alabama Medicaid Agency that equipment consigned to a clinic or physician office does not meet this requirement.

Alabama Medicaid usage of Invacare’s Seating/Mobility Evaluation Form

Effective August 1, 2010, Alabama Medicaid will require DME providers to complete

Invacare’s Seating/Mobility Evaluation Form as an attachment to the Alabama Medicaid Prior Review and Authorization form (Form 342).  Invacare’s Seating/Mobility Evaluation Form will replace Alabama Medicaid’s Motorized/Power Wheelchair Assessment Form (Form384). The Invacare Seating/Mobility Assessment Form will be accessible on the Alabama Medicaid website at www.Medicaid.Alabama.Gov; Billing; Forms; Prior authorization Forms.

Effective June 1, 2010, Alabama Medicaid began coverage of procedure code K0005 (ultra lightweight wheelchair).

Alabama Medicaid $50,000.00 Surety Bond Requirement Update

The Alabama Medicaid DME and Medical Supply providers will be required to have a $50,000 Surety Bond for each NPI by October 1, 2010.  A DME provider who has been a Medicaid provider for five years or longer with no record of impropriety, and whose refund requests have been repaid as requested will be exempt from the Alabama Medicaid $50,000 Surety bond requirement.

A DME and Medical Supply business is exempt from surety bond requirements if the DME and Medical Supply business:

(a) Is a DME supplier who has been a Medicaid provider for five years or longer with no record of impropriety, and whose refund requests have been repaid as requested; or

(b) Is a government-operated Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS); or

(c) Is a state-licensed orthotic and prosthetic personnel in private practice making custom-made orthotics and prosthetics; or

(d) Are physicians and non-physician practitioners, as defined in section 1842(b)(18) of the Social Security Act; or

(e) Are physical and occupational therapists in private practice; or

(f) Are providers who received $100,000 or less Medicaid payment in the past two calendar years; or

(g) Are pharmacy providers; or

(h) Are phototherapy providers who only provide phototherapy services for infants; or

(i) Are Federally Qualified Health Centers.

DME suppliers who have been a Medicaid provider for five years or longer who are initially exempted from the Medicaid Surety Bond requirement as referenced in Rule (12)(a) of Administrative Code , Chapter 13, will be subject to the Surety Bond requirement if the Medicaid Agency identifies a consistent problem with improper billing or fraudulent activity.

DME providers requesting initial enrollment as an Alabama Medicaid provider will be required to have a $50,000 Surety Bond for three years before qualifying for the $100,000 two year exemption.

If you have additional questions or need further clarification, please contact Ida Gray at 334-353-4753.

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H1N1 News

CDC Health Advisory - Seasonal Influenza A (H3N2) Virus Infections

Summary
Influenza A (H3N2) virus infections have been recently detected in people in a number of states across the U.S., including two small localized outbreaks. Sporadic cases of influenza and localized summer outbreaks from seasonal influenza viruses are detected each summer. Clinicians are reminded to consider influenza as a possible diagnosis when evaluating patients with acute respiratory illnesses, including pneumonia, even during the summer months. Treatment decisions should not be made on the basis of a negative rapid influenza diagnostic test result since the test has only moderate sensitivity. False positive results also can occur, particularly at times when overall influenza prevalence is low. For patients for whom laboratory confirmation is desired, or to confirm initial influenza cases in a community in which cases have been tested by rapid influenza diagnostic tests, it is recommended that reverse transcriptase -polymerase chain reaction (RT-PCR), and/or viral culture is utilized. Clinicians should use empirical treatment with influenza antiviral medications for persons hospitalized with suspected influenza, and for suspected influenza infection of any severity in high-risk individuals, regardless of influenza immunization status. Early initiation of treatment provides more optimal clinical responses, although treatment of moderate, severe, or progressive disease begun after 48 hours of symptoms can still provide benefit.

Background
During late June and July, 2010, the number of seasonal influenza A (H3) viruses reported to CDC increased slightly compared with previous months. In the first part of July, two small RT-PCR-confirmed outbreaks were detected in two non-bordering eastern counties in Iowa. The first included four of 13 members of a college sports team who became ill. Three of the four tested positive for influenza A by rapid tests and two of the three were further tested and found to be positive for influenza A (H3) by RTPCR. The second outbreak involved nine of 12 children in a child care setting and one parent reporting influenza-like illness; two were rapid test positive for influenza A and one was PCR positive for influenza A (H3). Specimens and isolates have been sent to CDC for further characterization. None of the patients had a history of recent travel and no epidemiological links were identified between the two outbreaks. Between June 20 and July 23, 2010, CDC also received additional influenza A (H3) positive specimens from 11 other states along with a smaller number of sporadic samples positive for 2009 H1N1 influenza A and B viruses. Localized summer outbreaks in the United States from seasonal influenza viruses and sporadic cases of influenza are detected each summer. Antigenic characterization of the influenza A (H3) viruses received at CDC are pending. However, based on hemagglutinin gene sequencing data from four viruses isolated from July specimens, these viruses are expected to be antigenically similar to A/Perth/16/2009-like H3N2 viruses. An A/Perth/16/2009-like H3N2 virus is included in the 2010-11 seasonal influenza vaccine. Perth-like H3N2 viruses were first identified in early 2009, but have not yet circulated widely in the United States. Past influenza vaccines did not contain this strain, so vaccination with last year’s seasonal vaccine would not be expected to provide substantial protection against this H3N2 Perth-like strain.

Recommendations
Health care providers are reminded to consider influenza as a possible diagnosis when evaluating patients with acute respiratory illnesses, including pneumonia, even during the summer months. The neuraminidase inhibitors oseltamivir (Tamiflu®) and zanamivir (Relenza®) are currently recommended for use against circulating influenza viruses. The adamantanes (amantadine and rimantadine) are not recommended because of high levels of resistance to these drugs among recently circulating influenza A (H3) and 2009 H1N1 pandemic viruses. Clinical judgment is an important factor in treatment decisions for patients presenting with influenza-like illness. Prompt empiric antiviral treatment with influenza antiviral medications is recommended while results of definitive diagnostic tests are pending, or if diagnostic testing is not possible, for patients with clinically suspected influenza illness who have: Illness requiring hospitalization, progressive, severe, or complicated illness, regardless of previous health status, and/or patients at increased risk for severe disease. Persons at high risk of influenza complications include people aged 65 years and older, young children, pregnant women, people with long-term health conditions like asthma, diabetes, neurologic and neurodevelopmental disorders, heart disease, and people with immunosuppressive conditions or medications.

Antiviral treatment, when clinically indicated, should not be delayed pending definitive laboratory confirmation of influenza. Influenza antiviral medications are most effective when initiated within the first 2 days of illness, but these medications may also provide benefits for severely ill patients when initiated even after 2 days. Point of care rapid tests capable of detecting influenza A and B virus infections are available, but health care providers and public health personnel should be aware that rapid influenza diagnostic tests have limited sensitivity and false negative results are common. Thus, negative results from rapid influenza diagnostic test should not be used to guide decisions regarding treating patients with influenza antiviral medications. In addition, false positive tests can occur and are more likely when influenza is rare in the community. When laboratory confirmation is desired, testing by RT-PCR and/or viral culture is recommended. Providers are asked to report unusual increases in febrile respiratory disease outbreaks to their local and state health departments and to confirm positive rapid test results with PCR or culture when community circulation of influenza viruses is low.

For More Information
More information on influenza prevention, diagnosis and treatment can be found at www.cdc.gov/flu.
Beginning this influenza season, the Advisory Committee on Immunization Practices (ACIP) recommends influenza vaccination of all persons 6 months of age and older. These updated recommendations can be found at http://www.cdc.gov/mmwr/pdf/rr/rr59e0729.pdf.

Click here for WHO site information.

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 FDA Approves Vaccines for the 2010-2011 Influenza Season

Food and Drug Administration (FDA) approved vaccines for the 2010-2011 influenza season in the United States on July 30, 2010. The seasonal influenza vaccine protects against three strains of influenza, including the 2009 H1N1 influenza virus, which caused the 2009 pandemic. Last year, two separate vaccines were needed to protect against seasonal flu and the 2009 H1N1 pandemic flu virus because the 2009 H1N1 virus emerged after production began on the seasonal vaccine, but this year, only one vaccine is necessary. The Centers for Disease Control and Prevention has published recommendations for annual influenza vaccination to include all people aged six months and older. The expanded recommendation is to take effect in the 2010-2011 influenza season. More information on the approved vaccine is available in an FDA News Release.

Attention Immunizing Pharmacists

The CDC has posted communications materials related to the Advisory Committee on Immunization Practices (ACIP) recommendations on the use of CSL Biotherapies vaccine (brand names Fluvax Junior and Fluvax) for the 2010-2011 influenza season. CDC’s ACIP media statement and Q&As can be found at the following URL’s on the Web. For more information, visit:
- ACIP Media Statement: http://www.cdc.gov/media/pressrel/2010/s100806.htm
- Q&A: CSL Seasonal Influenza Vaccine Safety in the United States: http://www.cdc.gov/flu/protect/vaccine/qa_cslfluvac.htm

Immunization Tips for pharmacists from the Immunization Action Coalition. (read more)

ADPH Announces Plans for Returning Expired H1N1 Vaccine

The Alabama Department of Public Health is assisting in the federal H1N1 Vaccine Recovery Program. Information on the program has been sent to all medical providers who ordered H1N1 influenza vaccine through the department in 2009 and 2010.

There are two phases of returning vaccine planned. Phase one involves vaccine which has now expired. This vaccine was supplied from three different pharmaceutical companies. The department is expected to ship 78,000 doses back to the federal government in this phase.

Phase two involves returning remaining doses of vaccine in late July and early August. This H1N1 vaccine was supplied by a fourth pharmaceutical company. The department will ship back 92,000 doses in this phase.

“The recovery program is intended to remove doses of monovalent H1N1 vaccine before the seasonal influenza vaccine comes to provider offices,” said Winkler Sims, director of the Immunization Division. “This will decrease confusion with seasonal influenza vaccine which will become available in late August and early September to provide protection in the coming flu season.”

The 2010-2011 seasonal flu vaccine will have the normal number of three flu strains, one of which will be H1N1 A/California. Individuals who were vaccinated with H1N1 vaccine will still need to be vaccinated with the seasonal flu vaccine to have protection from all three strains that are expected to be circulating during the next flu season.

Detailed instructions on disposal procedures are listed below. For more information contact the Immunization Division at 1-800-469-4599.

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Advance Notice for Termination of the Emergency Use Authorization (EUA) of Medical Products and Devices

Per the FDA-issued advance notice letters listed below, the declaration of Public Health Emergency determination for 2009 H1N1 Influenza expires on June 23, 2010.

• Termination of Declarations of Emergency Justifying EUA of Certain Antiviral Drugs: Tamiflu (oseltamivir phosphate), Relenza (zanamivir), and Peramivir 
• Termination of Declaration of Emergency Justifying the Authorization of Emergency Use of Certain Personal Respiratory Protection Devices 
• Termination of Declaration of Emergency Justifying EUA of Certain In Vitro Diagnostic Tests 

Information regarding Termination and Disposition of CDC-requested and FDA-issued EUA Products: Antiviral Drugs:

• Relenza (zanamivir) and Tamiflu (oseltamivir)
• Disposition Letter for Relenza and Tamiflu 
• Attachment 1 to the Disposition Letter for Relenza and Tamiflu: Questions and Answers Regarding Termination of the Emergency Use Authorizations (EUAs) for Tamiflu (oseltamivir) and Relenza (zanamivir) 
• Attachment 2 to the Disposition Letter for Relenza and Tamiflu:Update regarding Stockpiled Antivirals at or Nearing Expiration 
• Peramivir IV
• Disposition Letter for Peramivir IV 
• Attachment to the Disposition Letter for Peramivir: Questions and Answers for Hospitals and Healthcare Professionals Regarding Termination of the Emergency Use Authorization (EUA) for Peramivir IV 

Devices:

• N95 Respirators
• Disposition Letter for Certain Personal Respiratory Protection Devices Authorized for Emergency Use 

For questions regarding EUAs, contact: EUA.OCET@fda.hhs.gov

Pharmacist Vaccinators Are Encouraged to Enroll in ImmPRINT

Pharmacist vaccinators statewide are encouraged to become informed about and to register for ImmPRINT (Immunization Provider Registry with Internet Technology). The Immunization Division of the Alabama Department of Public Health manages this immunization registry. Alabama's immunization database, which began development in 1997, is accessible to vaccine providers and their staff statewide, free of charge, via the Internet. ImmPRINT is a population-based registry with patients of all ages. With each provider enrollment, immunization histories become more comprehensive.

For more information on ImmPRINT enrollment or to answer any other questions, please contact Mike Hudgens or Sharon Jenkins via the web at adph.org/immunization or by phone at 1.800.469.4599 or 1.334.206.5023

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Need to Know

Free Online Service Helps Alabama Tobacco Users Quit

Alabamians tired of being addicted to tobacco have a new free service to help them quit. The service -- Alabama QuitNow-- is a web-based program designed to work with the user to make a personalized plan for quitting tobacco. This service includes free master’s level counseling and four weeks of free nicotine replacement therapy (NRT) patches if the user is actively engaged in counseling and is medically eligible.

The site is available 24 hours a day, seven days a week. Tobacco users can log in and begin the counseling process. Anyone can visit the site for information or register to become a member. Members can chat with other users who are quitting at the same time.

While anyone can visit the site, free counseling services and NRT are available to Alabama residents only. Alabamaquitnow.com is funded through the Alabama Department of Public Health (ADPH) with a grant from the American Recovery and Reinvestment Act.

The free online service is in addition to the Alabama Tobacco Quitline, a phone-based service that provides the same free programs to users who prefer to talk to a counselor to make their quit plan. Callers may dial 1-800-QuitNow (1-800-784-8669) and sign up for phone services. Alabama’s Quitline has been in operation since 2005 and is funded by ADPH and the Centers for Disease Control and Prevention.

Alabama has one of the highest smoking rates in the nation; more than one in five Alabamians use tobacco. More than 7,600 Alabamians die each year as a result of their smoking, with another 850 nonsmokers in the state dying as result of secondhand smoke.

Free Internet and telephone services mean no one has to leave home or pay for medication to help them quit. Individuals must be enrolled in counseling to get the free NRT. The NRT is mailed directly to the user if there are no concerns about medications the user is taking. If the user is taking certain medications that could interfere with the NRT, the Quitline will ask the user’s doctor for permission to send the NRT.

Live counselors are available at both services from 8 a.m. to 8 p.m. Monday through Friday and on Saturday from 9 a.m. to 5:30 p.m. Messages can be left after those hours and will be returned the next business day. A Spanish-speaking counselor is available, and other languages are available as needed through a translator program for the phone service.

Healthcare providers can use the fax referral form found on the ADPH Web site and on the Alabama QuitNow site to refer their patients. Counselors at the Quitline or alabamaquitnow.com can directly contact the patient to help him or her make a plan to quit tobacco use. If the patient agrees, the healthcare provider can have access to the patient’s progress in quitting tobacco. Tobacco users are twice as likely to quit if recommended by their healthcare provider. ADPH also provides accredited training for healthcare provider staff.

For more information about Alabama QuitNow or the Quitline, call Julie Nightengale at (334) 206-6432.

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Highly contagious pertussis re-emerges; required TDAP vaccine protects against it

Pertussis is a highly contagious and sometimes fatal bacterial disease which has increased alarmingly in the past decade. To help provide protection, all students 11 and older entering the sixth grade in Alabama schools this school year must have a tetanus-diphtheria-acellular pertussis (Tdap) vaccine.

Each pupil 11 or older who enters the sixth grade will be required to have a new certificate of immunization. This is because of the change from tetanus-diphtheria (Td) to (Tdap) vaccine.

The Tdap vaccine will protect adolescents from pertussis and keep them from spreading disease to siblings, other family members and other students. The Tdap school requirement will go up by one higher grade each school year. For example, Tdap will be required for students entering seventh grade in 2011-2012, eighth grade in 2012-2013, up through twelfth grade in 2016-2017.

“Adolescents have one of the highest rates of pertussis cases,” said Winkler Sims, director of the Immunization Division of the Alabama Department of Public Health. “The new sixth grade requirement for students age 11 or older will protect students from pertussis at the adolescent age in school and will protect them through the remainder of their school experience.”

The number of reported pertussis (whooping cough) cases in Alabama in all ages has increased from 68 in 2008 to 315 in 2009. Already in the first six months of 2010 there have been 93 reported cases of pertussis.

Pertussis is a bacterial infection of the lungs and spreads from person to person through moisture droplets in the air, probably from coughs or sneezes. A person with pertussis develops a severe cough that usually lasts four to six weeks or longer.

For more information contact the Immunization Division at 1-800-469-4599.

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BCBS - IMPORTANT ACTION REQUIRED

Effective 07/01/2010, Blue Cross and Blue Shield of Alabama will change BIN’s for all Part D business. Medicare Part D members were issued new cards indicating the new BIN information. Please refer to the member’s card for filing claims.  

In addition, commercial claims for date of service prior to 07/01/2010 will also use a ‘run out’ BIN.

Pharmacies will have difficulty reversing transactions processed under the old BIN after 07/01/2010 when new BINs must be used.  It is vital to reverse all necessary transactions by 06/30/2010 in order to prevent disruption. 

View the copy of Pharmacy Focus that has the BIN/PCN changes itemized.  If you have any questions please contact Becky Tutwiler, Senior Pharmacy Network Analyst at 205-220-6545.

NAN Alert: Potential for Serious or Fatal Errors Due to Epinephrine Shortage

The National Alert Network (NAN) for Serious Medication Errors was activated on June 16, 2010, for an urgent message on the potential for serious or fatal errors with epinephrine due to a shortage of emergency syringes. As epinephrine emergency syringes 1 mg/10 mL are currently on backorder, the NAN advises health care providers of various errors that may occur with the use of alternative injectable epinephrine products. The message also advises pharmacists to evaluate all potential areas where epinephrine emergency syringes are used, including area emergency services and response teams, and communicate information about the shortage and recommended substitute products. Additional specific recommendations are included in the alert.

Pharmacy Verification Network

Single-source, secure database of pharmacy managed profiles required for verification and credentialing (overview) (learn more)

Additional Patient Care Opportunities to be Released!
Mirixa Corporation has launched initial Community CCRx? Welcome Program 2010 cases in mid-February. Visit www.Mirixa.com to log in and check for your available opportunities.
The Welcome Program is available to all new Community CCRx beneficiaries, and cases are created based on patient requests for service under the program. This program offers patients a comparison of the patient’s current medications to the Community CCRx formulary, and is designed for pharmacists to recommend cost-saving changes to the patient’s medication therapy. If you identify a new Community CCRx member, you should encourage the member to contact Community CCRx Customer Service at 866.684.5353 to request this service specifically at your pharmacy. Based on the patient’s request, your pharmacy will receive a Welcome Program patient care opportunity for that specific patient.

ACIP issues 2010 clinical guidelines regarding adult immunizations

(posted 1/29/10) (read more)

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CMS Delays Ban on Faxed Prescriptions
Deadline Moved to Jan. 1, 2012
Physicians who participate in Medicare and depend on computer-generated faxes to transmit prescriptions to pharmacies can breathe a collective sigh of relief. CMS has extended its deadline for banning faxed prescriptions by three years, moving the Jan. 1, 2009, deadline to Jan. 1, 2012.
The deadline change is included in the 2009 Medicare Physician Fee Schedule final rule announced by CMS on Oct. 30. According to CMS' press release, the agency reversed its position "in the interest of patient care and safety and to encourage prescribers and dispensers to adopt e-prescribing."
Although many physicians initiate prescriptions through their electronic health record, or EHR, systems, their computers actually generate a fax to the pharmacy.

Had the deadline been imposed on Jan. 1 of next year, many physicians might have reverted back to paper-based prescriptions.
E-prescribing offers proven benefits to physicians, including reductions in medication errors, a reduced call burden from pharmacies and electronic access to formulary information.

(read the CMS press release)

Annual Inventory of Controlled Substances 680-X-3-.08
(1) Every pharmacy shall take an initial inventory of all controlled substances on hand and shall take a new inventory of all stocks of controlled substances on hand on January 15th or the alternative fixed date approved by the Board of each year following the date the initial inventory was taken.
(4) The inventory by a pharmacy must be taken either as of the opening of business or as of the closing of business. The pharmacy shall indicate on the inventory records whether the inventory was taken as of the opening of business or as of the close of business, the date the inventory was taken, followed by the person responsible for taking the inventory.
(5) In determining the number of units of each finished form of a controlled substance in a commercial container, which has been opened, the pharmacy shall do as follows:
(a) If the substance is listed in Schedule II, an exact count or measure of the contents shall be made.
(b) If the substance is listed in Schedule III, IV or V, an estimated count or measure may be made of the contents unless the container holds more than 1000 tablets or capsules in which case an exact count of the contents must be made.
Compliance Note: The yearly inventory document will be an item reviewed during a routine inspection. KEEP IT ACCESSIBLE!

Report on Pharmacy Education and Training: Relevance to Clinical Practice and the Expanding Role of Pharmacists

(read the article)

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