In This Issue:

MPA CEO Perspective

MPA News

• Jalloul Awarded Hubert H. Humphrey Award
• MPA Welcomes Student Pharmacist for March

National Association News

• APhA Releases Survey Results Quantifying the Impact of PBMs
• ASHP-Accredited Webinar on Technician Shortage

MPA Member Updates

• Renew Your MPA Membership Now
• Cabrini Clinic Volunteer Opportunities
• MPF 2023 Golf Classic — Save the Date

CE Events

• Upcoming CE Opportunities

Legislative and Regulatory News

• Recording Available for PBM Transparency Act Hearing
• FDA Approves New Nasal Spray for Migraines
• Upcoming Changes to Michigan Driver's Licenses and IDs
• Michigan Dispensing Law Changes
• Medicare to Expand CGM Coverage for People with Type 2 Diabetes
• Proposed Medicaid Policy Changes for CGMS
• Michigan Senate OKs Abortion Ban Repeal

COVID-19 Updates

• MDHHS Addresses End of PHE in May
• Moderna Under-6 Vaccine Minimum Order Quantity Update
• MDHHS Issues Proposed Medicaid Policy

State News

• MDHHS Launches OpiRescue Smartphone App to Help Michigan Residents Prevent and Reduce Opioid Overdoses

Professional Practice

• VPD Evaluation and Reporting
• MDHHS Provider Relations Seeks Feedback

The snow falling outside my window only makes me dream about one thing – the MPF Golf Classic that tees off at 9 a.m. June 21, 2023, at Eldorado Golf Course in Mason. Whether you’re planning to golf or to sponsor, please save the date now so you won’t forget to register when the time comes later this month. It’s a great time to golf with friends and network with business acquaintances who can help you succeed. And let’s not forget the great food and prizes for everyone in support of the Foundation!

If June seems far off for warm temperatures, then plan to spend some time at the Michigan Reception during the American Pharmacists Association (APhA) Annual Meeting March 24-27, 2023. All Michigan attendees are welcome to attend as guests of the event in the Sheraton Phoenix Downtown, Ahwatukee B, from 5 to 7 p.m. March 25. Beer, wine and appetizers will be served. Hosts include the Michigan Pharmacists Association (MPA), Ferris State University College of Pharmacy, University of Michigan College of Pharmacy and Wayne State University Eugene Applebaum College of Pharmacy and Health Sciences.

Somewhere in between is the National Community Pharmacists Association (NCPA) Congressional Fly-in April 26-27, 2023, in Alexandria, Virginia. If you’re passionate about independent pharmacy and the need for pharmacy benefit manager (PBM) reform, then you absolutely need to be in attendance. Please register via this link, then contact MPA Director of Government Affairs Eric Roath (eroath@michiganpharmacists.org), to let him know of your interest in meeting with members of the Michigan Congressional delegation. We will schedule Congressional visits in concert with NCPA and contact you with your schedule.

So much to look forward to! Hope to see you at ALL of these events.

Jalloul Awarded Hubert H. Humphrey Award

Congratulations to our very own Farah Jalloul, Michigan Pharmacists Association (MPA) director of professional development, who has been named the 2023 Hubert H. Humphrey Award winner by the American Pharmacists Association (APhA)!

The award is named after the former United States vice president and senator, who also was a pharmacist and a longtime APhA member. The Humphrey Award was established in 1978 "to recognize APhA members who have made major contributions in government and legislative service."

In addition to her role with MPA, Jalloul transitioned into a liaison role between MPA and the Michigan Department of Health and Human Services (MDHHS) during the COVID-19 pandemic. She facilitated discussions between state officials and pharmacists throughout Michigan. She continues to serve as the state's pharmacy emergency preparedness coordinator and represents pharmacy on a state level.

MPA Welcomes Student Pharmacist For March

Shaina Shah is a fourth-year Pharm.D./MBA dual-degree student at the University of Toledo who is joining the Michigan Pharmacists Association (MPA) for the month of March.

"I am really excited to complete a rotation with MPA and learn more about patient advocacy and expand my understanding of association management," Shah said.

After graduation, Shah will be moving to Connecticut to complete a two-year medical affairs and scientific communications fellowship program with Boehringer Ingelheim. 

Fourth Edition Pharmacy Law Books Available to Purchase

The fourth edition of Michigan Pharmacists Association's "Pharmacy Law Simplified: A Practical Approach to Contemporary Practice" is now available for purchase!

"Michigan Pharmacy Law Simplified" is intended to be informative and provides additional guidance to pharmacy professionals in relation to pharmacy practice in the state of Michigan. The book compiles state and federal laws and rules relevant to the practice of pharmacy, avoiding legal jargon.

To get your hands on a copy, visit the MPA store, fill out the Online Store Order Form and email it to MPA@MichiganPharmacists.org.

APhA Releases Survey Results Quantifying the Impact of PBMs

The American Pharmacists Association (APhA) recently announced the results of a survey regarding the effects of pharmacy benefit managers (PBMs).

APhA’s survey sought to collect and quantify current pharmacists’ experiences with PBMs to inform policymakers and the public about their impact on pharmacies, pharmacists and patients.

Survey respondents (547) represented all settings of pharmacy practice in all U.S. regions and were distributed across the spectrum, including recent graduates, longtime practitioners and pharmacy owners. The survey was conducted by APhA from Jan. 28, 2023, to Feb.15, 2023, and methodology can be found here.

 Key findings included the following:

• 91.5 percent of respondents agreed that PBM practices are negatively affecting their practice and their ability to provide patient care.
• 93.3 percent of respondents agreed that patient steerage practices impact their pharmacy and the patient care they provide. (Patient steering is requiring or incentivizing patients to use certain pharmacies, often ones owned by the PBM).
• 88.5 percent of respondents agreed that “clawback” fees impact their pharmacy and the patient care they provide. (These are fees collected by the PBM after the point of sale, increasing patient out-of-pocket costs for medications. They are also known as DIR fees, or price concessions).
• 82 percent of the respondents agreed that spread pricing impacts their pharmacy and the patient care they provide. (Spread pricing is a practice in which the PBM charges the plan sponsor more than they pay the pharmacy for medication and keeps the “spread” as a profit).
• 75 percent of pharmacists disagreed that the current ingredient costs/dispensing fees they receive from PBMs are sufficient to sustain their pharmacy business. This includes reimbursements from the PBM to the dispensing pharmacy for the cost of drugs and services provided to a patient.
• When asked about federal policy solutions that could alleviate PBM issues, respondents called for transparency and accountability from PBMs first and foremost.

ASHP-Accredited Webinar on Pharmacy Tech Shortage

The pharmacy technician shortage remains an issue for many health systems. The American Society of Health-System Pharmacists (ASHP) has developed a comprehensive website, podcasts and expert articles on this issue and now has a live webinar prepared for March 28. ASHP is producing all the content and resources. Chiesi has provided grant support. 

Click here for more information on the March 28 webinar. The program offers 1.0 contact hours of free credit. 

Renew Your Membership Now Before It's Too Late!

There are many benefits to renewing your membership with the Michigan Pharmacists Association (MPA) including:

• Direct access to experts that can answer law and practice questions
• Networking opportunities with pharmacy professionals, such as complimentary membership in our local county associations and practice sections
• Free and discounted CE opportunities such as the MPA Annual Convention and Exposition - the state’s largest pharmacy conference
• Being part of the collective voice advocating for the future of the profession
• MPA Career Connect, a free service for you and other pharmacy professionals looking for job opportunities
• Competitive home, auto, life and business insurance through MPA’s affiliated PSI Insurance Agency

MPA exists for and is effective because of its members. RENEW today to ensure that your benefits are secured and that MPA has the resources to move the mountains ahead for you, for the profession and for patients.

If you are not renewed by March 30, 2023, you will no longer be considered an MPA member and will not receive PRN. If you choose not to renew, this will be the second-to-last edition of PRN you receive.

Michigan Pharmacy Foundation Golf Classic

Register Below!

Implicit Bias Training

4-6 p.m. virtual session

April 10

Pharmacy Technician Advanced Immunization Training Home Study



1-2:30 p.m. virtual session April 18

Pharmacy-Based

Immunization Training

4-6 p.m. March 22

Registration

closes March 17

Recording Available for PBM Transparency Act Hearing

On Feb. 16, 2023, the U.S. Senate Committee on Commerce, Science and Transportation listened to testimony regarding the bipartisan S.127, “Pharmacy Benefit Manager Transparency Act of 2023.”

According to the Committee’s website, the legislation:

• Prohibits Arbitrary, Unfair, or Deceptive Practices. The bill would prohibit PBMs from engaging in spread pricing; arbitrarily, unfairly, or deceptively reducing or clawing back drug reimbursement payments to pharmacies; and arbitrarily, unfairly, or deceptively charging pharmacies more to offset federal reimbursement changes. 
• Incentivizes Fair and Clear PBM Practices. PBMs that pass along 100% of rebates to payers or plans and fully disclose prescription drug rebates, costs, prices, reimbursements, fees and other information to health plans, payers, pharmacies and federal agencies would not be liable under the Act. 
• Improves Transparency and Competition. The bill would require PBMs to report how much money they make from spread pricing, pharmacy fees and clawbacks; differences in the PBMs’ reimbursement rates or fees they charge affiliated pharmacies and non-affiliated pharmacies; and whether and why they move drugs in formulary tiers to increase costs. It also directs the Federal Trade Commission to report to Congress its enforcement activities and whether PBMs engage in unfair or deceptive formulary design or placement. 
• Protects Whistleblowers. The legislation protects whistleblowers from being fired or facing other retaliation for exposing violations.



To listen to the hearing in its entirety, click here.

FDA Approves New Nasal Spray For Migraines

Pfizer reports that FDA has approved its drug zavegepant (Zavzpret) for the treatment of migraines. The nasal spray medication will be available in pharmacies in July, the company said.

The drug contains a migraine inhibitor that works by impeding the release of proteins called calcitonin gene-related peptides. The drug was found to perform better than a placebo in relieving pain and certain symptoms, according to clinical trial results published in The Lancet Neurology. Trial participants who received zavegepant as a nasal spray were more likely to report returning to normal function within 30 minutes to 2 hours. The trial monitored 1,269 patients, of whom about one-half used the drug and the remainder received a placebo.

Researchers examined how patients reported feeling 2 hours after using either substance. About 24 percent who received zavegepant reported being free from pain, compared with about 15 percent who received a placebo, the study found. Timothy A. Collins, chief of the headache and pain division at Duke University Medical Center's neurology department, said the product gives physicians a new option for patients with migraines, especially for those with nausea, who may want to avoid swallowing a tablet. He also said the drug causes fewer adverse effects, such as drowsiness, and is safe for patients who have had a heart attack or a stroke.

Upcoming Changes to Michigan Driver's Licenses and IDs

In the next few months, the Michigan Department of State will begin issuing new Michigan driver’s licenses and ID cards without the magnetic stripe on the back. The state is encouraging facilities that still utilize the magnetic stripe to update their card reader technology at this time.

All Michigan licenses and IDs will continue to display a PDF417 generated 2D barcode on the back of the card, which can be scanned using most card reader technology. Also, those who are unable to update their card reader technology in time will still be able to manually enter a Michigan license or ID number into the point-of-sale or information system instead.

The upcoming changes will also involve updates to the PDF417 generated 2D barcodes. As a result, it may be necessary to update the data mapping of barcode readers to accommodate the new barcode format. Both the new cards and current barcodes will need to be accounted for, as the current license format will remain in circulation until cards with the stripe are completely phased out in early 2028. For more information, reference the Barcode Data Calibration sheet. This document may be provided to software vendors to upgrade or assist with changes if needed.

The State Department will follow up with additional information as it prepares to implement these changes in the coming months. Any questions about card reader technology or license or ID security may be sent to MDOS-Info@Michigan.gov. 

Michigan Dispensing Law Changes

Public Act 80 of 2022 was enacted on May 19, 2022, with an effective date of March 29, 2023. This act allows a pharmacist to dispense a prescription, except a prescription for a controlled substance, written by a prescriber licensed in another state or province of Canada. The act defines “prescriber” as:

• A licensed dentist
• A licensed doctor of medicine
• A licensed doctor of osteopathic medicine and surgery
• A licensed doctor of podiatric medicine and surgery
• A licensed physician’s assistant
• A licensed optometrist
• An advanced practice registered nurse
• A licensed veterinarian
• A nurse anesthetist

A pharmacist who dispenses a prescription written by a prescriber licensed in another state or province of Canada must comply with the requirements of MCL 333.17751. Additionally, a pharmacist who receives a prescription under MCL 333.17751(2) from an advanced practice registered nurse prescriber or physician's assistant prescriber in another state or province of Canada may dispense the drug or device without determining whether the advanced practice registered nurse prescriber or physician's assistant prescriber is authorized under the laws of the other state or province of Canada to issue the prescription.

Pursuant to MCL 333.17763(e), a pharmacist may only dispense a prescription for a controlled substance written by a physician, dentist or veterinarian who is licensed in another state and authorized by law to prescribe controlled substances in that state. 

Should you have any questions, please contact bplhelp@michigan.gov or visit michigan.gov/bpl.

Medicare to Expand CGM Coverage

for People with Type 2 Diabetes

The Centers for Medicare and Medicaid Services (CMS) announced on March 2 an updated policy effective April 16 that will expand continuous glucose monitor (CGM) coverage to more people with type 2 diabetes.

The expanded coverage of the new policy will apply to insulin-treated individuals with diabetes who have traditional Medicare coverage (not Medicare Advantage), as well as certain non-insulin-using individuals who have a history of what has been classified as “problematic hypoglycemia.”

“There are millions of people with type 2 diabetes using basal insulin who now will be eligible for CGM coverage, either through Medicare or private insurers who are likely to follow the CMS determination,” said Dr. Roy Beck, medical director at the Jaeb Center for Health, adding, “A positive offshoot of this will be that primary care providers will become more experienced with CGM since most people with type 2 diabetes treated with basal without bolus insulin are followed in a primary care setting.”

Traditional Medicare claims are processed through local entities called Medicare Administrative Contractors (MACs), private healthcare insurers permitted to process Medicare claims who decide coverage and payment policies for a range of services, and medical equipment, including CGMs. A group of MACS initially proposed a new policy to expand coverage to include CGMs last October.

Proposed Medicaid Coverage Policy Changes for CGMS

The Michigan Department of Health and Human Services (MDHHS) periodically issues notices of proposed policy. These documents inform interested parties of proposed changes in Michigan Medicaid policy.

Proposed policy must undergo a public comment period before becoming final. The notices provide a way for interested parties to comment on proposed policy. People may comment by email or postal mail before the comment due date. Contents are, in effect, a draft; they do not represent official Medicaid policy.

Attached are proposed Medicaid policy changes to current Medicaid coverage of continuous glucose monitoring systems (CGMS) to incorporate coverage of new healthcare common procedure coding system (HCPCS) codes, update definitions, standards of coverage, documentation and prior authorization requirements. Comments on this proposed policy are due March 30. Comments may be forwarded to Lisa Trumbell at TrumbellL@michigan.gov.

Michigan Senate OKs Abortion Ban Repeal

Senate Democrats ushered through a package of bills March 8 to strip the state's 1931 abortion ban law and associated criminal penalties from statute over Republican objections and a flurry of amendments that failed prior to final votes.

Over in the House, legislation expanding the Elliott-Larsen Civil Rights Act to include protections from discrimination based on sexual orientation and gender identity or expression passed the House by a wide margin that included several GOP votes.

Before the Senate were HB 4006, HB 4032, which passed the House last week, along with SB 2, SB 37, SB 39 and SB 93 . Each of the bills were passed by votes of 20-18 along party lines.

Following passage of Proposal 22-3 last November the 1931 abortion ban was repealed, and Democrats have sought to remove the language surrounding it and penalties from the books.

Several amendments were offered by Republicans prior to final passage of the bills, all of which were rejected along party lines. Amendments rejected included proposed banning partial-birth abortion, coercion into obtaining an abortion, requiring parental consent of a minor child's attempt to obtain an abortion, funding for adoption services and preventing an abortion based solely on a diagnosis of Down syndrome.

Republicans said their amendments would prevent unlimited access to abortion that they said voters were not in favor of beyond the previous protections in the now-overturned Roe v. Wade decision.

Democrats countered by saying eliminating the language from statute is in response to the will of voters who approved Proposal 3 last November.

SB 4 and HB 4003 passed the House 64-45, with eight Republicans joining all Democrats in voting yes on the bill expanding protections in the civil rights law that have long been sought by the LGBTQ community, Democrats, business leaders and some Republicans.

The bills cleared committee before being taken up on the floor. Sen. Jeremy Moss (D-Southfield), the Senate bill sponsor, who is gay, and Attorney General Dana Nessel, who is also gay, were both on the floor during the vote.

Objections from some Republicans surrounded religious freedom. Supporters of the expansion, however, said religious freedom is protected by ELCRA, the First Amendment and U.S. Supreme Court decisions.

"No one is asking for a fundamental shift in religious tolerance. All we are asking is for the ability to live and work in our state with the same humanity and protections as every other Michigander," Rep. Laurie Pohutsky (D-Livonia) said on the House floor.

Rep. Rachelle Smit (R-Shelbyville) said she supports the original intent of ELCRA, but the religious beliefs of small business owners and employers need to be respected.

"Now, let me be clear discrimination of any kind is wrong, and nobody should be treated unfairly or unjustly because of their personal choices," she said. "However, this expansion would infringe upon the religious rights of employers and business owners. Many religious individuals and organizations hold deeply held beliefs about sexuality and gender. Forcing them to act in a way that goes against their beliefs is a violation of the religious freedom."

Republicans voting yes: Rep. Timmy Beson of Bay City, Rep. Matthew Bierlein of Vassar, Rep. Graham Filler of Duplain Township, Rep. Mike Mueller of Linden, Rep. Kathy Schmaltz of Jackson, Rep. Bill Schuette of Midland, Rep. Mark Tisdel of Rochester Hills and Rep. Pauline Wendzel of Watervliet.

— From gongwer.com.

MDHHS Addresses End of PHE in May

The U.S. Department of Health and Human Services is planning for the federal Public Health Emergency (PHE) for COVID-19, declared under Section 319 of the Public Health Service Act, to expire at the end of the day on May 11, 2023.  

The Michigan Department of Health and Human Services (MDHHS) has issued many COVID-19 response Medicaid policy bulletins and "L letters," which changed existing policy and processes under the guidance of the federal PHE. Providers will see an increase in updated COVID-19 response policy bulletins and L letters to accommodate the end of the PHE. Refer to the PHE policy crosswalk table below to see current and upcoming policy changes. 

MDHHS encourages providers to take the following steps to prepare for the end of the federal PHE:



• Review the PHE policy crosswalk table webpage to see which policy bulletins or L letters may impact your provider type.  
• Continue to verify beneficiary eligibility prior to services. Visit the Eligibility and Enrollment webpage for step-by-step instructions. 
• Eligibility redetermination or renewal dates can be viewed within the CHAMPS eligibility inquiry screen.
• Help beneficiaries verify or update their contact information in MIBridges.

For more information on how benefits are changing with the end of the COVID-19 PHE, visit Michigan.gov/2023BenefitChanges. 

Moderna Under 6 Vaccine Order Quantity Update

Supplies of the Moderna under 6 bivalent pediatric COVID-19 vaccine continue to be extremely limited. To ensure broader availability of this vaccine, the Michigan Department of Health and Human Services (MDHHS) Division of Immunization has set an order quantity limit for the vaccine to 20 doses per order. This change was implemented on March 8. As a reminder, one carton of this vaccine contains 20 doses in 10 two-dose vials.  

Because ancillary supplies are packed well in advance of demand, they will continue to be shipped in minimum quantities to support 100 administrations per kit with this product. If you have sufficient supplies to support the administration of the doses you order, MDHHS recommends opting out of receiving ancillary kits when placing orders for Moderna bivalent pediatric vaccines.

Proposed Medicaid Policy 2305-F2F

The Michigan Department of Health and Human Services (MDHHS) has issued 2305-F2F: Reversal of Temporary COVID-19 Relaxation of Face-to-Face Requirement Policies and Update of Face-to-Face and In Person Definitions proposed policy for public comment.



The policy discontinues the temporary COVID-19 relaxation of face-to-face policies at the end of the Public Health Emergency (PHE) – including bulletins MSA 20-12, MSA 20-30 and Telemedicine Coverage section of MSA 20-42. It also updates the definition of face-to-face and in person language.  

The proposed policy has a proposed effective date of May 12, 2023 (the end of the PHE). Comments on the proposed policy are due on April 18, 2023, and may be forwarded to frankmane@michigan.gov.

Proposed Medicaid policies may be accessed on the MDHHS website.

MDHHS Launches OpiRescue Smartphone App to Help 

Michigan Residents Prevent and Reduce Opioid Overdoses

It can be downloaded at Apple iOS app store or through Google Play. 

MDHHS partners, including Prepaid Inpatient Health Plans and Syringe Service Programs, actively involved in caring for members of the public experiencing opioid use disorder will have access to a dashboard for their region. The dashboard will allow those partners to view overdose reversal data in near real time and allocate additional resources as needed to areas with increased reports of overdose reversals.

For more information on Naloxone and how to obtain the medication, visit Michigan.gov/Naloxone.

VPD Evaluation and Reporting

Due to the increased risk of vaccine-preventable diseases (VPD), the Michigan Department of Health and Human Services (MDHHS) Division of Immunizations is reaching out to remind clinical partners of protocols and resources for evaluation and reporting of patients suspected of having a VPD. Appropriate specimen collection and reporting are crucial to expedited public health action that can limit and control disease transmission.

The COVID-19 pandemic changed the epidemiology of VPD due to limited travel and various other precautions, but it also severely interrupted routine medical care. Examples of measles in Ohio and paralytic polio in New York State demonstrate that as society returns to normal, the risk of, and susceptibility, to outbreaks of VPD will increase. This is especially true in an environment in which routine immunization coverage is lower due to pandemic-related disruptions and decreasing confidence in vaccines. High levels of RSV and influenza activity this fall and winter have also demonstrated that population-level naivety to some of these pathogens can result in a higher burden of both infection and severe outcomes (for example, hospitalization).

We have been fortunate to have relatively few cases and outbreaks of VPDs in Michigan over the last few years, but that also can result in our systems being less familiar with VPD workups, specimen collection, and reporting. As a result, MDHHS Bureau of Infectious Disease Prevention is reminding clinicians of the important role they can play when evaluating patients with a suspected VPD.

Please see the attached document for additional data and resources regarding best practices for VPD surveillance.

If you have additional questions, please contact checcimms@michigan.gov.

MDHHS Provider Relations Seeks Feedback

Do you often visit the Michigan Medicaid Provider Alerts webpage for tools and resources and don’t see what you want, or do you love what you see? The Michigan Department of Health and Human Services (MDHHS) Provider Relations wants to hear from you.

Please take this quick six-question survey to let MDHHS know how it can better serve Michigan providers (survey link).

For questions regarding Provider Training or this survey, please contact Provider Outreach and Education at ProviderOutreach@Michigan.gov.