News from the WV Board of Veterinary Medicine
STATE OF WEST VIRGINIA
DEPARTMENT OF HEALTH AND HUMAN RESOURCES
BUREAU FOR MEDICAL SERVICES
350 Capitol Street, Room 251
Charleston, West Virginia 25301-3712
Telephone: (304) 558-1700 Fax: (304) 558-1451
Notice to Pharmacy Providers
On October 17, 2018, prescription claims will deny for Medicaid members whose prescribers are not enrolled with Medicaid. West Virginia Medicaid is required to deny these prescriptions in order to comply with Federal regulations.
If a prescription denies for one of your patients due to edit 7091 (Prescriber not enrolled with Medicaid), please ask the member to contact the prescriber’s office and request that an enrolled prescriber in that office provide them with a prescription which can be written, electronically prescribed or transmitted via telephone or fax.
Exception: if a patient is prescribed a drug used to treat a behavioral health condition (depression, schizophrenia, anxiety, ADD, ADHD, etc) and it results in a denial with Edit 7091 (prescriber not enrolled with Medicaid), please use the NPI of the behavioral health facility in which your patient is being treated. You may call the facility, the Molina Pharmacy Help Desk at 888-483-0801 or the Bureau for Medical Services Pharmacy Office at 304-558-1700 to obtain the NPI number. This is a temporary measure while Molina enrollment continues to process enrollment applications through 2018.
For claims prescribed by pharmacists, you may temporarily use the NPI of your pharmacy. But please continue to pursue your individual pharmacist enrollment with Molina.
You will be notified in the future when the enrollment process has been completed and you can begin using the individual prescriber’s NPI.
Thank you for your help in this matter. For more information, you may call the Molina Pharmacy Help Desk at 888-483-0801 or the Bureau for Medical Services at 304-558- 1700.
Hepatitis A-Statewide Outbreak: Provider's Guide to Transmission, Risk Groups, and Prevention
DATE: September 11, 2018 The West Virginia Board of Pharmacy (“Board”) continues to receive inquiries regarding the sale of Cannabidiol (“CBD”) in pharmacies. The position of the Board is that the sale of CBD products in the pharmacy setting is prohibited. There are a number of factors that influenced the Board’s decision, but our duty to protect the public is the most significant. It has been reported that some of the products contain no CBD, while others not only contain CBD, but also include a significant amount of tetrahydrocannabinol (“THC”). The lack of Food and Drug Administration (“FDA”) involvement with the increasing number of these CBD products give us great concern regarding their safety and composition. THC is a schedule I substance in both federal and state law (WV Code § 60A-2-201(d)(32)), so its presence in these CBD products is a violation of both. The legal status of CBD is less clear, but it appears to be included in the DEA regulations as a schedule I marijuana extract (drug code 7350). The THC issue, and the questions about CBD’s legal status were also a consideration in our decision. To date, the only CBD product that has gained FDA approval is Epidiolex. As such, Epidiolex is currently the only CBD product that may be lawfully sold in the pharmacy setting.
On and after October 17, 2018, West Virginia Medicaid will begin to deny all claims for prescriptions written by any prescriber not enrolled with West Virginia Medicaid. This includes hospital residents and interns, advanced practice nurse practitioners, physician assistants and pharmacists who administer vaccines. Even though the facility you are employed by (clinic, hospital or pharmacy) is currently enrolled, individual prescribers must also be enrolled. Failing to enroll with West Virginia Medicaid as a prescribing provider could cause serious consequences for your patients. The requirement for prescribers to enroll is a provision of the Patient Protection and Affordable Care Act of 2010. All prescribers serving Medicaid patients MUST enroll and their name and national provider identifier (NPI) must be recorded on claims for prescription medications submitted for Medicaid members on and after October 17, 2018. Providers may enroll as a billing provider or an “ordering, referring, or prescribing” (ORP) provider.” “ORP only provider” is a category for prescribers who write orders, refer, or prescribe medications, but do not actually submit claims to Medicaid for their services. “ORP only providers” may not bill Medicaid for services. If you are not already enrolled, you may go to the website of the West Virginia Medicaid claims processor, Molina Medicaid Solutions, at https://www.wvmmis.com and enroll online as a billing provider or as an “ORP only provider.” The quickest enrollment option is the ORP-only online application process, if applicable. Provider application approval is 5 days from receipt of a completed application. All required documentation can be uploaded to the portal. A paper application can be requested by calling Molina Provider Enrollment at 888-483-0793. To prevent interruptions in Medicaid members’ access to needed prescription medications, prescribers must make sure they are enrolled with West Virginia Medicaid. For questions, please contact Molina Provider Enrollment at 888-483-0793 or the Molina Pharmacy Help Desk at 888-483-0801.