Pharmacies and other dispensers with more than 26 pharmacist and technician employees may need to act immediately to be in compliance with the Nov. 27 end of a phased exemption granted by the FDA in 2024. Pharmacies that are not able to claim the FDA’s small dispenser exemption to a limited part of the law, but still need extra time to complete data connections with their wholesalers or other immediate trading partners, need to act now and apply for an exemption.
The following items are occurring or being requested during Accreditation Commission for Health Care (ACHC) accreditation surveys and CMS On-Site inspections. They will be added to the monthly task lists.
The National Supplier Clearinghouse Advisory Committee (NSCAC) is a communications vehicle between the home medical equipment (HME) industry and the National Provider Enrollment (NPE) Contractors. Part of the work the NSCAC does, is to provide communication
to CMS on other contractors tasked with enrollment activities, such as the 2 site visit contractors and the appeals and rebuttals contractors. If a concern arises during a site inspection, rebuttal, or appeal, the following forms can be used to report the issue(s):
Eagle-eyed members tipped NCPA off to a change of vaccine administration reimbursement policies in Medicare Part B fee-for-service that quietly went into effect July 1, 2025. CMS and its Medicare Administrative Contractors (MACs) require modifier 59 "Distinct Procedural Service" be added to the second (or any additional) vaccine administration codes when the COVID-19 vaccine is administered on the same date of service as other Part B vaccines. For example, in addition to the CPT or HCPCS codes for the COVID-19 and flu vaccine products, the claim should include 90480 and G0008-59, respectively, to claim reimbursement for administering the vaccine products.
A community pharmacy chain in western Pennsylvania is at the center of a court challenge that lawyers say highlights gaps in corporate accountability and patient rights within health care. Lawyers plan to file a federal restraining order against Express Scripts, which removed Martella's Pharmacy from in-network coverage for the University of Pittsburgh Medical Center (UPMC) and Highmark patients, effective August 18.
The lawyers contend that the move, reportedly made without notifying patients or the state Department of Human Resources, represents a breach of patient-provider agreements and federal notice mandates. Without convenient access to their medications, the attorneys add, residents of Cambria, Somerset, and Westmoreland counties who depend on community-based pharmacy care face undue hardship. For now, Martella’s Pharmacy remains open and continues to serve its customers. See More… Source: APhA’s Pharmacy Today
Credentialing Reminder for Pharmacies: Set Yourself Apart
Every December, part of your monthly task list includes submitting credentialing documentation to your PSAOs (Pharmacy Services Administrative Organizations). While DMEs, sleep clinics, chiropractors, and small medical practices are not required to do so, pharmacies, especially those working with Pharmacy First and Cardinal Health, are required to submit credentialing documentation. These organizations have accepted the R.J. Hedges training and credentialing programs because our clients consistently meet compliance standards and benefit from our comprehensive resources.
This year, we are asking every pharmacy to submit the credentialing documents to your PSAO. The reasoning is simple: you've trusted us for your compliance needs, so why shouldn’t the other PSAOs recognize that same commitment? Credentialing with verifiable proof should carry weight and it does.
Here’s what you need to do:
1. Access the credentialing documents:
Go to the Compliance Portal and scroll to the bottom of the Home page.
Check the following items in the Compliance Tools and Resources Section:
License Verification – Review the list of items to ensure all your licenses, bonds, and insurance information are up to date. Items in green expire in 90 days or less and items in red expire in 30 days or less and may need to be updated. If something seems incorrect, reach out to your Project Manager for assistance.
OIG – SAM Exclusion Verification – Review for accuracy
2. Download the required reports:
License Verification – Print (download) the following reports found on the right side of the screen:
License Report
Certification of Pharmacy Compliance and Credentialing
OIG – SAM Exclusion Verification – Print (download) the following report found on the right side of the screen:
OIG ReportCOVID-19 Updates
3. Submit the documents:
Once you have the reports, mail, email, or fax all three documents directly to your PSAO.
By completing this task, you’re not only staying compliant but also setting yourself apart from
other pharmacies. Show your PSAO that your pharmacy is committed to excellence and
trustworthiness in credentialing and compliance.
The CDC has finally released information about COVID-19 recommendations for the 2025-2026 season. There are no new standing orders yet but as soon as they are published, we will get them posted on the portal. In the meantime, CDC posted Interim Clinical Considerations for Use of COVID-19 Vaccines in the United States on November 4, incorporating changes to COVID-19 vaccine recommendations adopted at the September ACIP meeting. A summary of notable content appears below.
In coming days, Immunize.org will release updated standing orders templates for COVID-19 vaccination, in addition to an updated Checklist of Current Versions of U.S. COVID-19 Vaccination Guidance and Clinic Support Tools.
New and updated materials will be announced in IZ Express and posted on the What’s New on Immunize.org web page. The Ask the Experts: COVID-19 web page will be updated in the weeks after the release of these materials.
Medicare now requires all managing employees be listed on Medicare applications. As we help prepare new applications or complete revalidations we will need the Full Legal Name, Date of Birth, Country and State of Birth, and Job Title(s) for all managing employees.
In the event of an inspection, the inspector may speak with any manager and that person must be on this Medicare Application to prevent a Development Notification which will delay the issuing of your PTAN and, if not completed in 30 days, could result in your PTAN being revoked/denied.
The following information is from Information from https://www.novitas-solutions.com/webcenter/portal/MedicareJL/pagebyid?contentId=00302596
All existing Medicare providers and suppliers must report all current managing employees on their Medicare enrollment record to avoid having that enrollment deactivated.
Managing employees are general managers, business managers, administrators, directors, or other individuals who exercise operational or managerial control or directly or indirectly conduct day-to-day operations of the provider/supplier. These individuals work either under contract or through some other arrangement, whether or not the individual is a W-2 employee of the provider or supplier.
Roles that qualify as managing employees (not an exhaustive list):
Other examples include but are not limited to a hospice or skilled nursing facility administrator and/or a hospice or skilled nursing facility medical director.
Contact your MAC or NPE if you’re unsure if an individual meets the definition. Updates can be made by:
To learn more, see the Medicare Program Integrity Manual, Chapter 10 (PDF).