Gov. Sara Huckaby Sanders (R) recently appointed Jimmy Harris to serve as the new Commissioner of the Insurance Department (AID). Harris is expected to be more aggressive on enforcement of complaints against PBM’s violating the laws and rules.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
On December 29, 2025, the Department of Health Care Services (DHCS) became aware of a preliminary injunction issued by the US District Court in Maine blocking the Health Resources and Services Administration (HRSA) from implementing the 340B Rebate Model Pilot Program, which was set to begin on January 1, 2026, pending further legal action. The preliminary injunction applies to the implementation of the 340B Rebate Model Pilot Program in the state. In light of the issuance of the preliminary injunction, DHCS will not implement the policy guidance previously provided specific to the drugs that are part of the 340B Rebate Model Pilot Program until further notice. Accordingly, providers should continue submitting Medi-Cal Rx and medical claims, as applicable, consistent with all existing Medi-Cal 340B billing policies.
Also in California, required system upgrades to the Medicaid Management Information System (CA-MMIS) are scheduled to take place on January 11. The upgrade may go into an extended maintenance period, which begins at midnight on January 11 and may continue through 10:00 am on January 11. During the extended window, the Medi-Cal Point of Service (POS), Automated Eligibility Verification System (AEVS), Leased Line vendors, Case Management Information and Payrolling System (CMIPS) and certain Transactions Services on the Medi-Cal Providers website applications may experience intermittent issues.
Also in California, as announced last year, CalRx partnered with Civica to make insulin more affordable and accessible statewide. Beginning January 1, 2026, CalRx/Civica Insulin Glargine pens will be available to California pharmacies at a cost of $45 per 5-pack of 3 mL pens, with a suggested maximum retail price of no more than $55 for consumers. To help patients locate pharmacies that plan to carry CalRx insulin, CalRx intends to publicly post participating pharmacy locations; see CalRx Pharmacy Survey to provide input. For more information, see resources listed below. For additional questions, please contact CalRx (info@calrx.ca.gov) or Civica (insulinquestions@civicarx.org).
Also in California, the Board of Pharmacy published its Board of Pharmacy News Roundup (January 2026). Please review the news in its entirety for important updates and information.
Finally in California, the Board of Pharmacy seeks to remind affected licensees about Proposition 34, a ballot initiative that was approved by the voters in November 2024. Proposition 34 added the Protect Patients Now Act of 2024 (Act) to the Welfare and Institutions Code (see sections 14124.39-14124.52). Among its provisions, the Act establishes requirements for a “Prescription Drug Price Manipulator” (as defined in subdivision (l) of WIC section 14124.48) to report specified information to certain agencies, including the Board, by no later than April 30, 2026. Public comments related to the Act, and information relating to entities that qualify as Prescription Drug Price Manipulators, may be submitted to Prop34@dca.ca.gov.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
The Legislature will convene on January 14 and adjourn on or before May 13.
Also in Colorado, the Attorney General’s Office and the Colorado Opioid Abatement Council (COAC) announced up to $23 million in new statewide opioid abatement funding available through grant opportunities. Round 4 Infrastructure Funding Opportunity prioritizes capital or operational investments in rural, underserved or disproportionately impacted communities, and encourages collaborative or multi-organization proposals.
Also in Colorado, the Department of Health Care Policy and Financing (HCPF) and Behavioral Health Administration (BHA) are currently developing a Prospective Payment System (PPS) Guardrails Plan and seeking feedback from our partners. PPS is a flexible, advanced reimbursement model tying payment to daily encounters instead of to individual services. It is provider-specific and based on each provider’s unique cost structure, designed to cover a safety net provider’s actual cost of services. The Guardrails Plan will detail the structure of the PPS payment, financial and data reporting requirements and quality requirements. It will also explain the monitoring and oversight processes, and potential impacts of noncompliance. The first stakeholder session is scheduled for January 23 from 11:00 am to 12:00 noon. Please register in advance in Zoom. Contact hcpf_bhbenefits@state.co.us with any questions.
Finally in Colorado, the Board of Pharmacy voted unanimously to make permanent rules regarding pharmacists’ authority to provide immunizations. The emergency rule changes from September 5, 2025, delink pharmacists’ immunizations authority from the Center for Disease Control (CDC) guidelines, and grant authority for pharmacists to independently prescribe any vaccine under their own license/NPI (National Provider Identifier), and got rid of the need for a physician authorization protocol. These rules were sent to the Secretary of State to be published in the Colorado Register and take effect no later than January 14.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
CMS awarded the state $157 million as part of a national program aimed at bolstering rural health care across all 50 states. The initial award represents the first batch of funding the state hopes to receive over the next five years. The full award amount for the state remains unclear at this time, but the state will receive at least $500 million from the federal program. Delaware officials said they plan to use those funds to invest heavily into health infrastructure in Kent and Sussex counties, including building the state’s first medical school and two new homeless service shelters in the lower counties. State leaders also hope to fund 13 additional programs, including additional preventative care, financial assistance for medical students that commit to working in Delaware for five years after graduation and robust nutritional education.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
The Department of Revenue has launched its new eFile and Pay system for quarterly, semiannual and annual filers. Please take a moment to review the latest Department of Revenue Tax Information Publication (TIP) link online.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
2026 Critical Access Pharmacies eligibility list is available online as well as the most recent Medicaid Preferred Drug List.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
The Legislature convened its short session on December 1, 2025, and will adjourn on March 14.
Also in Indiana, the Family and Social Services Administration (FSSA) projects over $465 million in state savings over the biennium driven by declines in enrollment in key Medicaid programs, including the Healthy Indiana Plan (HIP) and Hoosier Healthwise (HHW).
Also in Indiana, the Health Coverage Programs (IHCP) issued a Bulletin reminding pharmacies that effective January 1, 2026, MDwise is no longer be a managed care health plan option for Healthy Indiana Plan (HIP) or Hoosier Healthwise (HHW) members. This bulletin addresses the transition of MDwise member claims and prior authorization (PA) requests for medications reimbursed through the pharmacy and medical benefits.
Finally in Indiana, at a December 2025 hearing, the Interim Director of Medicaid and Secretary of the Family and Social Services Administration (FSSA), Mitch Roob, asked the State Budget Committee to approve Medicaid’s submission of a State Plan Amendment (SPA) to CMS to change how 340B claims are processed by Medicaid managed care organizations (MCOs). The proposal would limit reimbursement to covered entities at actual acquisition cost, or close thereto, which would permit Medicaid to receive rebates from manufacturers in lieu of covered entities realizing 340B program savings for MCO claims. Director Roob testified that he expects this to provide an additional $63 million in revenue to Medicaid.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Gov. Kim Reynolds (R) and the Department of Health and Human Services (HHS) announced the state has been awarded funding through the Rural Health Transformation Program. The state’s innovative proposal, Healthy Hometowns, will receive $209 million for the first year of implementation. Healthy Hometowns is a plan to strengthen health care in rural communities by making care more accessible, connected and patient focused. Healthy Hometowns includes five key initiatives: building partnerships to expand health care options in rural areas; improving cancer prevention, treatment and outcomes; supporting projects that bring different types of providers together under one roof; making health records accessible across the state so patients can get care wherever they are; and investing in telehealth and mobile health care programs, including high-risk maternal transport.
Also in Iowa, the Department of Health and Human Services (HHS), Medicaid posted the following: INFORMATIONAL LETTER [IL] NO. 2710-MC-FFS-D RE: Pharmacy 90-Day Supply Requirement – AMENDED, effective December 1, 2025. This letter serves as an amendment to IL-2710. Published on November 14, 2025. The update includes excluding the Indian Health Service providers from the 90-supply requirement. The effective date of the informational letter remains the same.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
The Legislature will convene on January 12 and adjourn by April 10.
Also in Kansas, Mandy Czechanski is the new Executive Director of the Kansas Pharmacy Association (KPhA).
Finally in Kansas, the Department of Health and Environment (KDHE) hired Myers and Stauffer to conduct a study on the cost of dispensing. The results confirmed what pharmacists have been saying all along, that the cost to dispense has risen rapidly while reimbursements continue to decline. The results showed the cost to dispense a prescription is $11.38 for chain pharmacies and $15.85 for independent pharmacies, which is well above the current Medicaid rate of $10.50.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
