Arkansas
The Insurance Department (AID) issued Bulletin 12-2025 which seeks public input on revisions to the Data Submission Guide for the All-Payer Claims Database.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
California
The Department of Health Care Service posted the following on the Medi-Cal Rx Web Portal. Please note the update on GLP-1 coverage effective January 1, 2026; see details below in the alert.
Also in California, as part of the Board's actions during the November 5-6 Board Meeting, the Board approved a policy statement related to the transition to a Standard of Care Practice Model for some pharmacist-provided health care services. Specifically, under provisions of Assembly Bill (AB) 1503 (Berman, Chapter 196, Statutes of 2025), certain pharmacist-provided patient care services are transitioning to a standard of care practice model.
Finally in California, the Board of Pharmacy approved a policy statement related to the role of the Pharmacist-in-Charge (PIC). Specifically, under AB 1503, new provisions reinforce the decision-making autonomy of the PIC related to staffing decisions.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Colorado
Facing a $850M budget deficit, Gov. Jaris Polis (D) proposed cuts to the Medicaid professional dispensing fee (PDF) for pharmacies. For fiscal year 2025-2026, the Health Care Financing and Policy (HCFP) will cut the tiered fee by $85,000 and propose a $506,000 reduction for 2026-2027. Reimbursements for high-volume pharmacies will drop from $10.25 to $9.93 and from $9.31 to $8.72.
Also in Colorado, a Rural Health Transformation Program Webinar for all stakeholders will be held from 10:00 am – 11:30 am Mountain Time on December 2.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Illinois
The purpose of this Provider Notice is to inform pharmacy providers that the claims adjudication system is now able to process and pay compound claims. The processing system had been paying compound claims at zero since the Change Healthcare outage in March 2024.
At this time, pharmacy providers are encouraged to void and rebill those claims that were either paid at zero or held pending restoration. This applies to fee-for-service (FFS) billing only.
Please call the Bureau of Professional and Ancillary Services at 877-782-5565 and speak to a pharmacy consultant to obtain any necessary overrides on rejections that may occur while rebilling these claims.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Iowa
The Department of Health and Human Services (HHS), Medicaid posted the following. Please note effective December 1, the optional 90-day supply allowance will now be a required 90-day supply prescription list. The list of medications for this requirement is posted on the PDL website; see letter below for details.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Louisiana
The Department of Health (LDH) announced a webinar on December 4 from 10:00 am to 11:00 am Central Time. This event aims to inform stakeholders about LDH’s Rural Health Transformation Program (RHTP) submission.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Minnesota
The Department of Health (MDH) released the final updated Form and Manner for Prescription Drug Data Sets, as well as an updated Frequently Asked Questions Document. Updates impact reporting by all reporting entities, including manufacturers, wholesalers, pharmacy benefit managers and pharmacies.
The updates reflect statutory changes from the 2025 legislative session (Laws of Minnesota, 2025 – 1st Special Session, chapter 3, article 2, sections 6-14) and responses to input received during the comment period. The updates include changes to align reporting elements, modified registration requirements and a change to the reporting period for reporting data on drugs of substantial public interest.
MDH has updated the Rx Data Portal to integrate the statutory changes and make additional enhancements to support reporting entities. These updates are now live and available to all reporting entities.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Nevada
Gov. Joe Lombardo (R) convened a special session of the state Legislature on November 13 to address several key issues, including expanding healthcare access and workforce training.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
North Carolina
The latest Medicaid Pharmacy Newsletter, dated November 2025, is now available on the Medicaid website. In addition to the December 2025 check write schedule, this edition of the newsletter includes the following articles:
- Reminder: Immunizing Pharmacist Enrollment in NC Medicaid Contraceptives and NRT Protocol Reimbursement to Pharmacies
- Reminder on NC Medicaid Pharmacy Co-payment Requirements
- NC Medicaid's Participation in Centers for Medicare & Medicaid Services Cell and Gene Therapy Access Model for Sickle Cell Disease
- Discontinuation of Coverage: Xifaxan (Rifaximin)
- North Carolina to Launch First-of-its-Kind NC Medicaid Managed Care Plan for Children and Families on December 1, 2025
- Updates to Coverage for Wegovy and Zepbound for Clinical Indications Other than Weight Loss
- Immunizing Pharmacist Enrollment and Medical Claims Billing Update
Providers are encouraged to review this important information. The 2025 Medicaid Pharmacy Newsletters can be viewed here.
Also in North Carolina, effective December 7, the Electronic Funds Transfer (EFT) Attestation will be added to the reverification provider application and to full Manage Change Requests (MCRs) when active electronic funds transfer (EFT) information is present. This attestation requires a signature from the Office Administrator (OA) on the provider's record.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.