California
The Department of Health Care Service posted the following weekly notices on the Medi-Cal Rx Web Portal: Medi-Cal Rx Weekly Wrap up for May 2-8.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Colorado
Prior to the General Assembly adjourning on May 7, lawmakers passed several bills of interest to pharmacies, including:
- HB25-1094, governing PBM practices – Allowing a PBM to earn income derived from a flat-dollar service fee assessment and prohibits a PBM from earning income based on the cost of a prescription drug; prohibiting a PBM from designing a formulary to favor a certain branded pharmaceutical or biologic; requiring a PBM to credit income from a source other than a flat-dollar service fee to a health insurance carrier or a self-funded health benefit plan beneficiary; setting the amount that a PBM shall reimburse an unaffiliated pharmacy or a PBM-affiliated retail, mail order or specialty pharmacy for a prescription drug; and requiring a PBM to make certain documents and data available to a carrier, a self-funded plan or the insurance commissioner upon request and authorizing the health benefit plan to execute an audit to validate compliance with the contract.
- HB25-1222, the bill's rate floor and telepharmacy provisions only apply to independent pharmacies, passed out of both houses on May 1. For the purposes of this bill, "rural independent pharmacies" are defined as a drug outlet that is privately owned by at least one licensed pharmacist with no ownership interest by or affiliation with a chain pharmacy or a publicly traded prescription drug outlet. The bill will reimburse independents not less than NADAC, plus pay a dispensing fee. It also includes audit protection provisions, and it exempts independent pharmacies from the direct supervision rule if the initial interpretation and final evaluation of the prescription are done by a pharmacist in person or remotely.
Finally in Colorado, SB25-045, legislation that requires school of public health to analyze model legislation for implementing a single-payer, nonprofit, publicly financed, and privately delivered universal health-care payment system for Colorado that directly compensates a provider. A report detailing its findings must be submitted to the General Assembly by December 31, 2026. The bill creates the Statewide Health Care Analysis Collaborative under the Department of Health Care Policy and Financing (HCPF) to assist the university in its report.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Connecticut
On May 12 and 13, the General Assembly procedurally moved SB 11 and HB 7192 through their respective committees. This legislation came out of the bi-cameral, bi-partisan Prescription Drug Taskforce that began last fall. Amongst the provisions, HB 7192 would provide that PBMs owe a fiduciary duty to health carriers; prohibit a PBM to charge a health plan a contracted price that differs from what the PBM pays the pharmacy for the services; expand the contents of the insurance commissioner’s annual report on health carrier rebates to include certain information on how rebates affected cost sharing; and require the insurance commissioner to require carriers to annually report on pricing offered to, and profit generated between, the carrier and any PBM or mail-order pharmacy. NACDS participated in the taskforce and supported both bills during the committee process. NACDS, with the Connecticut Association of Chain Pharmacies, participates with the Connecticut Patients Not PBMs coalition, made up of pharmaceutical companies, patient advocacy groups and pharmacy industry peers. The Connecticut legislative session ends firmly on June 4.
For more information, please contact NACDS’ Mike Sargent at 207-272-6435.
Delaware
On May 21, the Board of Pharmacy will hold its next regular meeting. The agenda includes:
- President’s report from Dr. Coffield
- Executive Director’s Report
- Application Review
- Pharmacist Application Review
- Committee Reports
- Legislative Committee Report 2.
- Professional Liaison Reports
- Controlled Substance Liaison Report
- Inspection Report from Pharmacist Compliance Officer- Dr. Matthew Moritz, PharmD
- PMP Report from Pharmacist Administrator- Dr. Jason Slavoski, PharmD
- Pharmacist/Pharmacy Ratification Listing
- Pharmacist In Charge/Consultant Pharmacist Interviews
- Pharmacist & Pharmacy Discussion /Action Items
- DHSS/DPH Discussion Items
For more information, please contact NACDS’ Mike Sargent at 207-272-6435.
Idaho
Myers and Stauffer is the vendor contracted to conduct the annual prescription volume survey of pharmacy providers on behalf of the Department of Health & Welfare. In accordance with the Idaho Administrative Code 16.03.09.665.01j, the prescription volume data collected from pharmacies will be used to determine their dispensing fee tier for the following calendar year. Each year, surveys are distributed starting May 1 and will be due by May 31. Providers who fail to participate in the survey will be placed in the lowest dispensing fee tier of $11.51. Below are the current dispensing fee tiers based on Total Annual Prescription Volume:
- Fewer than 40,000 claims: $15.11 dispensing fee
- Between 40,000 and 69,999 claims: $12.35 dispensing fee
- 70,000 or greater claims: $11.51 dispensing fee
Please note that the requested information applies to total pharmacy volume and is not limited to prescription/sales information related to Department of Health & Welfare recipients unless otherwise indicated.
2025 Idaho Prescription Volume Survey
Providers should fill out the survey form for all pharmacy NPIs within their organization that are enrolled with Idaho Medicaid. For providers with 5 or more pharmacy NPIs, please upload via the “multiple store” submission option at the survey link above. For questions or help completing the survey, please contact Myers and Stauffer at pharmacy@mslc.com or toll free at 800-591-1183.
Also in Idaho, Myers and Stauffer is working with the Department of Insurance to conduct a survey of costs incurred by pharmacies to dispense prescription medications to Idaho residents. All pharmacies that dispense prescriptions to Idaho residents are requested to complete the pharmacy dispensing fee survey.
Myers and Stauffer mailed a packet with survey information to pharmacies on April 17. Providers can also access the survey documents and download an electronic version of the survey tool located on the Dispensing Fee Survey webpage.
It is very important that all pharmacies cooperate fully by filing an accurate cost survey. Pharmacies are encouraged to return the requested information as soon as possible, but forms must be returned no later than May 29.
If you have any questions, please call toll free at 1-800-374-6858 or send an email to disp_survey@mslc.com.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Illinois
The Department of Healthcare and Family Services released an updated Preferred Drug List.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Indiana
Gov. Mike Braun (R) signed into law SB 140, PBM reform legislation establishing commercial reimbursement floors. The bill, effective January 1, 2026, requires reimbursement not less than the greater of the reimbursement level paid to PBM-owned or affiliated pharmacies, one of the following reimbursement methodologies depending on whether pharmacies hold permits to sell liquor. For pharmacies not holding permits to sell liquor, the reimbursement floor is NADAC, plus the professional dispensing fee from the Medicaid fee-for-service program. For pharmacies holding permits to sell liquor, the rate floor will be the actual acquisition cost (AAC) plus a “fair and reasonable” dispensing fee.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Kansas
The Department of Health and Environment issued two bulletins for paying pharmacists for services. The Stand-Alone Vaccine Counseling and Pharmacists bulletin authorizes pharmacists to provide and bill for vaccine counseling services for patients under the age of 21 years, retroactive to April 1, 2025. The Pharmacist as Provider, Emergency Opioid Antagonists and Medication Therapy Management adds payment for the extra counseling required when pharmacists dispense emergency opioid agonists (EOA) using the statewide protocol, commonly referred to as the naloxone protocol. This should be billed with the date of service dispensed and counseled, retroactive to January 1, 2025.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Maine
The Joint Committee on Appropriations and Financial Affairs met daily the week of May 12 for budget work sessions. The Chairs have yet to bring up the pharmacy tax. The bill remains pending before the joint committee. NACDS, working with the Maine Pharmacists Association and Retail Association of Maine, helped advocate against a potential "compromise" that would have exempted the independent pharmacies from the tax. While being fundamentally unfair, that compromise would have negated the federal match, eliminating the tax's utility. NACDS will continue to lobby the Governor's office and the legislature throughout the budget process. The bill must be moved by the Joint Appropriations Committee and approved by both chambers of the legislature. The fiscal year ends June 30.
For more information, please contact NACDS’ Mike Sargent at 207-272-6435.