Beginning January 1, 2027, all Kentucky insurance carriers will be required to reimburse all outpatient pharmacy claims at NADAC + $16.31, following the Insurance Commission’s announcement of the results of their recent cost of dispensing study. The study was required by the comprehensive commercial market PBM reform law NACDS worked with members and the Kentucky Retail Federation to pass in 2024.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
The House advanced key PBM provisions this week as part of a comprehensive health care reform package to address the cost and accessibility of primary care services in the Commonwealth. The legislation, HR 5618, includes two main PBM provisions targeting PBM rebate contracting practices and as well as PBM common ownership. The bill mandates that insurers and PBMs must pass along at least 80 percent of estimated drug rebates to consumers at the pharmacy point of sale. Additionally, it tightens regulatory oversight of vertically integrated PBM “affiliated entities” within the Division of Insurance, reinforcing NACDS-supported regulations that were adopted earlier this year. Moving forward, the House bill will go to conference negotiations where there will be an opportunity to add additional PBM reform measures to the final package.
For more information, please contact NACDS’ Mike Sargent at 207-272-6435.
Gov. Mike Kehoe (R) signed two bills that include a provision to raise the 12-month purchase limit for ephedrine, phenylpropanolamine and pseudoephedrine from 43.2 grams to 61.2 grams, while keeping existing daily and monthly limits. The bill also requires manufacturers to fund a real-time tracking system for the sale of the products beginning on October 1. For more information, see HB 2372 & SB 878.
Also in Missouri, on August 1, pharmacists can begin renewing their license. To renew, pharmacists must complete 30 hours of approved continuing education (CE) prior to renewing.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
The August 12-13 Board of Pharmacy Meeting Agenda and meeting materials are now available. Please note the Board will discuss Divs 006/007/110/145 – Mobile Pharmacy (2026 HB 4131) (OAR 855- 006-0005, OAR 855-007-0030, OAR 855-007-0080, OAR 855-007- 0100, OAR 855-007-0110, OAR 855-110-0007, OAR 855-145-0001, OAR 855-145-0005, OAR 855-145-0010, OAR 855-145-0015, OAR 855- 145-0020, OAR 855-145-0025, OAR 855-145-0030; see attachment #B1. Please be advised that additional meeting materials may be added to the agenda prior to the board meeting. Visit the board website for current meeting materials.
Also in Oregon, the Prescription Drug Affordability Board (PDAB) published the "Oregon PDAB Quarterly" newsletter, Issue 15.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
On July 22, Nurse Practitioners (TNP) filed a lawsuit seeking to invalidate Texas' physician delegation of collaborative practice requirements for nurse practitioners. The plaintiffs are asking a Texas court to declare the current framework unconstitutional under the Texas Constitution's Due Course of Law Clause and private nondelegation doctrine. The lawsuit argues that Texas improperly requires licensed nurse practitioners to obtain permission from private physicians before exercising authorities already granted by the state. While pharmacists are regulated differently than nurse practitioners, a broad judicial ruling limiting the state's ability to condition practice authority on physician approval could influence future pharmacy policy debates on expanding patient access through pharmacist-provided clinical services. NACDS is monitoring the lawsuit.
Also in Texas, Lt. Gov. Dan Patrick (R) announced a third round of interim charges for the Senate to address before the 2027 Legislative session. Pharmacy issues are in the January and March reports.
Also in Texas, the Health and Human Services Commission's (HHSC) Vendor Drug Program (VDP) Medicaid provided information on dispensing emergency prescriptions for the July flooding disaster declaration.
Also in Texas, due to a potential supply gap, Sandoz is currently allocating brand-name Ritalin LA products, resulting in a product backorder. In response, the Health and Human Services Commission (HHSC) temporarily removed the non-preferred status from certain generic Ritalin LA products on the preferred drug list (PDL).
Also in Texas, the Texas Pharmacy Congress will meet on the campus of the Texas A&M College of Pharmacy on August 6-7.
Also in Texas, the Board of Pharmacy posted the agenda for the August 4 meeting in Austin.
Also in Texas, effective July 1, HHSC requires a prescription for dispensing at-home COVID-19 test kits through the outpatient drug benefit for people enrolled in Medicaid and CHIP. The change is due to the end of federal regulations requiring coverage of at-home COVID-19 test kits and applies to fee-for-service and managed care. There are no changes to the maximum limit of four test kits per month.
Also in Texas, the Department of State Health Services (DSHS) Immunization Section is hosting a back-to-school webinar for the Vaccines for Children (TVFC) and Adult Safety Net (ASN) Program Providers on August 7 from 10:00 am – 11:30 am.
Finally in Texas, Stephanie Stephens will assume the role of Chief Medicaid and CHIP Officer, also known as Medicaid Director, on August 15. Stephens will lead Medicaid and CHIP Services through the Sunset review and the legislative session while HHSC identifies a successor. She will succeed Emily Zalkovsky.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
The Department of Health Care Services posted the following on the Medi-Cal Rx Web Portal:
Also in California, the Department of Health Care Services posted the following:
Also in California, Medi-Cal Rx appreciates your continued partnership and support in ensuring the continuity of care for members. Medi-Cal staff are requesting stakeholder feedback regarding the services provided by the Resolution Team (also known as the Special Population and Managed Care Plan Clinical Liaison Team). Participation in the Stakeholder Survey for the Resolution Team will help with efforts for continuous process and quality improvement. Please submit your responses no later than July 19.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Medicaid eligibility requirements for some Health First Colorado members will change significantly because of federal legislation, H.R. 1. To help community partners understand the changes and help keep eligible members covered, the Department of Health Care Policy & Financing launched a new Toolkit and will host a Medicaid Work Requirements Webinar on July 21.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Attorney General James Uthmeier issued a Civil Investigative Demand to CVS Health Corporation, owner of both the Caremark pharmacy benefit manager and hundreds of CVS retail pharmacies in Florida. The probe examines whether CVS/Caremark steers patients to its own locations, reimburses its affiliated stores more generously than independent pharmacies for identical prescriptions, imposes burdensome audits that claw back payments and enforces restrictive contracts that threaten small businesses. Such practices allegedly contribute to pharmacy closures and "pharmacy deserts," leaving families and seniors with fewer options and higher costs. The Civil Investigative Demand requires thousands of documents and sworn testimony on reimbursement rates, pharmacy contracts, patient steering, audits, rebates, differential treatment of own versus independent stores and expansion plans. Compliance is required by July 28.
Also in Florida, the Statewide Medicaid Managed Care annual open enrollment (OE) season begins October 1 and ends November 30 for all enrollees in all regions. During open enrollment, enrollees may choose a different managed care plan or remain with their current plans. Enrollees will begin receiving OE reminder letters in July. All OE mailings will be completed by September 30. Beginning October 1, enrollees can request a plan change using one of the methods below. All plan changes requested will become effective on December 1.
Finally in Florida, the state's 2026 Back-to-School Sales Tax Holiday begins on July 20 and ends on August 20. Participation is mandatory. Retailers cannot opt out of the Back-to-School Sales Tax Holiday.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
The Idaho Retailers Association is gathering information for a new initiative that could benefit pharmacies and patients. The Idaho Medical Association is working with the American Medical Association on an awareness initiative regarding a Medicaid covered benefit: Self-Measured Blood Pressure for adults, including blood pressure cuffs from the validated device list.
Their goal is to provide Idaho physicians with a list of pharmacies that are verified to carry the validated cuffs (assuming not all pharmacies carry them). Additional educational information about the campaign will be forthcoming, but the first step is to make sure everywhere in Idaho has a pharmacy nearby that can provide the device.
Please answer the following three questions at your earliest convenience and email your responses to pameaton@idahoretailers.org.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
