Kansas
The legislative research department issued an agenda for special interim committee meeting to discuss the 340B drug program and PBMs.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Louisiana
The Department of Health (LDH) issued an Informational Bulletin 25-27 on revisions being made to align with CMS 2434-F 2024 Final Rule on 340B.
Also in Louisiana, effective October 1, the Medicaid program will phase out its single Pharmacy Benefit Manager (PBM) and return to managed care organizations (MCOs) to manage its own pharmacy services—including prior authorizations, claims processing and prescription coverage—through its designated PBM. The Department of Health provided a list of the new PBMs for Medicaid Health Plans. This change does not apply to fee-for-service (FFS) members or members who have behavioral-health only coverage through their Medicaid health plan.
Also in Louisiana, Walmart pharmacist Inga Collins volunteered to serve on the Louisiana Rural Health Transformation Task Force representing chain pharmacies.
Finally in Louisiana, Act 711 of the 2024 Regular Session authorizes pharmacists to initiate HIV PrEP and PEP, the human immunodeficiency virus (HIV) pre-exposure and post-exposure prophylaxis for individuals aged seventeen and older. A standing order for HIV Pre and Post-Exposure prophylaxis medications has been created by the Department of Health (LDH). In addition, the legislation mandates that pharmacists complete a training program approved by the Accreditation Council for Pharmacy Education (ACPE). This training may take place as a stand-alone course or as part of an equivalent curriculum-based training program offered by an ACPE-accredited college/school of pharmacy.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Maine
On September 12, the state's Center for Disease Control and Prevention (Maine CDC) issued a standing order authorizing qualified health care professionals -̶ including pharmacists -̶ to administer the 2025- 2026 COVID-19 vaccine. The standing order serves as a prescription for all Maine people, allowing them to receive the COVID-19 vaccine at pharmacies, clinics and health care offices across the state. Under the standing order, Maine people no longer need to obtain a prescription through their health care provider to receive the vaccine.
Also in Maine, on September 12, the Maine Bureau of Insurance issued a bulletin to state-regulated health insurance carriers reinforcing that they are required under state law to provide full coverage of the cost of the COVID vaccine when administered consistent with recommendations of the medical academies.
For more information, please contact NACDS’ Mike Sargent at 207-272-6435.
Massachusetts
The Board of Pharmacy shared a reminder that the Opioid Pain Medication Drug Fact Sheet that must be distributed when dispensing a Schedule II or III prescription has been updated to reflect statutory changes. Please also note the change to state law that requires an opioid antagonist (e.g., naloxone) to be offered whenever a Schedule II opioid is dispensed.
For more information, please contact NACDS’ Mike Sargent at 207-272-6435.
Minnesota
The vaccine protocol templates for the COVID-19 vaccine have been updated on Vaccine Protocols. Only minor changes have been made to provide clarity. The protocol content has not been changed.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Missouri
The Department of Social Services, through the MO HealthNet Division, is seeking input on key initiatives and priorities to consider for potential funding for the Rural Health Transformation Program. The deadline to submit comments on this form is September 30. More information is available on the Press Release .
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Montana
Effective October 1, the drug gabapentin will be a Schedule V controlled substance in the state, pursuant to the new law HB 41. Please see the below Fact Sheets for information to help with implementation:
For additional information, contact the Board of Pharmacy at (406) 841-2371 or dlibsdpha@mt.gov, or the Prescription Drug Registry (MPDR) Program at (406) 841-2240 or dlibsdmpdr@mt.gov.
Also in Montana, the Board of Pharmacy cancelled its Full Board Meeting on October 3. The board will meet again on December 5.
Finally in Montana, effective October 1, Bausch Health US, LLC and its subsidiary Salix Pharmaceuticals have terminated their participation in the Medicaid Drug Rebate Program. State Medicaid Programs are prohibited from utilizing federal funds to pay for medications manufactured by companies that don't participate in the Medicaid Drug Rebate Program.
Therefore, several medications, most non-preferred, will no longer be covered by Montana Healthcare Programs. The most notable are Retin-A and Xifaxan. Generic Retin-A will replace the brand as a preferred product. Unfortunately, Xifaxan does not have a generic alternative. The manufacturer has said that they will provide Xifaxan to Medicaid members through a patient assistance program. The application for which can be found here. Please, alert members and their providers so that they can start this process and avoid interruptions in care.
Below is a complete list of labelers whose rebate agreements and coverage will be terminated October 1. For more information, please contact Shannon Sexauer, PharmD, Medicaid Pharmacist, Allied Health Services Bureau, at shannon.sexauer@mt.gov.
| Labeler Code | Labeler Name |
| 99207 | BAUSCH HEALTH US, LLC |
| 68682 | OCEANSIDE PHARMACEUTICALS |
| 68012 | SANTARUS, INC. |
| 66530 | SPEAR DERMATOLOGY PRODUCTS, INC. |
| 66490 | BAUSCH HEALTH US LLC |
| 65649 | SALIX PHARMACEUTICALS, INC. |
| 57782 | BAUSCH & LOMB INC. |
| 25010 | BAUSCH HEALTH US, LLC |
| 16781 | BAUSCH HEALTH US, LLC |
| 13548 | BAUSCH HEALTH US, LLC |
| 00884 | PEDINOL PHARMACAL INC |
| 00187 | BAUSCH HEALTH US, LLC. |
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Nebraska
The Department of Health and Human Services announced CMS approved state Plan amendment 25-0010: Recovery Audit Contractor, waiving the requirement to implement a Recovery Audit Contractor for an additional two years effective December 1, 2025, through November 30, 2027. Neb Rev Stat 68-974(3)(a) excludes Managed Care claims from the scope of the Recovery Audit Contractor. Recall, the state implemented Heritage Health, combining physical health, behavioral health and pharmacy programs into a single managed care system, effective January 1, 2017.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Nevada
After three hours of discussion and debate at the September 4 workshop meeting over the latest draft regulation on pharmacy staffing, the board of pharmacy direct staff to redraft the language for a workshop meeting in Las Vegas on October 16. NACDS will continue to engage on this issue.
Also in Nevada, NACDS submitted the state survey on the Rural Health Transformation Program funds.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
New Mexico
Gov. Michelle Lujan Grisham (D) called lawmakers into a special session starting on October 1 consider a package of measures, including:
- Funding the Rural Health Care Delivery Fund to allow stabilization grants for quality health care providers.
- Taking action to make health insurance premiums more affordable in the marketplace and for New Mexicans losing Medicaid coverage.
- New investments in food assistance for children, senior citizens and families in need.
- Additional resources to help the Health Care Authority prepare for upcoming Medicaid enrollment changes.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
New York
The state's Department of Health updated its Preferred Drug List, effective September 15.
The NYRx Education and Outreach team shared an update to the NYRx Brand Less Than Generic Program Update effective October 1.
- Arnuity Ellipta® and Exelon® patches will be ADDED to the program.
- Apriso®, CellCept® suspension, Retin-A® cream, and Targretin® gel will be REMOVED from the program.
For more information, please contact NACDS’ Mike Sargent at 207-272-6435.
North Carolina
The latest Medicaid Pharmacy Newsletter, dated September 2025, is now available on the NC Medicaid website. In addition to the October 2025 checkwriter schedule, this edition of the newsletter includes the following articles:
- NC Medicaid to Change Coverage for GLP-1 Weight Management Medications
- Mailing and Delivery Fees to Retail Pharmacy Claims
- Reminder: Immunizing Pharmacist Enrollment in NC Medicaid Contraceptives and NRT [Nicotine Replacement Therapy] Protocol Reimbursement to Pharmacies
- Reminder on NC Medicaid Pharmacy Co-payment Requirements
- Children and Families Specialty Plan (CFSP) to launch December 1, 2025
Providers are encouraged to review this important information. The 2025 Medicaid Pharmacy Newsletters can be viewed online.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
North Dakota
Medicaid issued the following updates:
- Dulera is experiencing manufacturing delays. Due to sporadic backorders expected through October:
- The PA requirement for Advair Diskus and Advair HFA will be delayed at this time. Members may continue or switch to Advair Diskus or Advair HFA if Dulera is unavailable.
- The Dulera 200 mcg/5 mcg quantity limit allows one inhaler to be billed as a 60 days supply.
- Asmanex HFA will be allowed concurrently with Dulera 50 mcg/5 mcg. You will need to contact us to request an override for this option.
- Effective October 1: Dulera will be the only ICS/LABA inhaler that does not require PA.
- Advair HFA and Advair Diskus will be non-preferred status and require PA.
- All other ICS/LABA inhalers remain non-preferred status and require PA.
- Please work with prescribers to transition patients now to avoid treatment disruption.
Dulera contains formoterol and can be used for single-inhaler maintenance-and-reliever therapy (SMART) as recommended in asthma guidelines. ND Medicaid allows up to two Dulera inhalers per 30-day supply for SMART use.
- Effective October 1: Steqeyma no longer requires PA.
- Selarsdi and Yesintek remain Step 1 non-preferred status and require PA.
- Stelara and other ustekinumab biosimilars remain Step 2 non-preferred status and require PA.
- Effective October 1: Ozempic and Rybelsus will be preferred status and will not require PA.
- Victoza (brand) and liraglutide labeler 00480 remain preferred status and do not require PA.
- Liraglutide labelers 00143 and 71288 will be non-preferred status and require PA.
- Trulicity remains non-preferred status and requires PA.
- Effective October 1: Clonidine patches will require PA for members 10 years and older.
- Electronic age verification occurs during adjudication at the point of sale.
- See Non-Solid Dosage Forms criteria.
- Effective October 1: The manufacturer of Xifaxan and Trulance will cease participation in the Medicaid Drug Rebate Program (MDRP).
- Xifaxan and Trulance will no longer be eligible for coverage by ND Medicaid.
- Medicaid members may apply to the manufacturer's patient assistance program (PAP) to obtain Xifaxan or Trulance (https://www.bauschhealthpap.com/).
ND Medicaid cannot pay for a drug when the manufacturer does not participate in the MDRP due to federal law, Sec.1927. [42. U.S.C. 1396r-8] (a).
- Manufacturers choose whether they will sign up for the MDRP.
- Manufacturer participation is outside of ND Medicaid's control.
An alternative, participating manufacturer's product or different drug that is covered must be used for Medicaid to be able to pay.
For more information, contact LeNeika Roehrich, PharmD, BCGP.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Oklahoma
On September 9, the Attorney General Gentner Drummond (R) announced a $32.1 million settlement with CVS Caremark, a PBM for the state's HealthChoice plan. The settlement resolves allegations that CVS Caremark withheld millions of dollars in drug rebates intended to reduce healthcare costs for state employees between January 2020 and December 2024. Approximately $27 million, after attorney fees, will be returned to HealthChoice within 30 days to benefit state employees, retirees and their families. The agreement also mandates quarterly rebate reporting, prompt rebate remittance and expanded definitions to ensure transparency and accountability.
Also in Oklahoma, NACDS submitted the state survey on the Rural Health Transformation Program funds.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Oregon
The West Coast Health Alliance, comprised of California, Hawaii, Oregon and Washington, jointly announced Consensus 2025-26 Respiratory Virus Immunization Recommendations for COVID-19, influenza and respiratory syncytial virus (RSV) vaccines. The recommendations state that immunization is safe and effective, and it offers the best protection available against respiratory viruses. The recommendations also endorse broad access to the COVID-19 vaccine for anyone who chooses protection.
Also in Oregon, at the Board of Pharmacy Special Meeting on September 17, the board adopted the following Temporary Rules and Vaccination Protocols:
September 17 Temporary Rule Noticed
- REPEALED – Standard Vaccination Protocol for Persons 3 through 6 Years of Age & Assessment and Treatment Care Pathway
- REPEALED – Standard Vaccination Protocol for Persons 6 Months through 2 Years of Age & Assessment and Treatment Care Pathway
- Div 102 – Board Delegated Limited Authority for Vaccine Protocol rules *Effective September 17
Email all rulemaking related inquiries to pharmacy.rulemaking@bop.oregon.gov.
Also in Oregon, the Division of Financial Regulation issued Bulletin No. DFR 2025-6 regarding coverage of the COVID-19 vaccination. This bulletin clarifies the division's expectations around the coverage of COVID-19 vaccination by health benefit plans in the state in accordance with Bulletin No. DFR 2021-1. For more information, please visit the FAQs about COVID-19 vaccine insurance coverage requirements related to the West Coast Health Alliance.
Finally in Oregon, the Board of Pharmacy posted its agenda and meeting materials for the October 8-10 meeting. Please note on October 8 the board will meet in Executive Session for most of the day and anticipates resuming Open Session around 4:30 pm and on October 9 the board anticipates meeting in Executive Session after roll call and resuming Open Session at 1:00 pm. The board anticipates meeting in Open Session on October 10 and will break for lunch between 12:00 noon-1:00 pm. 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.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
South Carolina
The Board of Medical Examiners has approved revisions to the SC Protocol for Administration of Vaccines by Pharmacists effective September 17. These changes follow recommendations from the Joint Pharmacist Administered Vaccines Committee on September 15.
Key Update:
Pharmacists, pharmacy interns, and eligible pharmacy technicians are now authorized to administer FDA-approved COVID-19 vaccines without a licensed practitioner's order, provided administration follows recommendations from one of the following:
- ACIP (Advisory Committee on Immunization Practices)
- AAP (American Academy of Pediatrics)
- AAFP (American Academy of Family Physicians) or
- ACOG (American College of Obstetricians and Gynecologists)
Important Reminders:
- Age restrictions still apply. As outlined in Appendix J, pharmacists may only administer FDA-approved or EUA COVID-19 vaccines to individuals 16 years of age and older, in accordance with guidelines from the groups above.
- All pharmacies must have a printed copy of the most current protocol in the area where vaccines are administered.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Tennessee
Certification of low-volume status must be submitted to each PBM you work with by December 1 annually to ensure you receive the low-volume dispensing fee. The Department of Commerce & Insurance (TDCI) rules 0780-01-95-.01(1) outlines requirements for submitting such certifications, including submitting proof of the pharmacy’s actual prescription volume from July 1, 2024 to June 30, 2025.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Texas
Gov. Greg Abbott (R) signed into law HB 25, legislation allowing pharmacists to dispense ivermectin without requiring a prescription order from a licensed healthcare practitioner effective December 4.
The second 30-day special legislative session ended early on September 4.
Also in Texas, the Health and Human Services Commission (HHSC) sent CMS a state plan amendment regarding substitutions when there are drug shortages. Considering CMS is encouraging states to do this, Texas is expecting quick approval.
Also in Texas, the Board of Pharmacy posted the agenda for the September 25 Prescription Monitoring Program (PMP) Advisory Committee meeting.
Also in Texas, the Health and Human Services Commission (HHSC) Vendor Drug Program (VDP) is currently accepting stakeholder comments on requiring a prescription for the COVID-19 At-Home Test Kit. Currently, at-home COVID-19 test kits are available without a prescription. The policy change includes requiring a prescription for test kits filled and dispensed for members in Medicaid and CHIP. HHSC does not propose changing the quantity limit of a maximum of four test kits per month.
Also in Texas, the Department of State Health Services (DSHS) issued a Texas COVID-19 Vaccine Information Statement, outlining the benefits, risks, development process, long-term studies, legal protections and adverse event reporting related to the COVID-19 vaccine. Pharmacies are required to provide patients with this document and obtain written informed consent from the patient as a result of HB 4535, which took effect on September 1.
Finally in Texas, NACDS submitted the state survey on the Rural Health Transformation Program funds.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Vermont
The Board of Pharmacy met in a special meeting on September 17 to approve a revision of the State Pharmacist Prescribing Protocol for COVID 19 and Influenza Vaccines Ages 5 and Up.
- The Purpose of updating this protocol is to remove requirements that COVID vaccines are only administered based on ACIP recommendation. Essentially removing the tie to ACIP.
- Technicians will still be able to administer vaccines
For more information, please contact NACDS’ Mike Sargent at 207-272-6435.
Washington
The Department of Health (DOH) issued a COVID-19 Vaccine Standing Order authorizing health care providers to administer the most updated versions of the COMIRNATY, MNEXSPIKE, SPIKEVAX and NUVAXOVID COVID-19 vaccines to all persons aged 6 months and older, including pregnant individuals.
Also in Washington, the Health Care Authority is continuing to solicit Rural Health Transformation Program (RHTP) input through September 26 at 5:00 pm Pacific time. Written comments are limited to 10 pages or less. Slides or other formats are welcome. Specifically, they want to meet the needs of Washington's rural communities:
- Projects with an implementation plan that are ready to launch soon
- Input about community needs and regional trends
- Recommendations for leveraging RHTP funds
- Initiatives to transform rural health care delivery
- Opportunities to support workforce, infrastructure and technology
Finally in Washington, Gov. Bob Ferguson (D) joined the Oregon, Hawaii and California governors known as the West Coast Health Alliance (WCHA), announced coordinated winter virus vaccination recommendations to include the 2025–26 COVID-19 vaccine, influenza and RSV.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Wyoming
The Department of Health is conducting a series of public meetings to gather input on rural healthcare challenges, strengths and opportunities. Please note, later this fall, the Department of Health will release a statewide survey to collect additional input and help refine Wyoming's priorities for the application. These engagement opportunities will be posted to the Department of Health site for this project.
Also in Wyoming, the Department of Health announced, effective September 2, Jesse Springer has been appointed the state's Interim State Medicaid Agent and Senior Administrator for the Division of Health Care Financing. This division oversees Medicaid and the Children's Health Insurance Program (CHIP).
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
California
The Department of Health Care Services posted the following:
- August 2025 Pharmacy Medi-Cal Update Bulletin
- August 2025 Durable Medical Equipment and Medical Services Medi-Cal Update Bulletin
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Florida
The proposal to roll back certain school vaccine requirements will not take effect for at least 90 days, according to the state health department. The initial changes would apply only to chickenpox and a few other illnesses, while any expansion to include diseases, such as polio and measles would require legislative action.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Kentucky
MedImpact, the state’s single PBM, announced that beginning September 28 they will cover and reimburse certain new COVID vaccines and issued an updated protocol.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
New York
Effective September 1, 2025, NYRx, the state's Medicaid Pharmacy program, announced coverage for the 2025-2026 formulations of the COVID-19 vaccine. Effective September 5, 2025, in accordance with the Executive Order #52 and the guidance issued by the Commissioner of Health, pharmacists are authorized to order patient-specific orders for COVID-19 vaccination for patients aged 3 years and older for off-label usage of COVID-19 vaccine. See Advisory Immunization Notification titled 2025-20206 COVID-19 Guidance for Pharmacists located at https://commerce.health.ny.gov. Enrolled pharmacy providers will be reimbursed for vaccine cost and administration when administered to eligible members. Pharmacies will bill NYRx using the National Council on Prescription Drug Programs (NCPDP) D.0 format.
The Department has since then issued an update on non-patient specific standing order for the administration of the Pfizer-BioNTech updated COVID-19 vaccine (2024-2025 Formula) for persons 5 years of age and older by pharmacists.
For more information, please contact NACDS’ Mike Sargent at 207-272-6435.