Illinois
The Pharmacy Practice Act allows pharmacists in the state to provide PrEP (pre-exposure prophylaxis) under a standing order issued by either an Illinois-licensed physician or the Illinois Department of Public Health (IDPH). IDPH has now issued said standing order, along with a corresponding press release. In accordance with the law and the standing order’s protocols, pharmacists are required to complete specific training. Additionally, IDPH will monitor and collect data on the program’s utilization. For patients, IDPH has established this website.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Iowa
The Department of Health and Human Services, Iowa Medicaid posted INFORMATIONAL LETTER NO. 2685-MC-FFS-D – June 2025 Iowa Medicaid Pharmacy Program Changes effective June 1.
Also in Iowa, Gov. Kim Reynolds (R) announced the US Department of Agriculture Food and Nutrition Service approved a demonstration project for the state's own summer food pilot program. Healthy Kids Iowa is an alternative to the summer EBT program that serves Iowa children healthier foods at a lower cost by leveraging Iowa's already-existing, successful network of summer feeding programs and community providers. With the state's summer feeding demonstration project, each family will be able to select $40 worth of fresh and nutritious food for each eligible child per month. Families will be able to choose their monthly items, respecting their preferences and cultural and dietary needs. The Healthy Kids Iowa pilot program will run in June, July and August 2025.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Maine
On May 1, the Joint Committee on Appropriations and Financial Affairs held another budget work session, that was called on short notice. The Chairs never brought up the pharmacy tax, nor moved the budget. 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 next legislative work session for the Joint Committee on Appropriations and Financial Affairs was May 8. 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.
Massachusetts
On April 29, the Joint Committee on Financial Services heard both H1091 and S800, Acts Relative to Pharmacists as Health Care Providers. These bills would authorize the Department of Public Health to allow pharmacists to order, test, screen and treat patients. H1091 and S800 would also require pharmacies to be reimbursed for services. NACDS submitted testimony and will continue to support the bill throughout the legislative session which ends July 31, 2026.
Also in Massachusetts, the Board of Pharmacy released three updates:
Policy 2025-01: Rapid Microbial Methods (Rapid Sterility Testing)
Outlines general considerations and requirements for compounding pharmacies contemplating the use of an alternative sterility testing method.
Addresses non-resident Designated PIC absences and departures.
Pharmacies can order take-back envelopes and access other information on this website.
For more information, please contact NACDS’ Mike Sargent at 207-272-6435.
Nebraska
The Department of Health and Human Services (DHHS), Division of Medicaid and Long-Term Care (MLTC) is seeking individuals to serve on the Medicaid Advisory Committee (MAC). The MAC has a broad focus and includes a diverse range of stakeholders, including healthcare providers, community organizations, advocates and policy experts. The MAC advises the Medicaid agency on overall policy development and program improvements. For the MAC, the MLTC is seeking healthcare providers, community-based organizations, tribal representatives, public health professionals, social service providers, advocates and others with insight into the Medicaid system. To learn more or apply, explore the following online resources:
- Learn more: https://dhhs.ne.gov/Pages/MAC.aspx
- Apply now: https://dhhs.ne.gov/Documents/MLTC-39.pdf
Also in Nebraska, the Department of Health and Human Services (DHHS) recently sent out its first issuance of Summer Electronic Benefit Transfer (EBT) benefits. Throughout the 2025 Summer EBT period, households with eligible school-age children can receive assistance in buying groceries with the program's second year of operation. A one-time payment of $120 will be issued for each eligible child, intended to cover the three summer months at $40 a month. Eligible families will have 122 days, or four months, to use Summer EBT benefits. Summer EBT benefits can be used to purchase food at grocery stores, online food retailers, and farmer's markets that accept SNAP EBT.
Finally in Nebraska, Gov. Jim Pillen (R) signed LB 168, the 340B Contract Pharmacy Protection Act, legislation prohibiting any manufacturer from either directly or indirectly, denying, restricting, or prohibiting the acquisition of any 340B drug by or delivery of any 340B drug to any authorized 340B location.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
North Dakota
Gov. Kelly Armstrong (R) signed several bills of interest into law including HB 1087, legislation replacing “certificate of authority” requirement for PBMs with a “licensure” requirement; HB 1584, legislation outlining requirements for licensure of PBMs; creating a PBM enforcement fund, strengthening enforcement of PBM laws and regulations and establishing penalties for PBMs found in violation of laws and regulations; and HB 1473, legislation prohibiting any manufacturer from either directly or indirectly, denying, restricting or prohibiting the acquisition of a drug by a contract pharmacy and from interfering with the ability of a covered entity or contract pharmacy to dispense a drug to an eligible patient of the covered entity.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
New York
On May 5, NYRx issued a notice NYRx Helpful Hints for Pharmacies: Diabetic Testing Supplies.
Diabetic Test Strips and Lancets: NYRx coverage of preferred blood glucose test strips and lancets for members with diabetes aligns with Medicare Coverage of Diabetes Supplies.
Pharmacies must submit claims based on units per days' supply as follows:
- Members who use insulin: Maximum 300 test strips and lancets per 90-day supply
- Members who do not use insulin: Maximum 100 test strips and lancets per 90-day supply
Continuous Glucose Monitors and Disposable Insulin Pumps: Continuous Glucose Monitors and Disposable Insulin Pumps should be billed at the pharmacy point-of-sale for the proper quantity and days' supply as outlined on the product label.
What Pharmacies Need to Do: The pharmacy should become familiar with the NYRx Preferred Diabetic Supply Program. When submitting claims for preferred diabetic supplies do not request a PA (prior authorization) from the prescriber if the claim rejection states one of the following:
- Maximum Quantity Exceeded
- Early Fill Overuse
- Recipient Ineligible on Service Date
- Refill Number Exceeds Maximum
- Therapeutic Duplication
- Client Has Medicare Part D or Client Has Other Insurance
- Coordination of Benefits Claim Processing
- NYRx is always the payor of last resort and federal regulations require that all other available resources be used before NYRx considers payment.
The NYRx Education & Outreach Call Center is available by phone at 1-833-967-7310 or by email at NYRxEO@primetherapeutics.com from 8:00 am to 5:00 pm ET, Monday through Friday, excluding holidays.
For more information, please contact NACDS’ Mike Sargent at 207-272-6435.
Oregon
The Board of Pharmacy announced the agency’s new director, Dr. Gary Runyon, PharmD, a graduate of the University of Tennessee College of Pharmacy. Gary brings over 22 years of diverse pharmacy experience to Oregon, where he relocated in late 2020. Gary joined the Board of Pharmacy as a Compliance Officer, then transitioned to the Pharmacist Consultant position before becoming Executive Director effective April 14.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
South Carolina
NACDS submitted comments to the Senate Banking and Insurance Committee ahead of its hearing on SB 342, which includes several NACDS priorities related to reimbursement reform. As this marks the first session of a two-year legislative term, NACDS expects to continue advocating for this and related legislation throughout the summer and fall in preparation for the 2026 session.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Virginia
Virginia Pharmacies had a remarkable win in Virginia, when Gov. Governor Glenn Youngkin (R) signed our Medicaid PBM reform bill, HB 2610, after initially vetoing it and replacing it with a study. NACDS and VACDS were present on the ground in Richmond throughout the process, working with members and partners to pull every lever to secure a final victory. T NACDS issued a press release to praise Gov. Youngkin’s signature, and the legislature’s willpower, that led to the enactment of Virginia’s “single PBM” bill.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Alaska
NACDS submitted a comment letter to the Department of Health regarding the March 2025 Cost of Dispensing survey results from Myers and Stauffer citing a drop in the average cost of dispensing a Medicaid prescription.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Arizona
Gov. Katie Hobbs (D) signed HB 2628 (Chapter 32), legislation permitting pharmacists to order and administer emergency medication to manage an acute allergic reaction to a medication administered at the pharmacy.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
California
The Board of Pharmacy posted information for the following meetings:
- The Legislation and Regulation Committee Meeting will be held on April 9 beginning at 9:00 am Pacific. For details, please review the agenda.
- The Full Board Meeting will be held April 9-10 beginning at 1:00 pm Pacific on April 9. For details, please review the agenda.
Also in California, the Department of Health Care Service posted the following weekly notices, alerts, and monthly bulletin on the Medi-Cal Rx Web Portal. Please note effective April 25, Medi-Cal Rx will complete implementation of Pediatric Integration by reinstating Reject Code 75 – Prior Authorization Required for all continuation of therapy claims for members 21 years of age and younger; see alert below for details.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Idaho
Alex Adams, former executive director of the Board of Pharmacy, has been tapped to serve as the US Department of Health and Human Services assistant secretary for family support. The US Senate, which confirms presidential nominations, received his nomination. The State Legislature introduced a House Joint Memorial No. 8 to honor his work in the state.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Indiana
The Family and Social Services Administration (FSSA) issued Bulletin202538 providing updates to the Point-of-Sale Quick Check (PSQC) automated prior authorization (PA) system, PA criteria, mental health utilization edits, Statewide Uniform Preferred Drug List (SUPDL) and Preferred Brand Drug List.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Iowa
The Iowa Pharmacy Association (IPA) announced the selection of Matthew Pitlick, PharmD, BCPS, as its next Executive Vice President & CEO. Since its founding in 1880, Pitlick will serve as IPA’s ninth Chief Executive Officer. Matthew Pitlick is a graduate of Drake University College of Pharmacy and Health Sciences. Pitlick served as clinical faculty at the University of Health Sciences and Pharmacy in St. Louis, MO, for eight years before returning to his home state of Iowa. In 2018, Pitlick completed a one-year fellowship in Association Management with IPA. Dr. Pitlick will begin his service as incoming CEO on April 28, allowing for a brief overlap with Kate Gainer, PharmD, who will conclude her service as IPA’s CEO on June 6.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Kansas
The Department of Health and Environment (KDHE), Medicaid, is encouraging pharmacy providers to participate in a Myers and Stauffer pharmacy cost of dispensing survey. Responses are due April 23. The survey results will be used to evaluate the costs associated with dispensing medications in the Medicaid pharmacy program. To help prepare pharmacies to participate in the survey, Myers and Stauffer will be conducting an informational online seminar at 3:00 pm Central Time on April 8, presenting details about the survey process, discussing what information is being requested and answering questions regarding the survey form. Attendance at one of the online seminar sessions requires a reservation. Please call 800-374-6858 or email disp_survey@mslc.com for a reservation and further meeting details. For additional details and links to the survey, please visit the website.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Maine
On March 30, MaineCare provided notice regarding the financial status of the state and its need to temporarily withhold reimbursement. Relevant from the notice:
For the payment cycle that will run on April 2, we will continue to take only the following actions, consistent with the approach for the previous three payment cycles:
- Pay Critical Access Hospital prospective interim payments (PIPs) at 70 percent the normal levels;
- Hold payment for all hospital claims greater than $50,000;
- Hold payment for multi-state chain, large health system and out-of-state retail pharmacies and durable medical equipment services; and
- Hold payment for out-of-state providers of hospital, ambulance, pharmacy (excluding pharmacies within 15 miles of the Maine border) and durable medical equipment services.
For more information, please contact NACDS’ Mike Sargent at 207-272-6435.
Maryland
The Prescription Drug Affordability Board’s (PDAB’s) Stakeholder Council will meet virtually April 28, 2025, at 2:00 pm. The agenda and other meeting materials will be available on the Stakeholder Council page of the PDAB’s website prior to the scheduled meeting. You must register in advance for the meeting link.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
New York
On April 1, the state's Department of Health announced that beginning this summer, NYRx, the Medicaid Pharmacy Program, will accept electronic prior authorization (ePA) requests via CoverMyMeds® in addition to phone and fax requests.
CoverMyMeds is a tool designed to simplify the prior authorization process by prompting prescribers to answer required clinical questions that can offer real-time approvals if clinical criteria are met. Prescribers can electronically submit prior authorization requests, upload supporting documents and track request status in real time. Additionally, pharmacy providers who utilize CoverMyMeds will have the opportunity to initiate medication ePA requests on behalf of the member for completion by the prescriber. CoverMyMeds will direct the case to the prescriber's queue and prompt them to complete and submit the ePA to NYRx. Further communications, including effective dates, resources, and educational events, will be coming soon.
What Pharmacy Providers and Prescribers Need to Do
- Read the Quick Guide to CoverMyMeds Prior Authorization Requests to learn more about CoverMyMeds.
- Visit the CoverMyMeds Log In page to create an account, complete your profile and become familiar with the application.
Also in New York, the NYRx Education & Outreach (E&O) team would like to invite interested parties to live training webinars, held weekly on Mondays, Wednesdays, and Fridays from 12:00 noon – 1:00 pm Eastern, excluding holidays. The live webinars focus on different areas of NYRx, the Medicaid Pharmacy Program. Registration is required to join. To attend an online seminar, starting April 2025, please click on the links provided below, or you may visit the NYRx Education & Outreach website to register.
At each presentation's end, there will be time for a live question/answer session. Please share this information with others in your organization that may be interested or would find this online seminar helpful.
NYRx Pharmacy Webinar: *NEW* A customized online seminar directed toward pharmacies, pharmacists and pharmacy staff who care for NYS Medicaid members.
- It is held weekly on Wednesday, from 12:00 noon – 1:00 pm Eastern. To register:
- April 9: click here
- April 16: click here
- April 23: click here
- April 30: click here
Please send an email to NYRxEO@primetherapeutics.com for any questions or if you and your organization would like to schedule a webinar specific for your office staff or network. The NYRx E&O is happy to accommodate your schedule. Want to learn more about NYRx E&O? Visit our website: NYRx Education and Outreach website.
For more information, please contact NACDS’ Mike Sargent at 207-272-6435.
Oregon
The Board of Pharmacy posted the April 9-11 Board Meeting agenda and meeting materials. Please note that on April 9, the board will meet in Executive Session immediately after recusal announcements and anticipates resuming Open Session around 4:30 pm. Also, note that on April 10, the board will meet in Executive Session after roll call and anticipates resuming Open Session between 1:00 pm-2:00 pm. Finally, the board will meet in Open Session on April 11. Please see the meeting agenda for additional information.
Also in Oregon, State Plan Amendment (SPA) 24-0019 to increase professional dispensing fees for fee-for-service pharmacies, with fees ranging from $9.99 to $16.87 per prescription, depending on volume, and $20.86 for 340B covered entities is pending with the Centers for Medicare and Medicaid. As submitted by the Oregon Health Authority, this SPA proposes to update Oregon's professional dispensing fees (PDF) to $16.87 for pharmacies with a prescription volume of less than 40,000 claims per year, $11.93 for pharmacies with a prescription volume of 40,000 to 79,999 claims per year, and $9.99 for pharmacies with a prescription volume of 80,000 or more.
The Prescription Drug Affordability Board posted its April 2025 issue of The Quarterly. Highlights of this issue include the following. Past issues are available online.
- PDAB would love to hear from Oregonians, Page 1
- PDAB selects subset list for affordability reviews, Page 2
- PDAB member profile: Dan Kennedy, Page 5
- News you can use, Page 6
- Senate Health Care Committee advances Senate Bill 289, Page 7
- 2025 board meeting calendar, Page 8
Also in Oregon, the Prescription Drug Affordability Board posted it is agenda for the April 16 meeting. Register here in advance.
Also in Oregon, the Oregon Health Authority Health Systems Division: Medical Assistance Programs adopted this temporary rule, OAR 410-122-0186, to amend Medicaid fee-for-service durable medical equipment, prosthetics, orthotics and supplies to comply with the recently approved state plan amendment (SPA), effective October 1, 2024.
Finally in Oregon, the Division of Financial Regulation recently announced the following permanent rulemaking: ID 2-2025: Prescription Drug Price Transparency program updates
Rules: 836-200-0500, 836-200-0505, 836-200-0510, 836-200-0515, 836-200-0520, 836-200-0525, 836-200-0530, 836-200-0531, 836-200-0532, 836-200-0535, 836-200-0540, 836-200-0545, 836-200-0550, 836-200-0555, 836-200-0560.
Rules Summary: Adds a definition for "dosage;" combines the definitions for "inaccurate information" and "incomplete information;" adds clarification about what is not included in the definition of "new prescription drug;" removes dosage guidance from the definition of "one-month supply;" adds clarification to the definition of "reporting manufacturer; removes outdated timelines; sets timeline for reporting manufacturers to create an online account with the department; requires reporting manufacturers to provide the department with at least one contact person, with valid contact information, that is an employee who manages access to the account and receipt of trade secret determinations; updates the threshold for reporting new prescription drugs to reflect current specifications in Medicare Part D; provides a definition for the "date of introduction;" clarifies "good faith" language; clarifies requirements of manufacturer reporting including: drug strength, package size, and the date the drug was first approved; the description of the marketing used in the drug's introduction; and potential factors used to establish the price of the new drug; and more.
Filed: March 26, 2025
Effective: April 1, 2025
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Rhode Island
Medicaid posted its April 2025 Provider Update. Please note the “Pharmacy Spotlight” with information about the Medicaid Fee-for-Service program’s Stand Along Vaccine Counseling project in Spring 2025. This project allows pharmacies to be reimbursed for vaccine counseling services using the Service Billing (SI) and Service Reversals (S2) Transactions on the NCPDP transaction standard. See the update for additional details. All previous provider updates may be found online.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
South Carolina
NACDS attended in the SC Senate Labor, Commerce, and Industry Committee’s presentations on PBMs and the Future of Pharmacy. The session featured insights from several stakeholders, including the SC Pharmacy Association; Eunice Medina, Director of the SC Department of Health, and Human Services; the Cicero Institute; and the SC Alliance of Health Plans.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Tennessee
The Department of Health is confirming the state's first measles case in 2025 in a Middle Tennessee resident. The likely source of the infection is being investigated. Subsequently, the Department of Health confirmed three additional cases of measles in Middle Tennessee, which is also being investigated by public health officials.
Also in Tennessee, the Department of Commerce & Insurance added a new PBM Compliance Pharmacist position to serve as a pharmacy consultant and professional resource to the PBM Compliance Section. The position will be responsible for enforcement of current statutes and rules related to PBMs as well as assisting with compliance audits of PBMs, assisting with PBM complaint analysis and investigation and analysis of PBM Annual Reports.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Texas
Bills supported by all pharmacy groups are beginning to advance in the Senate.
- SB 493 prohibits "gag clauses" in contracts that prevent pharmacies from telling patients when the cash price for a drug is lower than the price under their insurance plan. SB 493 addresses contractual provisions between some health insurers, pharmacy benefit managers and pharmacies that prohibit pharmacists from freely informing patients if paying out-of-pocket (cash price) for the prescription may be cheaper than the insured's copay.
- SB 1122 builds upon the landmark US Supreme Court Rutledge decision and PBM reforms passed in recent years, HB 1919 and HB 1763, by extending the applicability of patient and pharmacy protections already in law to all PBM activity in the state, regardless of the health plan types. It further codifies the February 2025, Texas Attorney General Ken Paxton opinion letter KP-0480, which asserts that Texas has the authority to regulate PBM practices impacting its residents and local pharmacies, even when ERISA-governed plans are involved.
- SB 1236 amends current law relating to the relationship between pharmacists or pharmacies and health benefit plan issuers or pharmacy benefit managers. SB 1236 would amend Chapter 1369, Insurance Code, to provide reasonable contract protections for pharmacies and pharmacists in their relationships with PBMs. It would also amend existing statutes to clarify language regarding PBM audits and provide transparency in the applicability of Texas laws to contracts and benefit enrollees. This bill was heard in the Senate Health and Human Services Committee on April 1.
Also in Texas, another priority bill we are trying to advance includes HB 4533 by Rep. Tom Oliverson, MD, (R), legislation that would establish the fee-for-service reimbursement as the rate floor for Medicaid managed care organization claims.
Also in Texas, all pharmacy groups collaborated on making our united voices heard on our priority legislative issues at the March 26 Pharmacy Day at the Capitol. More than 400 pharmacists, interns and pharmacy students participated in 150 scheduled meetings, urging lawmakers to pass legislation to help save neighborhood pharmacies and the health of their patients.
Finally in Texas, Gov. Greg Abbott (R) launched a Department of State Health Services (DSHS) online interactive map identifying where Texans can acquire life-saving naloxone (NARCAN) to prevent fentanyl poisonings. This tool is part of the statewide "One Pill Kills" campaign.
For more information, contact NACDS’ Mary Staples at 817-442-1155.