Oklahoma
Three PBM reform bills community pharmacies supported were unanimously approved by the Senate Business and Insurance Committee and will now advance to the full Senate.
- SB 789 addresses below-cost reimbursements by establishing a reimbursement rate floor of no less than 106% of the NADAC plus a professional dispensing fee of $15.00; NACDS sent a support letter;
- SB 993 sets requirements and limits for audits; and
- SB 773 enhances the Attorney General's enforcement authority ensuring proper reimbursement.
Also in Oklahoma, NACDS and the Your Care Coalition rallied support for SB 741, the test and treat bill, before the Senate Health and Human Services Committee on March 3. The bill title was amended and passed out of the committee. The next action will be on the Senate floor.
Also in Oklahoma, SB 806, Food is Medicine legislation that would improve access to important nutrition services for SoonerCare beneficiaries by incentivizing improvements in their health and controlling healthcare costs by seeking a 1115 waiver, passed out of the Senate Health and Human Services Committee and was referred to the full Senate. NACDS sent the Senators a support letter.
Finally in Oklahoma, legislation all pharmacies support, SB 906 by Sen. Paul Rosino (R), increasing the retail pharmacy technician to pharmacist ratio from 2:1 to 4:1, which is what is currently the ratio in other practice settings, cleared the Senate Health and Human Service Committee and referred to the Senate floor.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
South Dakota
SB 154, legislation prohibiting pharmaceutical manufacturers from interfering in contracts between 340B entities and pharmacies, passed the Senate and passed the House Health and Human Services Committee with 8-5 vote.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Tennessee
The Department of Commerce and Insurance (TDCI) recently posted a consent order with Express Scripts citing multiple violations of PBM laws and rules in the state, including improper payments regarding 277 claims, which adversely affected 40 pharmacies in the state. Express Scripts must pay a civil penalty of $250,000.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Texas
The Department of State Health Services (DSHS) briefed health partners on the measles outbreak throughout Texas. DSHS is posting updates on Tuesdays and Fridays when there are new cases to report.
Also in Texas, the Health and Human Services Commission (HHSC) issued an updated Pharmacy Provider Procedure Manual.
Also in Texas, Gov. Greg Abbott (R) appointed Heisha Freeman as a public member to the Board of Pharmacy, replacing Garrett Marquis who resigned. Freeman's term will expire on August 31, 2029.
Finally in Texas, March 14 marks the 60th day of the 89th Regular Legislature Session, and the deadline for House and Senate members to file a bill.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Utah
HB 519, legislation addressing the 340B drug discount program, passed the House and was introduced in the Senate. This bill would prohibit a pharmaceutical manufacturer from restricting, prohibiting or otherwise interfering with a 340B entity's ability to acquire a 340B drug or participate in the 340B drug discount program.
Also in Utah, HB 257, legislation related to health insurance pharmacy benefits, passed the House and was introduced in the Senate. This bill would require a health benefit plan to ensure pharmaceutical rebates are used for certain purposes to benefit enrollees and require a PBM offers certain options to self-funded health benefit plans that (1) comply with provisions of Subsections 31A-22-643(4) and (5), collectively and individually; and (2) do not include spread pricing.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Virginia
After an intense advocacy effort compressed into a 60-day legislative session, pharmacy scored a major victory in Richmond this session with the passage of SB 875 and HB 2610, companion Medicaid Managed Care PBM reform bills. The bills overwhelmingly passed the General Assembly in a bipartisan vote. The bills would require the Medicaid managed care plans to contract with a single PBM under terms set by the Department of Medical Assistance Services (DMAS). The contract would require:
- clear statements of the PBM's fiduciary duty to the state;
- pass-through pricing;
- a common formulary, reimbursement methodologies and dispensing fees negotiated by DMAS; and
- transparency in drug pricing.
NACDS issued an NACDS RxIMPACT action alert and urges members with operations in the Commonwealth to contact Gov. Glenn Youngkin (R) to express how critical these bills are to patient access and pharmacy viability. Should he sign the bill, Virginia would join Ohio and Kentucky as the third state to reform PBM practices in Medicaid Managed Care under a single PBM.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Washington
HB 1520 and SB 5513, identical pharmacists’ scope expansion of practice bills, failed to get scheduled for a public hearing this session. To advance the independent authority legislation next session, pharmacies need to engage in the Sunrise Review process and submit support letters by April 1.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Wyoming
On February 28, Gov. Mark Gordon (R) signed SF 119, legislation to streamline and simplify professional and occupational licensure requirements for miliary service members or miliary spouses.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Arkansas
HB 1150 prohibits out-of-state PBMs from having in-state pharmacies, passed the Committee on Commerce and Insurance and is pending further action by the House.
Also in Arkansas SB 58, Act 52, is a new law approved on February 13, 2025, removes the prohibition for a nonprofit tax-exempt, or government-funded hospitals, to hold a licensed pharmacy permit.
Finally in Arkansas, HB 1442, is a patient freedom to choose their pharmacy and prevent anti-competitive practices bill was scheduled for a hearing in the House Public Health, Welfare and Labor Committee on February 20.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Arizona
NACDS submitted a letter of support to the Senate Regulatory Affairs and Government Efficiency Committee for SB 1214, legislation expanding public access to pharmacy test and treat services. Additionally, NACDS, along with the American Pharmacists Association, Walgreens, and Walmart, submitted a letter of support to the Arizona Senate Regulatory Affairs and Government Efficiency Committee for Arizona SB 1214, legislation that would permit pharmacists to provide test and treat services for common illnesses, such as flu, strep throat, and other respiratory conditions. The bill passed out of the committee with a 5-2-0-0 vote.
Also in Arizona, NACDS submitted a letter of support to the House Health & Human Services Committee for HB 2208, legislation establishing a cost-based reimbursement rate floor that will provide pharmacies and pharmacists with long-overdue reimbursement predictability related to crucial healthcare services provided in local communities across the state. The bill passed out of the committee with a 9-0-2-0-0 vote.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
California
The Board of Pharmacy announced the modification and/or extension of the waivers of Pharmacy Law issued in response to the Los Angeles Fires.
The waiver that provides flexibility to increase the number of pharmacy technicians a pharmacist may supervise has been modified and the expiration date has been extended to June 30, 2025 (or the termination date of the state of emergency, whichever is sooner).
The expiration date of the waiver that provides flexibility for pharmacy personnel to perform some functions from outside of a licensed pharmacy has been extended to June 30, 2025 (or the termination date of the state of emergency, whichever is sooner).
The expiration date of the waiver to allow for the delivery of drugs to an alternate location has been extended to March 31, 2025 (or the termination date of the state of emergency, whichever is sooner).
Also in California, the Department of Health Care Services posted the following:
- February 2025 Pharmacy Medi-Cal Update Bulletin
- February 2025 Durable Medical Equipment and Medical Services Medi-Cal Update Bulletin
Finally in California, the Department of Health Care Services posted the following alerts and a weekly notice on the Medi-Cal Rx Web Portal. Please note the 2025 prescription volume attestation survey will be available to providers March 1 through March 31. Also, to avoid mail delivery delays and save paper, Medi-Cal Rx encourages pharmacy providers to opt into receiving the Medi-Cal Rx remittance information via the Electronic Remittance Advice (ERA) format.
- Centers for Medicare and Medicaid Services Payment for Error Rate Measurement Review
- Upcoming Pharmacy Professional Dispensing Fee Provider Self-Attestation
- Medi-Cal Rx Weekly Wrap-up for January 31-February 6
- State of Emergency Override Extension: Los Angeles and Ventura Counties
- Reminder: Providers Encouraged to Sign Up for Medi-Cal Rx Electronic Remittance Advice
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Connecticut
On February 20, 2025, the Joint Committee on Human Services held a hearing on several bills, including H6101, An Act Concerning Medicaid Coverage of Food as Medicine and Expanding Access to the Connecticut Farmers’ Market/Women, Infants and Children Nutrition Program. NACDS testified and submitted testimony in coordination with the Connecticut Chain Pharmacy Council and the Connecticut Food Association.
For more information, please contact NACDS’ Mike Sargent at 207-272-6435.
Indiana
SB 96, immunization legislation NACDS supports because it removes the list of vaccines a pharmacist can administer, allowing them to provide any vaccine recommended by the federal Centers for Disease Control and Prevention Advisory Committee on Immunization Practices that has been approved by the federal Food and Drug Administration under a drug order, under a prescription, or according to a protocol approved by a physician. The bill was amended, giving the Indiana Commissioner of Health the authority to remove a specific vaccination from the list of vaccines recommended and approved by the federal agencies, and then unanimously approved by the Senate.
Also in Indiana, NACDS rallied members to contact their senators to urge support for the rate floor bill that is scheduled for a Senate vote this week. SB 140 would establish a minimum dispensing reimbursement rate of NADAC plus a professional dispensing fee equal to the Medicaid Fee for Service fee, which is currently $10.64.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Iowa
NACDS sponsored and attended the recent Iowa Pharmacy Association’s (IPA) Pharmacy Day on the Hill that included 200 pharmacy professionals in Des Moines to advocate for PBM reform at the Iowa State Capitol. The comprehensive PBM reform bill (HSB 99 / SSB 1074) passed out of subcommittee in the House and Senate and moves on to consideration by the full committees in both chambers as early as this week. IPA also hosted a PBM Reform Press Conference, revealing the latest poll data demonstrating resounding support for PBM reform among Iowans. These companion bills include important NACDS PBM reform legislative priorities including patient choice of pharmacy, anti-mandatory mail order, and commercial cost-based rate floor reimbursement methodology for the product and professional dispensing fee as published by the Iowa Medicaid Enterprise provider fee schedule. Also, a PBM cannot deny a pharmacy or pharmacist the right to participate as a contract provider under a plan if the pharmacy or pharmacist agrees to the terms and requirements of the plan and the terms of reimbursement.
Also in Iowa, the Department of Health and Human Services (HHS), Iowa Medicaid posted INFORMATIONAL LETTER NO. 2660-MC-FFS RE: Quantity Limit Update on Needles and Syringes effective March 1.
Finally in Iowa, the Department of Inspections, Appeals & Licensing’s Professional Health Committee – Pharmacy announced a meeting to be held on February 26.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Kentucky
Gov. Andy Beshear (D) declared a state of emergency due to the severe storms that swept through the Commonwealth on February 14. In response, Medicaid has activated NCPDP procedures for pharmacies to override certain denials for members impacted by the storms. Gov. Beshear also activated the state’s emergency operations center and implemented the state’s price gouging laws to protect Kentuckians from overpriced goods and services as they recover from the storm.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Louisiana
The state Surgeon General Ralph Abraham sent a directive to state health workers on February 13, 2025, ending long-standing mass vaccination clinics and banning staff from promoting seasonal vaccines. Abraham also issued a letter to the public criticizing the state’s COVID response and public health institutions.
Also in Louisiana, NACDS submitted a letter supporting the proposed rules implementing House Bill 579 which we passed in 2024, enabling pharmacists to offer HIV prevention services.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Missouri
MO HealthNet (Medicaid) is conducting a survey regarding the implementation of the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities (SUPPORT) Act’s prescription drug monitoring program mandate. The SUPPORT Act required that states mandate that covered providers consult a qualified prescription drug monitoring program (PDMP) before prescribing controlled substances to covered individuals. States must report annual data about the use of PDMPs by covered providers before prescribing controlled substances to the Department of Health and Human Services (HHS).
Also in Missouri, effective January 9, 2025, the MO HealthNet Division (MHD) carved-out certain drugs from the 340B Drug Pricing Program reimbursement. It was necessary to allow the state to collect supplemental and value-based agreement rebates on certain therapies. The state cannot collect federal, supplemental, or value-based agreement rebates when a covered entity utilizes 340B stock.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Nebraska
The Department of Health and Human Services added the following items under the Vaccines for Children (VFC) Provider Resources dropdown.
- Daily Freezer Temperature Log
- Daily Refrigerator Temperature Log
- Daily Ultracold Freezer Temperature Log
- Quick Reminders
- Transport During Emergencies
- Vaccine Restitution Form
- VFC Borrowing Report
- Vaccine Storage Troubleshooting Report
- Clinic Line Listing Template
- Clinic Line Listing Blank
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
New York
The New York Department of Health held its monthly pharmacy industry call for NYRx, the state Medicaid pharmacy benefit program on February 19, 2025. The agenda included (1) DME supplies, processing of incontinence supplies, as this is the highest category of waste, fraud and abuse in the program today; (2) enhancements to the internal system for prior authorizations which allow the state to override and amend as needed; and (3) unenrolled providers are rejected by EMEDNY, if there are any concerns, make sure your pharmacy is enrolled when activating. The next monthly meeting will be March 19, 2025, at 1pm.
For more information, please contact NACDS’ Mike Sargent at 207-272-6435.
North Carolina
The Department of Insurance has published rules regulating Pharmacy Benefit Managers were published this week. The reason for this proposed action is to implement statutes for the licensure of pharmacy benefits managers (PBMs) and directed the Department to adopt rules for licensure (see G.S. 5856A-2). Entities to be licensed as PBMs have previously been licensed or registered as third-party administrators (TPAs). Borrowing from the licensure requirements for TPAs, the proposed rules further set out the requirements for licensure as a PBM. Additionally, where G.S. 58-56A-2 gives the Commissioner the authority to charge an initial application fee of $2,000 and a renewal application fee of $1,500, those fees will be established by the proposed rule 11 NCAC 24 .0102. The date of the public hearing will be April 1, 2025, at 10:00 a.m., NC Department of Insurance, Hearing Room 211, 3200 Beechleaf Ct., Raleigh, NC 27604.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
North Dakota
Register Now for the Informative Training Session: Supporting the American Indian Population in North Dakota. This one-hour recorded on-demand training is designed to equip you with the knowledge and skills necessary to develop new practices and approaches that will enhance health outcomes and improve the quality of life for the American Indian population in North Dakota. By participating in this training, you will gain valuable insights into the unique health challenges faced by this community and learn effective strategies to address these challenges.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Oklahoma
On February 20, the Senate Business and Insurance Committee scheduled a hearing for two PBM bills of interest to pharmacies, SB 789 addressing below cost reimbursements by establishing a reimbursement rate floor of no less than 106% of the NADAC plus a professional dispensing fee of $15.00, and SB 993 establishing requirements and limits for audits. NACDS submitted a support letter on SB 789.
Also in Oklahoma, Sen. Adam Pugh (R) filed SB 806 creating the Food is Medicine Act, directing Oklahoma Health Care Authority (OHCA) Medicaid to implement a financial incentive for contracted entities who improve health outcomes of covered members through nutrition services. OHCA is directed to seek federal approval from CMS to implement the Nourish My Health program. The state Department of Education will provide technical assistance with applying for grants and administering programs that expand student access to fresh, healthy food.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Ohio
The Board of Pharmacy announced that they have developed and posted a new tool in the form of a dashboard that provides data on pharmacy trends and access in the state. The dashboard includes data on closures, openings and “pharmacy deserts” across communities.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Oregon
NACDS prepared and delivered verbal and written testimony before the House of Representatives Behavioral Health and Health Care Committee in full support of HB 3212. Additionally, the testimony included how this crucial bill aims to reform PBMs and address their dangerous tactics that threaten the vitality of neighborhood pharmacies and patient access. Specifically, HB 3212 would prohibit spread pricing and patient steering, restrict PBMs from mandating pharmacies to provide a health care service at a loss, prohibit PBMs from requiring further accreditation standards beyond those currently required by the Oregon Board of Pharmacy, help to ensure network adequacy, and most importantly, help to ensure reasonable and relevant reimbursement to community pharmacies that covers the true costs for pharmacies to purchase and dispense prescription drugs. NACDS urged lawmakers to advance HB 3212 to help ensure reasonable pharmacy reimbursement and protect patients’ access to trusted pharmaceutical care across the state.
Also in Oregon, the Prescription Drug Affordability Board held a meeting on February 19. Generally, the agenda and materials for this meeting was focused on policies, processes, and administrative matters, plus a legislative update. Register here in advance.
Also in Oregon, the Oregon Health Authority (OHA) published proposed rules establishing guidelines for enhanced payment to qualified providers under the Culturally and Linguistic Specific Services program. A 22 percent and 27 percent increase in fee-for-service payments for traditional health worker providers, programs, and organizations in urban and rural areas, respectively, will enable OHA to continue investments to improve access to care, incentivize culturally and linguistically specific services, invest in workforce diversity and support staff recruitment.
Also in Oregon, the Board of Pharmacy posted the agenda for the February 24 Executive Director Recruitment Subcommittee Meeting.
Also in Oregon, the Immunization Policy Advisory Team will meet on March 6. Draft agenda items include welcome, introductions of new members; public comment; respiratory season wrap-up—COVID-19, influenza, pertussis, RSV; data dashboards; legislation update; Project Horizon—program resize; ALERT IIS Replacement Project update; school requirements—new administrative rules; wrap-up. The final agenda will be available at the meeting or via email request three days before the meeting date.
Finally in Oregon, on February 6, the Board of Pharmacy adopted a statement on semaglutide.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Tennessee
CDC and Tennessee Department of Health has released a call for cases investigating reports of serious adverse events, including deaths, following receipt of injectable ceftriaxone. To date, events have not been associated with a sole product manufacturer or lot, and a definitive causal link to ceftriaxone has not been established. A public health investigation is underway to identify and characterize serious adverse events associated with ceftriaxone exposure. Please make reports to the HAI/AR Program at HAI.Health@tn.gov.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.