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.
Virginia
After passing the General Assembly with overwhelming support, Gov. Glenn Youngkin (R) gutted the Medicaid Managed Care Single PBM bills (HB 2610 and SB 875) and sent them back to the General Assembly, leaving only language to study the issue. On April 2, the General Assembly held steadfast, rejecting the Governor's version, and voted to send the original bills as they passed the Legislature back to the Governor. Gov. Youngkin now has thirty days to sign or veto the measures. With the 2025 session at an end, his action will be the final word on the bills.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Washington
NACDS submitted comments for the Sunrise Review process of pharmacy practice regulations to the Department of Health, recommending adopting a standard of care model that would better utilize pharmacists’ clinical expertise in promoting healthcare access for its residents through community pharmacies.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
West Virginia
A bill granting pharmacists broad prescriptive authority passed the Senate overwhelmingly and is now in the House Health and Human Resources Committee for consideration. SB 526 allows pharmacists to prescribe any appropriate therapy to treat a condition diagnosed by a CLIA-waived test.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Alabama
Effective April 1, the Medicaid Agency will:
- Continue to monitor the stimulant shortage affecting ADHD (attention-deficit/hyperactivity disorder) medications. Should you need assistance, please contact Acentra Health at the number below for alternative prescribing and dispensing options.
- Require PA (prior authorization) for generic liraglutide. Brand Victoza will remain preferred and will be billed with a Dispense as Written (DAW) Code of 9.
Acentra Health
Medicaid Pharmacy Administrative Services
P.O. Box 3570, Auburn, AL 36831
Fax: 1-800-748-0116
Phone: 1-800-748-0130
View the alert for additional details.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Arizona
SB 1214, legislation that would permit pharmacists pursuant to a statewide written protocol to independently test and treat for flu, strep, COVID, PEP/PrEP or a condition related to an emerging or existing public health threat for individuals 12 years of age and older, passed the House Health and Human Services Committee with a vote of 7-5. Also, a pharmacist may delegate the task of performing the test to a licensed staff member under the supervision of the pharmacist.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
California
The Board of Pharmacy posted a agenda for the Enforcement and Compounding Committee meeting on March 27. Please note the discussion and consideration of implementation of AB 1902 (Chapter 330, Statutes of 2024) related to prescription drug labels: accessibility.
Also in California, the Board of Pharmacy has proposed additional modifications to Title 16 CCR § 1708.2, related to the Discontinuance of Business.
Any person who wishes to comment on the proposed additional modifications may do so by submitting written comments beginning on March 11 and ending on March 26 to the following:
Contact Person: Lori Martinez
Agency Name: California State Board of Pharmacy
Address: 2720 Gateway Oaks Drive, Ste 100, Sacramento, CA 95833
Email: PharmacyRulemaking@dca.ca.gov
Fax: 916-574-8618
Any responses to comments directly concerning the proposed modifications to the text of the regulations will be considered and responded to in the Final Statement of Reasons.
Also in California, the Board of Pharmacy extends its sincere appreciation to its licensees for assisting the survivors of the Los Angeles Fires. Your commitment to California consumers is commendable. The Board has received notification that the Emergency Prescription Assistance Program (EPAP) ended on March 15. Once the EPAP activation ended, the vendor stopped processing further prescription claims for individuals in the designated Los Angeles zip codes.
Also in California, the Department of Health Care Service posted the following weekly notice on the Medi-Cal Rx Web Portal: Medi-Cal Rx Weekly Wrap-up for March 7-13.
Finally in California, the Department of Health Care Services posted the following:
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Idaho
Gov. Brad Little (R) signed HB 231, legislation expanding grocery tax credit to offset the sales tax Idahoans pay on food. The new law increases the grocery tax credit to $155 a year, an increase above the current amount of $120 per year.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Indiana
NACDS launched an NACDS RxImpact Action Alert urging members to contact their hometown legislators to help advance SB 140, critical legislation that ensures PBMs pay pharmacies a reasonable reimbursement rate. Opponents are spreading misinformation across radio, print and TV, falsely labeling this bill as a “pill tax” on consumers. The bill passed the Senate and is stuck in the House Insurance Committee.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Kentucky
Gov. Andy Beshear (D) signed SJR 26, a significant step toward payment parity for pharmacists’ clinical services in Medicaid and CHIP. The Resolution directs Medicaid to provide a detailed report regarding pharmacist payment parity for review by the General Assembly during the upcoming legislative interim. The detailed report will include information on the technology necessary to adjudicate these claims with a pharmacy. It will also highlight the value that access to pharmacy clinical services can contribute to patient outcomes and overall healthcare savings.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Massachusetts
On March 21, the Department of Insurance hosted its second of three public hearings on PBM regulations. This hearing focused on the licensing process and standards. NACDS submitted testimony and participated in the hearing. The final hearing is scheduled for April 4.
For more information, please contact NACDS’ Mike Sargent at 207-272-6435.
Minnesota
The Department of Health (MDH) published the March 2025 list of drugs of substantial public interest with a focus on insulin products. It is the second list published as part of the statutory reporting requirement. You can also find it on MDH’s Public Interest Drug Lists webpage along with the Public Interest List Methodology & Summary—March 2025. Reporting entities, including pharmacies, have approximately 90 days to report (notifications will be sent 30 or more days after the list release date; reports are due 60 days after notifications are sent). Data and analysis from this and other Lists of Drugs of Substantial Public Interest will be made available on the Prescription Drug Price Transparency website. For direct updates, subscribe to the Prescription Drug Price Transparency email list. For more information, visit the Prescription Drug Price Transparency website.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Nebraska
Gov. Jim Pillen (R) signed LB 118, legislation increasing the pharmacist-to-pharmacy technician ratio to permit a pharmacist to supervise any combination of pharmacy technicians and pharmacist interns up to four people. For any pharmacist supervising four pharmacy technicians or pharmacist interns, at least one person must be a certified pharmacy technician.
Also in Nebraska, starting on June 1, Medicaid will no longer accept paper applications for Medicaid provider enrollment. All enrollments can be completed electronically at Maximus’ Nebraska Provider Data Management System (PDMS) website. For more information about Maximus’ PDMS, call 844-374-5022 or email at nebraskamedicaidPSE@maximus.com. For questions about how to enroll as a Nebraska Medicaid provider, call 402-471-9018.
Also in Nebraska, on March 19, the Department of Health and Human Services updated provider Bulletin 24-22: Coverage of Interpretation Services.
Finally in Nebraska, the Department of Insurance (NDOI) released a PBM-specific complaint form for reporting concerns. The form is reflective of what is in the Pharmacy Benefit Manager Licensure and Regulation Act that was passed in 2022. There is also a free text space for complaints that do not fall into those statutes. It is important to fill out this form completely and then send it to the NDOI via email or mail as follows:
Email: doi.insurancecomplaints@nebraska.gov
Mail: Nebraska Department of Insurance
P.O. Box 95087
Lincoln, NE 68509-5087
Any materials, medical records or documents that are provided at any time in connection with a complaint will be shared with the insurance companies or PBM against whom the complaint is filed, and their counsel. These documents may also be distributed to other parties engaged in a contested case or other matters pending before the Insurance Commissioner.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Nevada
SB 316, a PBM reform bill that NACDS supports that would require insurers to issue a report to the Insurance Commissioner that includes information regarding prescription cost data to help promote transparency and assess any impact on premiums. The bill also prohibits patient steering to affiliated pharmacies and unfair below cost reimbursements to nonaffiliated pharmacies; ensures any willing pharmacy terms; includes anti-discrimination provisions to protect pharmacy contracting; and subjects PBMs to civil monetary penalties for any violations. The bill is scheduled for a hearing in the Business and Commerce Committee on March 24.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
New York
On March 17, Gov. Kathy Hochul (D) announced the launch of DFS Connect, a new digital program launched by the Department of Financial Services (DFS) that will centralize the Department’s interactions with both regulated entities and consumers and ensure better service to businesses and consumers. Building on the state’s actions to protect New Yorkers from rising drug costs, the initial functions launched today on DFS Connect provide a streamlined and transparent way to file complaints for prescription drug prices that increase more than 50 percent over the course of a year and PBMs. Additionally, individuals can file complaints via mail or by calling the DFS Hotline.
Also in New York, the Office of Health Insurance Programs of the State Department of Health has approved the release of the January 2025 Medicaid Update. Relevant sections are below:
Pharmacy
- NYRx Medicaid Pharmacy Prior Authorization Programs Update
- Notice for Upcoming Over-the-Counter Coverage Changes
- NYRx Pharmacy Drug Coverage: Claims Processing Enhancements and Reminders
All Providers
For more information, please contact NACDS’ Mike Sargent at 207-272-6435.
Pennsylvania
It is our understanding that the Governor’s office is close to completing its review of the Pharmacy Technician Registration Final Regulation #16A-5433. We anticipate that if the Governor’s office sends the regulations back to IRRC (Independent Regulatory Review Commission) by April 14, IRRC can finalize them at its May 15 meeting. Following that, it would be published in the Pennsylvania Bulletin as final.
Also in Pennsylvania, the PACE Program issued a update regarding manufacturers who, effective April 14, will no longer have their products reimbursed by PACE (Pharmaceutical Assistance Contract for the Elderly).
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
South Dakota
Gov. Larry Rhoden (R) signed SB 154, legislation prohibiting pharmaceutical manufacturers from interfering in contracts between 340B entities and pharmacies and providing a 340B entity or a pharmacy may file a civil action against a pharmaceutical manufacturer for a violation and may request injunctive relief, actual and consequential damages and reasonable attorneys’ fees and costs.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Tennessee
The Emergency Prescription Assistance Program (EPAP) expires April 1. The Tennessee Pharmacists Association (TPA) recently learned that the Administration for Strategic Preparedness and Response (ASPR) does not plan to renew this program beyond the April 1 deadline. Pharmacies are encouraged to use the Healthcare Ready fact sheets to learn how they can best assist their eligible patients while EPAP funding is still available.
Also in Tennessee, TennCare has enhanced reimbursement rates for its Diaper Benefit Program, creating new revenue opportunities for participating pharmacies. Effective February 15, maximum allowable cost (MAC) rates increased for diaper brands on the covered product list, and since February 28, pharmacies have been able to submit claims for private-label and “unlisted” diapers using a Generic Diaper UPC. Diaper program updates provide higher reimbursements, greater inventory flexibility and increased foot traffic for pharmacies statewide.
Finally in Tennessee, the Department of Health is urging clinicians to identify, isolate and inform people regarding suspected measles cases. Immediately report cases by phone at 615-741-7247. According to the CDC (Centers for Disease Control and Prevention), there have been 222 cases of measles across 12 states during 2025 alone, including three identified outbreaks and one pediatric death.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Texas
The highly contagious measles virus continues to spread in the unvaccinated populations in eleven counties. The Department of State Health Services (DSHS) reported that there are currently 279 confirmed measles cases and two deaths since late January.
Also in Texas, March 14 was the bill filing deadline. In total, 5,646 bills have been filed in the House of Representatives and 3,028 in the Senate.
Also in Texas, HB 4051, legislation allowing test-and-treat for certain minor ailments, was filed by Rep. James Frank (R).
Finally in Texas, HB 4533, critical pharmacy legislation that would require a transparent reimbursement methodology for prescription drugs dispensed in Medicaid and state-funded programs, was introduced by Rep. Tom Oliverson, MD, (R).
For more information, contact NACDS’ Mary Staples at 817-442-1155.