Montana
Gov. Greg Gianforte (R) and the Department of Public Health and Human Services announced the state will receive $233 million dedicated to rural healthcare in 2026. Montana received the fourth-most money of any state. Only Texas, Alaska, and California received more. The state health department will now submit a revised budget to CMS.
Also in Montana, NACDS encourages interested members to review the information and updates on the state’s Rural Health Transformation Program (RHTP) website.
Highlights include the following:
- In the upper right corner of the website under “Stay Engaged”, please consider signing up for email updates.
- Review “Next Steps”. For questions about this project, please email HHSRuralHealthTransformation@mt.gov”.
- Review “Frequently Asked Questions”, particularly questions related to funding and stakeholder engagement.
- Review “Stakeholder Advisory Meetings”. Below are the agenda and presentation from the January 22, 2026 meeting.
- Rural Health Transformation Stakeholder Advisory Committee presentation: Please note RHTP governance overview (slide #5), procurement (slides #6 and #7), and program initiatives (slides #13 through #29)
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Nebraska
The Department of Health and Human Services posted the draft minutes from the Drug Utilization Review (DUR) Board’s January 13 meeting. The next meeting will be held on May 12.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
North Carolina
The latest Medicaid Pharmacy Newsletter, dated January 2026, is now available on the Medicaid website. In addition to the February 2026 check write schedule, this edition of the newsletter includes the articles:
- Reminder: Immunizing Pharmacist Enrollment in NC Medicaid Contraceptives and NRT Protocol Reimbursement to Pharmacies
- NC Medicaid's Participation in Centers for Medicare & Medicaid Services Cell and Gene Therapy Access Model for Sickle Cell Disease
- North Carolina to Launch First-of-its-Kind NC Medicaid Managed Care Plan for Children and Families on Dec. 1, 2025
- Billing Reminder of a Third-Party Prescription to Medicaid
- NC Medicaid Reinstitutes Coverage for GLP-1s in Weight Management
- Coming in May: New Pharmacy Benefits Administrator for NC Medicaid Direct
Providers are encouraged to review this important information. The 2026 Medicaid Pharmacy Newsletters can be viewed here.
Also in North Carolina, the Sales and Use Tax Division of the Department of Revenue (NCDOR) issued the following guidance on the application and remittance of sales tax as it relates to rounding due to the elimination of the penny. As noted in the guidance, any rounding due to the elimination of the penny should be conducted after the application of sales and use tax and all applicable sales and use tax must be remitted by the retailer to the NCDOR regardless of whether the retailer rounded up or down.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
North Dakota
Medicaid engaged Myers and Stauffer, LC, to perform a pharmacy cost of dispensing study. The survey results will be used to evaluate the professional dispensing fee in the state's Medicaid pharmacy program. The survey is expected to be mailed in February 2026. A stakeholder meeting was held on January 27. The presentation and survey are currently available at North Dakota Department of Health and Human Services Provider Portal | Myers & Stauffer. To listen to the recording of the meeting, please visit the above website and scroll down to "Cost of Dispensing". Please contact Kip Stephenson or Sandy Eckert with the Myers and Stauffer cost of dispensing survey help desk at (800) 374-6858 or disp_survey@mslc.com should you have any questions.
Also in North Dakota, Gov. Kelly Armstrong (R) signed SB 2402 at the conclusion of the 2026 Special Session on rural healthcare. This legislation expands pharmacist scope of practice to include limited prescriptive authority; test and treatment for influenza, strep throat and SARS-CoV-2; and therapeutic substitution.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Oregon
As a member of the West Coast Health Alliance (WCHA), the Oregon Health Authority announced endorsement of the 2026 American Academy of Pediatrics (AAP) Recommended Child and Adolescent Immunization Schedule.
Also in Oregon, the Board of Pharmacy posted the February 11-13, 2026 Board Meeting Agenda and meeting materials.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Pennsylvania
The Pennsylvania Pharmacy Coalition issued a news release on January 20 calling for PBM reform and announcing a new advocacy website that includes an updated state pharmacy deserts map. The Pennsylvania Association of Chain Drug Stores (PACDS) is a member of the coalition, and NACDS is actively working with the coalition and PACDS to advance our joint legislative agenda.
Also in Pennsylvania, NACDS reminds members that all pharmacy technicians must be registered with the Board of Pharmacy (PBOP) by June 28. The PBOP recently published an instructional video to assist applicants with the registration process. For more information, see:
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Texas
The Health and Human Services Commission's (HHSC) Vendor Drug Program (VDP) Medicaid hosted a quarterly pharmacy stakeholder meeting. One issue discussed was the usual and customary policy changes that VDP is making as a result of a new statute, HB 2402, requiring a pharmacy to exclude any fee, charge or rate offered as part of a monthly fee-based membership discount program when determining the usual and customary charge the pharmacies put on fee-for-service pharmacy claims. The proposed rule amendments went through an informal comment period in November 2025, and VDP told stakeholders that they are reviewing the comments received. NACDS and the other Texas pharmacy groups raised concerns about the recent SureScripts/GoodRx announcement and asked that the rule be revised and reissued as a draft in light of this new development.
Also in Texas, the Board of Pharmacy posted the agenda for the February 3 quarterly meeting in Austin.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Vermont
NACDS is providing the following information regarding updates and opportunities in the state.
- A news article that announced the state's Rural Health Transformation (RHT) award mentioned a project manager for the program. The job has been posted and the application deadline is February 1.
- Please visit the Vermont Agency of Human Services (AHS) H.R. 1/Rural Health Transformation Fund webpage for updates and information.
- For questions and comments, email ahs.rht@vermont.gov.
Also in Vermont, the state posted its application online. Please note specific mention of pharmacy related to expanded pharmacists' scope to include test-to-treat in more scenarios (i.e., COVID-19, flu, strep throat) on page 40. Additionally, on page 40, it is noted that changes are required to current statute to support and accommodate broad expansion of test-to-treat in pharmacies.
Also in Vermont, Rural Health Transformation (RHT) Program Provider and Community Partner Online Listening Session will be held on February 2 at 1:00 pm-2:00 pm EST. Please register online in advance.
Finally in Vermont, the AHS RHT Program team has created a listserv for interested parties to enroll for information about the program. NACDS encourages interested members to join this listserv to gain access to important insights and information. Please note once you subscribe to the listserv, you will receive an email asking you to "confirm" your registration. You must complete this two-step process to be added to the listserv.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Virginia
The Department of Medicaid Services (DMAS) Pharmacy Liaison Committee posted the minutes from its December 2025 meeting.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Washington
The Washington State Pharmacy Association (WSPA) is hosting two legislative days this year on January 28 and February 23 to meet with legislators to inform them about practice and priority issues.
Also in Washington, the Senate Health and Long-Term Care Committee is holding a hearing on January 30 on SB 5924, legislation expanding prescriptive authority for pharmacists by removing the administrative barriers to pharmacist-provided care by allowing independent prescribing and diagnosis within a pharmacist's scope of practice and based on individual training, education and experience. The legislation is modeled after laws enacted in Idaho and Iowa and builds on 46 years of safe pharmacist prescribing and diagnostic authority already permitted in the state through Collaborative Drug Therapy Agreements (CDTAs). This week, NACDS issued a CALL to ACTION asking members to register in support of the bill.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Wyoming
The state will receive $205 million in federal funding as part of CMS’ Rural Healthcare Transformation Program. The state’s funds will help cover chronic disease prevention and behavioral health; sustain Critical Care Access hospitals; sustain access to labor and delivery services in rural communities; innovative approaches to care delivery and payment models; workforce development and training; technological and consumer health solutions; and IT advances and technical assistance. To address concerns regarding sustainability, the state proposed the establishment of the “Wyoming Health Transformation Perpetuity”, designed to generate long-term revenue and establish auditing and reporting requirements.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Rural Health Corner
Rural Health Transformation Program implementation is advancing, and NACDS review shows 36 states directly include pharmacists/pharmacies in their plans, with five more outlining strategies applicable to pharmacy providers. Fourteen states (AR, DE, ME, MI, MO, NH, ND, OH, OR, RI, TN, UT, VT, WY) are also advancing test-and-treat legislation, signaling expanded roles for pharmacists in clinical care. While momentum is significant, coordinated engagement remains essential to influence care models, reimbursement and policies as states finalize implementation. NACDS created a members-only state-by-state resource, entitled "Rural Health Transformation Program State Funds Tracker".
For more information, contact NACDS’ Jermaine Smith at 703–837–4388.
Alaska
The legislature convenes on January 20, with a projected adjournment date on May 20.
Also in Alaska, State Department of Health Commissioner Heidi Hedberg and her team hosted a webinar this week to present approved initiatives and timelines, share updates on the funding process and discuss opportunities for healthcare providers to engage with the Rural Health Transformation Program.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Arizona
On December 29, 2025, Arizona received its official Notice of Award for $166,988,956.00 for Fiscal Year 2026 from CMS which was lower than the state requested. The state is actively engaging with CMS to advance the next steps and will submit a revised budget by January 30.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
California
The Department of Health Care Service posted the following on the Medi-Cal Rx Web Portal. Please review the numerous changes to Medi-Cal Rx effective January 1, 2026.
Also in California, the Board of Pharmacy published a Special Edition of The Script newsletter dedicated to AB 1503, the Sunset Measure for the Board of Pharmacy. This Special Edition focuses on:
- Standard of Care
- Nonresident Pharmacies
- Inspection of Nonresident Pharmacies
- Establishing Pharmacy Technician Advisory Committee
- Self-Assessment Process
- Define Pharmacy Technician Trainee
- Define Pharmacist
- Title Change to Advanced Pharmacist Practitioners
- Enforcing Pharmacy Law
- Pharmacist-in-Charge, Staffing
- COVID-19 Oral Therapeutics
- Emergency Refill Provisions
- Dispensing Hormone Therapy
- Pharmacy Records and Digital Conversion
- Ownership Prohibition
- Reporting to CAMER
- Chain Community Pharmacy Employee Notice
- Pharmacy Technician Duties
- High Risk Patients
- Retired Pharmacists License
- Mail Order Pharmacies
- Fees: Medically Underserved Area
Also in California, the Board of Pharmacy issued a notice to licensees to renew registration with the Institute for Safe Medication Practices (ISMP) for the California Medication Error Reporting (CAMER) System by January 31. Business and Professions Code (BPC) section 4113.1 establishes requirements for a community pharmacy to report medication errors to an entity approved by the Board.
Finally in California, the Department of Managed Health Care issued All Plan Letter RE: APL 25-020 (OPL [Office of Plan Licensing]) – Newly Enacted Statutes Impacting Health Plans (2025 Legislative Session). Please review information related to AB 116 and SB 41, PBM reforms enacted in 2025.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Colorado
The Department of Health Care Policy & Financing (HCPA) issued a press release announcing it will receive just over $200 million in Rural Health Transformation Program (RHTP) grant funds for the first year of the 5-year program. HCPF is now focused on responding to the CMS Request for Applications (RFA) materials and will soon provide details on establishing the RHTP Committee’s structure, membership and meeting schedules. NACDS will continue to closely monitor the state’s RHTP website and provide details as they become available.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Hawaii
Gov. Josh Green (D) announced the state has been awarded $188,892,440 through the CMS’ Rural Health Transformation Program (RHTP). When evaluated on a per-rural-resident basis using federal rural population data, Hawaii’s funding translates to one of the highest levels of investment in the nation, per capita. The Governor’s Office will coordinate with CMS, state departments, healthcare providers and community organizations to implement the plan’s transformational improvements in access, quality, workforce stability and system sustainability. The state will review approved uses of funds once released. More information will be released soon.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Idaho
On December 30, 2025, the state was awarded $185,974,368 in annual grants to be distributed over five years to implement the plan outlined in its grant application, which focuses on five initiatives: “improve rural access to care through technology; ensure accessible quality care through innovative models; sustain rural workforce with training, recruitment, and retention; implement population-specific, evidence-based projects to make rural America healthy again; and invest in rural health infrastructure and partnerships.” The state will use the funds to provide subgrants to support the goals and projects outlined in its application. For more information about the state’s Rural Health Transformation Program (RHTP) application, visit the Department of Health and Welfare’s RHTP website.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Massachusetts
As a reminder, pharmacy practice resources, regulations and other resources are available on the website. See below for new and updated information.
Policy 2023-09: Action Level Environmental Monitoring Results – identification to the species level is required for any growth found in ISO-5 areas and ISO-7 buffer rooms, and any action level growth in any other ISO classified areas.
Advisory: Environmental Monitoring – the edits align with the changes to Policy 2023-09: Action Level Environmental Monitoring Results.
Also in Massachusetts, the Department of Public Health (DPH) issued Guidance on Recommended Reference Materials for Pediatric Immunization Schedules. Please review this information, share it with colleagues and take any action steps that may be appropriate to integrate the recommendations into your practice. DPH also shared Childhood Immunization Discussion Guides that are available from the American Academy of Pediatrics.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Minnesota
The Rural Health Transformation webpage includes all current information available on the various programs the state is seeking to implement. The full program project narrative includes details on each program, eligible participants and the stakeholders and/or entities who will help develop each initiative. Members can:
- Sign up for MDH's RHTF listserv here.
- Track RFPs the state may issue related to the programs that are posted. In addition, major contracts (estimated value over $50,000) are advertised each Monday in the State Register .
Also in Minnesota, the Department of Health (MDH) issued an announcement RE: MDH Endorses AAP [American Academy of Pediatrics] Schedule, RSV-mAb on Regular Order Form, Educate Staff on Program.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Nebraska
The Department of Health and Human Services published the following new fee schedules effective January 2026:
- Durable Medical Equipment, Medical Supplies, Orthotics and Prosthetics
- Immunizations
Also in Nebraska, the Department of Health and Human Services published the following Medicaid Program Provider Bulletins:
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
New Hampshire
CMS awarded the state $204,016,550 for 2026 as part of the federal Rural Health Transformation Program, the largest award among New England states. New Hampshire’s application requested $200 million annually throughout the duration of the five-year program to strengthen rural health care access, quality and long-term sustainability. Gov. Kelly Ayotte (R) established the Governor’s Office of New Opportunities & Rural Transformational Health (GO-NORTH) to oversee implementation of the program. Implementation planning is underway, with initial investments expected to support rural providers and communities beginning in 2026. In anticipation of the CMS award, the Governor and Council and the Joint Legislative Fiscal Committee earlier this month approved an acceptance and expend for the anticipated grant award for the current biennium.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
New Jersey
On January 9, Gov. Phil Murphy (D) signed SB 2019, priority legislation that authorizes pharmacists to dispense HIV medications under the standard of care model. It also requires insurers to reimburse pharmacies for the service. The governor’s news release highlighted that the bill “will streamline access to critical health care services and prescription medications while enhancing New Jersey’s health care workforce.”
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
New York
Gov. Kathy Hochul (D) recently announced new insurance coverage requirements that took effect on January 1, 2026, including a $100 annual cap on out-of-pocket costs for EpiPens. The law applies to state-regulated commercial insurance policies and contracts that are issued, renewed, modified, altered or amended on or after January 1. Because not all policies renew or change on that date, implementation will occur on a rolling basis throughout the year, with full compliance expected by year-end. The cap does not apply to Medicare, Medicaid or ERISA self-insured plans and applies only after deductibles are met for high-deductible plans.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Ohio
The state released its first pharmacy-related Rural Health Transformation Program (RTHP) Request for Proposals (RFP), seeking a project manager for the Rural Health Workforce Recruitment, Retention and Upskilling Pipeline Program. The program envisions pharmacies playing a key role in both the workforce initiative, and in the “upskilling” portion of the program. The RFP specifically calls for the development of training programs for pharmacists to deliver point-of-care “test and treat” services in rural areas.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.