California
The Department of Health Care Service posted the following on the Medi-Cal Rx Web Portal. Please note the update on GLP-1 coverage effective January 1, 2026; see details below in the alert.
Also in California, as part of the Board's actions during the November 5-6 Board Meeting, the Board approved a policy statement related to the transition to a Standard of Care Practice Model for some pharmacist-provided health care services. Specifically, under provisions of Assembly Bill (AB) 1503 (Berman, Chapter 196, Statutes of 2025), certain pharmacist-provided patient care services are transitioning to a standard of care practice model.
Finally in California, the Board of Pharmacy approved a policy statement related to the role of the Pharmacist-in-Charge (PIC). Specifically, under AB 1503, new provisions reinforce the decision-making autonomy of the PIC related to staffing decisions.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Colorado
Facing a $850M budget deficit, Gov. Jaris Polis (D) proposed cuts to the Medicaid professional dispensing fee (PDF) for pharmacies. For fiscal year 2025-2026, the Health Care Financing and Policy (HCFP) will cut the tiered fee by $85,000 and propose a $506,000 reduction for 2026-2027. Reimbursements for high-volume pharmacies will drop from $10.25 to $9.93 and from $9.31 to $8.72.
Also in Colorado, a Rural Health Transformation Program Webinar for all stakeholders will be held from 10:00 am – 11:30 am Mountain Time on December 2.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Illinois
The purpose of this Provider Notice is to inform pharmacy providers that the claims adjudication system is now able to process and pay compound claims. The processing system had been paying compound claims at zero since the Change Healthcare outage in March 2024.
At this time, pharmacy providers are encouraged to void and rebill those claims that were either paid at zero or held pending restoration. This applies to fee-for-service (FFS) billing only.
Please call the Bureau of Professional and Ancillary Services at 877-782-5565 and speak to a pharmacy consultant to obtain any necessary overrides on rejections that may occur while rebilling these claims.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Iowa
The Department of Health and Human Services (HHS), Medicaid posted the following. Please note effective December 1, the optional 90-day supply allowance will now be a required 90-day supply prescription list. The list of medications for this requirement is posted on the PDL website; see letter below for details.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Louisiana
The Department of Health (LDH) announced a webinar on December 4 from 10:00 am to 11:00 am Central Time. This event aims to inform stakeholders about LDH’s Rural Health Transformation Program (RHTP) submission.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Minnesota
The Department of Health (MDH) released the final updated Form and Manner for Prescription Drug Data Sets, as well as an updated Frequently Asked Questions Document. Updates impact reporting by all reporting entities, including manufacturers, wholesalers, pharmacy benefit managers and pharmacies.
The updates reflect statutory changes from the 2025 legislative session (Laws of Minnesota, 2025 – 1st Special Session, chapter 3, article 2, sections 6-14) and responses to input received during the comment period. The updates include changes to align reporting elements, modified registration requirements and a change to the reporting period for reporting data on drugs of substantial public interest.
MDH has updated the Rx Data Portal to integrate the statutory changes and make additional enhancements to support reporting entities. These updates are now live and available to all reporting entities.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Nevada
Gov. Joe Lombardo (R) convened a special session of the state Legislature on November 13 to address several key issues, including expanding healthcare access and workforce training.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
North Carolina
The latest Medicaid Pharmacy Newsletter, dated November 2025, is now available on the Medicaid website. In addition to the December 2025 check write schedule, this edition of the newsletter includes the following articles:
- Reminder: Immunizing Pharmacist Enrollment in NC Medicaid Contraceptives and NRT Protocol Reimbursement to Pharmacies
- Reminder on NC Medicaid Pharmacy Co-payment Requirements
- NC Medicaid's Participation in Centers for Medicare & Medicaid Services Cell and Gene Therapy Access Model for Sickle Cell Disease
- Discontinuation of Coverage: Xifaxan (Rifaximin)
- North Carolina to Launch First-of-its-Kind NC Medicaid Managed Care Plan for Children and Families on December 1, 2025
- Updates to Coverage for Wegovy and Zepbound for Clinical Indications Other than Weight Loss
- Immunizing Pharmacist Enrollment and Medical Claims Billing Update
Providers are encouraged to review this important information. The 2025 Medicaid Pharmacy Newsletters can be viewed here.
Also in North Carolina, effective December 7, the Electronic Funds Transfer (EFT) Attestation will be added to the reverification provider application and to full Manage Change Requests (MCRs) when active electronic funds transfer (EFT) information is present. This attestation requires a signature from the Office Administrator (OA) on the provider's record.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Ohio
The state's single Medicaid PBM, Gainwell, announced that, effective December 8, claims for preferred GLP-1 receptor agonists (listed below), will require a diagnosis of 'diabetes mellitus, type 2' to be documented in the member's medical record (as determined by medical claims data) or submitted on the pharmacy claim. For members with a diagnosis of 'diabetes mellitus, type 2' documented, claims will continue to be eligible for coverage under the state's Medicaid pharmacy benefit. For all other non-FDA approved uses (such as prediabetes or weight loss), coverage will not be available. Please note claims and associated diagnoses are subject to audit, and results will be reviewed by the Department of Medicaid for compliance. Diagnosis codes must be submitted by the prescriber on the original prescription or added by the pharmacy in consultation with the prescriber, with documentation of the date, time and name of the individual providing the diagnosis, in addition to the name of the pharmacy staff member verifying the diagnosis.
Preferred GLP-1 receptor agonists include:
- Byetta/exenatide
- Trulicity/dulaglutide
- Victoza/liraglutide
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Oklahoma
The legislature convened an interim hearing to examine the influence of PBMs on prescription drug pricing and patient access to local pharmacies. Chaired by Sen. Spencer Kern (R) and pharmacist Rep. T.J. Marti (R), the session highlighted significant concerns regarding below-cost pharmacy reimbursements, opaque pricing structures and patient steering practices. Expert testimony by Antonio Ciaccia, 46brooklyn Research, and others underscored systemic incentives that diminish transparency and raise costs. The Attorney General’s office and the Insurance Department reported recovering $32 million through enforcement actions, positioning Oklahoma as a national leader in PBM oversight. Legislators signaled intent to pursue comprehensive PBM reform legislation again in 2026, aimed at enhancing transparency, safeguarding independent pharmacies and ensuring equitable drug pricing.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
South Carolina
Effective for dates of service on or after December 1, the Department of Health and Human Services (SCDHHS) is updating its billing policy for providers who purchase physician-administered drugs through the Health Resources and Services Administration’s (HRSA) 340B drug pricing program. The changes described in this bulletin only apply to services rendered to Healthy Connections Medicaid members in an outpatient setting who are enrolled in the fee-for-service Medicaid program.
These policy updates will be published in the Physicians Services, Clinic Services, Hospital Services and Federally Qualified Health Center (FQHC) Services provider manual by December 1, 2025.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Tennessee
The deadline to submit an attestation of low-volume status and proof of actual prescription volume to your contracted PBMs is December 1. Volume status is based on your pharmacy’s actual prescription volume from July 1, 2024, to June 30, 2025. For more information, please refer to the Department of Commerce and Insurance (TDCI) rules. The Tennessee Pharmacists Association’s PBM resource page also has some helpful information to assist you with this process.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
California
The Department of Health Care Service posted the following on the Medi–Cal Rx Web Portal: Mass Adjustment for Member Eligibility Data That Impacted Claim Funding for Claims Submitted March 10, 2022, through October 5, 2025.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Massachusetts
The Board of Pharmacy shared the following updates. As a reminder, pharmacy practice documents, regulations and other resources are available on the website.
Policy 2020-15: Scope of Practice
Updates to this policy define "handling" of medications and that it requires an individual pharmacy license as well as defining the "prescription area" and who may access it.
New Pharmacy Labeling Requirement
Pharmacies must now label Schedule VI medications prescribed for reproductive or gender-affirming care with the name and address of the healthcare practice instead of the individual prescriber upon request from the prescriber.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
New York
Effective November 6, Yeztugo® was covered as a pharmacy benefit by NYRx, the Medicaid Pharmacy Program, in addition to being covered by the Medicaid managed care medical benefit as a Practitioner-Administered Drug (PAD). To prevent pharmacy claim denial, it is important for the pharmacy to submit the claim for both oral and subcutaneous products on the same date of service.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Oregon
The Prescription Drug Affordability Board (PDAB) posted its draft agenda and meeting materials for the November 19 meeting. Check the PDAB website for updates to the agenda and the meeting materials. Register in advance.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Arizona
The Arizona Medicaid agency, the Arizona Health Care Cost Containment System and the Governor's Office invite you to attend this public webinar to learn more about Arizona's application for the Rural Health Transformation Program. This webinar will highlight the application submitted and will discuss the next steps regarding the program award and the funding of Arizona's programming. Click here to register and add to your calendar.
Date: November 13
Time: 11:30 am – 12:30 pm
Location: Virtual Via Google Meet. Please register in advance. (Meeting ID and passcode will be provided upon registration)
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
California
he Board of Pharmacy distributed its monthly News Roundup for November. This issue includes important information related to vaccines, albuterol and epinephrine standing orders for schools, the California Medication Error Reporting (CAMER), drug theft/drug loss online portal and PIC training webinar.
Also in California, the November 2025 issue of the Board of Pharmacy's newsletter, The Script, is now published online. The November 2025 newsletter includes information on:
- New Laws
- Regulations
- Immunization Alert
- Importance of Patient Consent Forms
- CAMER
- Inspection Results
- Citations Issued
- Technology the Pharmacist's Role in Medication Safety
- Standing Orders for Schools Regarding Albuterol and Epinephrine
- Well-Being Index
Also in California, the Board of Pharmacy sent the following reminder to licensees.
Business and Professions Code (BPC) section 4113.1 establishes requirements for a community pharmacy to report medication errors known as CAMER to an entity approved by the Board. The statute requiring medication error reporting by community pharmacies can be viewed at BPC section 4113.1. The Board approved the Institute for Safe Medication Practices (ISMP), an ECRI Company, as the entity to receive and review medication error reports under BPC section 4113.1. Information regarding CAMER registration can be found at https://mederrors.ismp.org/.
The Board reminds community pharmacy licensees that medication errors that occur on or after September 1, 2025, must be reported to the CAMER system consistent with legal requirements established.
Also in California, the Department of Health Care Service posted the following on the Medi-Cal Rx Web Portal:
Finally in California, pursuant to the announced pharmacy benefit policy changes effective January 1, 2026, the Department of Health Care Services (DHCS) mailed letters to Medi-Cal members to notify them of two upcoming changes:
- All Medi-Cal members received a letter concerning the exclusion of coverage for GLP-1 medications for weight-loss indications.
- Impacted Medi-Cal members received a letter concerning the need for prior authorization (PA) approval for select medications previously filled without a PA request.
Both letters provide members with information about the policy change and guidance concerning potential actions the member may take.
Questions may be submitted to the Pharmacy Benefits Division at Medi-Cal.PharmacyBenefits@dhcs.ca.gov or to the Medi-Cal Rx Education and Outreach team at Medicalrxeducationoutreach@primetherapeutics.com
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Iowa
Gov. Kim Reynolds (R) announced the state submitted its application to CMS for the Rural Health Transformation Program. The proposal, titled Healthy Hometowns, is aimed at building a high-quality, sustainable system of care that improves the health, well-being and quality of life in rural communities across the state. Healthy Hometowns is Iowa's strategic response—developed in collaboration with rural hospitals, health systems, and community partners—to address these challenges through a hub and spoke model of care. More information about Iowa's Rural Health Transformation proposal, including its application, is available online.
Also in Iowa, the Department of Health and Human Services (Iowa HHS) launched a new funding opportunity to help communities across the state respond to the opioid crisis. This funding comes from HF 1038 passed earlier this year, which directs 75% of Iowa's opioid settlement money toward efforts to reduce opioid misuse and its impacts.
The Iowa HHS will allocate this funding through a competitive application process. There will be two rounds of funding: one starting now and another in the spring. Each project can receive up to $1 million, with $7 million available in each round.
Projects must focus on one or more of the following goals:
- Identifying and addressing needs in communities affected by opioids.
- Using proven or community-based methods to support people impacted by opioid use.
- Working with local service providers to improve recovery outcomes.
- Promoting the use of medications for opioid use disorder (MOUD) and distributing overdose reversal drugs (OORM).
- Respecting the privacy and dignity of people receiving services.
- Using data to show results and improve services.
For more information or to apply, visit: https://www.iowagrants.gov/viewStorefrontOpportunity.do?OIDString=1758745329639%7COpportunity
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Kentucky
MedImpact issued an updated statewide physician protocol for COVID point-of-care testing and a revised covered over-the-counter drug list.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Maine
The Board of Pharmacy held its regular meeting on November 7. The agenda includes second notice of rulemaking on prescribing, dispensing and administering HIV medicine.
For more information, please contact NACDS’ Mike Sargent at 207-272-6435.
Massachusetts
The Board of Registration in Pharmacy held its regular meeting on November 6. The agenda included the following:
- New pharmacy labeling requirement (Shield Law 2.0)
- Pharmacy Advisory Committee meeting summary
- Recommendation for automated non-sterile compounding devices
MassHealth provided notice via All Provider Bulletin 412 to all providers using 340B drugs that it will stop paying for the high-cost drugs listed in this most recent bulletin, in addition to those outlined in All Provider Bulletin 390 and All Provider Bulletin 400. This follows M.G.L. c. 118E, § 13L, 130 CMR 405.000: Community Health Centers, 130 CMR 406.000: Pharmacy Services and 130 CMR 410.000: Outpatient Hospital Services.
MassHealth will implement these changes no sooner than May 4, 2026, through a follow-up All Provider Bulletin. MassHealth is inviting comments about these changes no later than December 3. See All Provider Bulletin 412 for details.
For more information, please contact NACDS’ Mike Sargent at 207-272-6435.
Nebraska
The Board of Pharmacy posted an agenda for its November 17 meeting.
Also in Nebraska, the Department of Health and Human Services (DHHS), in partnership with the University of Nebraska Public Policy Center, has launched the Prevention & Care Provider Survey to find out more about care of certain infectious diseases in the state.
This anonymous online survey asks about your experiences and perspectives related to prevention, testing and diagnosis, patient care and services in Nebraska, with some questions asking about HIV in particular. Your input is critical for informing policies on HIV prevention and care across the state.
To access the survey, please visit: https://go.unl.edu/hiv-providersurvey or scan the QR code with a mobile device.
The survey should take approximately 15 minutes to complete. All responses go directly to researchers at the University of Nebraska Public Policy Center. DHHS will receive only a summary of aggregated results, no individual responses or identifying information will be collected or shared.
The survey will remain open until December 5. If you have any questions about the survey, please contact Quinn Lewandowski of the University of Nebraska Public Policy Center at qlewandowski2@nebraska.edu or 402-472-9459.
Also in Nebraska, the Department of Health and Human Services posted the draft minutes from the Drug Utilization Review (DUR) Board's October 28 meeting. The next meeting will be held on January 13, 2026.
Finally in Nebraska, the Department of Health and Human Services added the Buprenorphine: Practical Clinical Guidance for Prescribers under DUR Resources.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
New York
The NYRx Education & Outreach team shared the following update.
Effective November 6, 2025, Rybelsus 3mg will be subject to the following clinical criteria:
- Prescriptions will be limited to a duration of 30 days, with no refills.
- Use for glycemic control will not be covered. System updates will be made to ensure alignment of coverage and criteria. Any claims that do not meet the criteria may be impacted and rejected at the pharmacy.
Any claims that do not meet criteria may be impacted and reject at the pharmacy.
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, contact NACDS’ Sandra Guckian at 703-774-4801.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
For more information, please contact NACDS’ Mike Sargent at 207-272-6435.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Ohio
Gov. Mike DeWine (R) announced that he is nominating Scott R. Partika to be the director of the Department of Medicaid, following the announcement that Director Maureen Cocoran is retiring. Partika's nomination must be confirmed by the Senate.
Also in Ohio, the Board of Pharmacy has posted the following:
For more information, contact NACDS’ Jill McCormack at 717-592-8977.