North Carolina
The Department of Health and Human Services announced Standing Orders issued by State Health Director Dr. Larry Greenblatt to allow pharmacists at retail locations to test and treat for influenza. Since October 1, pharmacists across the state are able to test for the influenza virus and then immediately treat with the appropriate medications to reduce severity of illness, when appropriate, as authorized under HB 67.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
North Dakota
The North Dakota State University (NDSU) Center for Immunization Research and Education (CIRE) will be hosting a webinar, titled “Vaccine Communication in an Age of Polarization” on October 23 from 12:00 noon -1:00 pm CT. This activity has been approved for the following FREE credit:
- 1 AMA PRA Category 1 Credit™ through the Minnesota Medical Association (CME credit)
- 1 contact hour of continuing pharmacy education credit through CEimpact for pharmacists and pharmacy technicians
To access additional webinar resources from NDSU CIRE, visit Science to Practice: Protecting Children from Respiratory Viruses in 2025-2026.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Ohio
Effective October 1, the quarterly supplemental dispensing fee that has been paid to retail pharmacies in Ohio since 2020 ended and became part of the claim-based dispensing fee structure. This resulted in a 9.6% dispensing fee increase for managed care pharmacy claims under the Single PBM. The increases range from $0.78 to $1.06 across the three dispensing fee tiers. Gainwell’s Frequently Asked Questions: Managed Care Pharmacy Dispensing Fees (October 2025 Update) provides further details. You can also utilize the dispensing fee lookup dashboard to check pharmacy tier designations and determine a location’s new dispensing fee.
Also in Ohio, Gainwell issued the following announcement: On October 1, 2022, Gainwell Technologies became the Single Pharmacy Benefit Manager (SPBM) for the Ohio Department of Medicaid (ODM). ODM only covers drugs that are part of the Medicaid Drug Rebate Program, with limited exceptions.
ODM was recently notified that drug manufacturer, Bausch Health, has decided to no longer participate in the Medicaid Drug Rebate Program. This means that medications made by this manufacturer will no longer be covered by Ohio Medicaid, effective November 1, 2025. The most common medications affected include: Aplenzin, Xifaxan, Relistor, Siliq, Jublia, and Trulance.
The manufacturer of these medications has extended coverage for selected drugs for Medicaid enrollees through their Patient Assistance Program. This program may provide the prescribed medication at no cost to your patient. More information about this option can be found at the following website: https://www.bauschhealthpap.com.
Prescribers also have the option to select an alternative covered medication from the Ohio Medicaid Unified Preferred Drug List (UPDL), found at: https:\\spbm.medicaid.ohio.gov. Select ‘Reference Material,’ then ‘Drug Coverage,’ and then ‘UPDL effective 10.01.2025’ and/or ‘OH SPBM Medical Necessity Policy.’
Affected Medicaid enrollees and prescribers have been notified of these changes. They may contact you, as their pharmacy provider, for additional guidance in navigating this change. We are providing this notification as a courtesy so that you are aware of the changes and recommended course of action to best help your patients. Thank you for your willingness to assist in this capacity.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Oregon
The Prescription Drug Affordability Board (PDAB) posted its draft agenda for the October 15 meeting. Check the PDAB website for updates to the agenda and the meeting materials. Register in advance.
Also in Oregon, the Oregon Health Authority Health Systems Division: Medical Assistance Programs issued a Notice of Proposed Rulemaking to amend rules to provide updates to Health Related Social Needs (HRSN) services covered in the Oregon Health Plan. Please note opportunities for food retailers related to Fruit and Vegetable Benefit Card, Fruit and Vegetable Box and Pantry Stocking Benefit. A hearing will be held on October 15 from 1:00 pm-1:45 pm. The last day and time to offer comments to the agency is October 21 at 5:00 pm.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Pennsylvania
The Department of Health (DOH) issued new guidance expanding the list of organizations patients and providers should consult for vaccine recommendations to include the American Academy of Pediatrics (AAP), American Academy of Family Physicians (AAFP) and American College of Obstetricians and Gynecologists (ACOG).
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Vermont
The Board of Pharmacy held its regularly scheduled meeting on September 24. The agenda included a discussion of the September 17 meeting to approve a revision of the State Pharmacist Prescribing Protocol for COVID 19 and Influenza Vaccines Ages 5 and Up. The Prescribing Protocol includes:
- The purpose of updating this protocol is to remove requirements that COVID vaccines are only administered based on ACIP recommendation. Essentially removing the tie to ACIP.
- Technicians will still be able to administer vaccines
For more information, please contact NACDS’ Mike Sargent at 207-272-6435.
Alaska
The Department of Health ignored comments from NACDS and others submitted last March on adopted regulations lowering Medicaid payment rates for pharmacy dispensing fees based on the 2020 Myers and Stauffer cost of dispensing report.
Also in Alaska, NACDS completed the state survey on the Rural Health Transformation Program funds.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Arizona
The Board of Pharmacy posted the following on its website this week. Pursuant to Executive Order 2025-12, the Notice of Emergency Rulemaking for Section R4-23-411 is effective as of September 22. Please visit the “COVID-19 Vaccine Updates” to review the Executive Order, Notice of Emergency Rulemaking and approval, and the COVID-19 vaccine standing order and protocol as well as Department of Health Services COVID-19 Resources.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
California
On September 17, Gov. Gavin Newsom (D) along with Oregon Gov. Tina Kotek (D), Washington Gov. Bob Ferguson and Hawaii Gov. Josh Green of Hawaii announced coordinated winter virus vaccination recommendations through the West Coast Health Alliance (WCHA). These recommendations include the 2025–26 COVID-19, influenza and RSV vaccines.
Also on September 17, Gov. Newsom signed AB 144, authorizing the state to base future immunization guidance on credible, independent medical organizations rather than the CDC's increasingly politicized Advisory Committee on Immunization Practices.
Also in California, on September 17, the Department of Public Health (CDPH) announced California Issues Respiratory Virus Immunization Guidance. This guidance includes the CDPH Immunization Recommendations, Coverage and Availability and Changes to State Law. For more information on immunization requirements and resources, visit CDPH's Public Health for All webpage; bookmark this webpage to stay informed on vaccines, screenings and preventive care updates.
Also in California, on September 17, the Department of Health Care Services (DHCS) issued a letter to DHCS Stakeholders RE: Medi-Cal Coverage of Vaccines.
Also in California, on September 17, the article titled "Medi-Cal Coverage of Vaccines per Assembly Bill 144 Requirements" was posted to the Medi-Cal News area on the Medi-Cal Provider website.
Also in California, the Board of Pharmacy is releasing information to ensure licensees remain apprised of recent developments undertaken to uphold scientific integrity in public health.
- On September 3, 2025, Governor Newsom announced that California, along with Oregon and Washington, launched a new West Coast Health Alliance to provide evidence-based unified recommendations for residents regarding who should receive immunizations. Hawaii also joined the alliance. The California Department of Public Health announced official immunization recommendations in accordance with this Alliance.
- Recent enactment of Assembly Bill (AB) 144 (Budget Act of 2025) provides authority for pharmacists to independently initiate and administer an immunization that, on January 1, 2025, had in effect an ACIP recommendation and that are recommended by the California Department Public Health. AB 144 also contains provisions related to Medi-Cal coverage of vaccines and immunizations. Learn more about Medi-Cal coverage of vaccines here.
The Board also reminds pharmacists that Business and Professions Code section 4052(a)(11) currently provides a pharmacist with the authority to administer immunizations pursuant to a protocol with a prescriber.
The Board will continue to release information as it becomes available, including any further changes to pharmacist authority related to vaccine administration. Thank you for your commitment to California patients.
Also in California, the Department of Health Care Services posted the following:
- September 2025 Pharmacy Medi-Cal Update Bulletin
- September 2025 Durable Medical Equipment and Medical Services Medi-Cal Update Bulletin
Finally in California, the Department of Health Care Service posted the following alerts on the Medi-Cal Rx Web Portal.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Hawaii
The Department of Health (DOH) issued immunization recommendations for the 2025–2026 respiratory virus season, as part of the West Coast Health Alliance (WCHA). Hawaii, along with California, Oregon and Washington, are members of WCHA. These recommendations provide evidence-based guidance for protecting against COVID-19, influenza and respiratory syncytial virus (RSV). Detailed recommendations are available on DOH’s Respiratory Virus, COVID-19 and Immunization Branch websites.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Idaho
The Division of Occupational and Professional Licenses published its September 2025 newsletter including the following items of interest: Congratulations! Nicole L. Chopski Elected NABP President-Elect, Fraudulent Activity and GLP-1 Drugs, 'Certification of No Dispensing of Controlled Substances' Form No Longer a Required Document for RDOs [Resident Drug Outlets], NDOs [Non-Resident Drug Outlets] and PDOs [Prescriber Drug Outlets], Celebrating the Career of Berkeley Fraser: A Legacy of Service to Idaho's Pharmacy Community, Struggling in Silence? You're Not Along – Health Is Here for Health Professionals, Pharmacy Professional Recovery Program Forum and Board of Pharmacy 2025 Meeting Schedule.
For more information, contact NACDS' Sandra Guckian at 703-774-4801.
Indiana: The Medicaid proposal to cut pharmacies' reimbursement remains unchanged, but the timeline for stakeholders to comment has been extended until October 27. A public hearing is scheduled on the same date to allow for public comments.
Also in Indiana, to address a $250 million Medicaid budget shortfall, the Family and Social Services Administration (FSSA), Office of Medicaid Policy and Planning (OMPP) is proposing to reduce the pharmacy dispensing fee from $10.48 to $9.63. This proposal is based on the 2024 survey conducted by Myers and Stauffer. If approved by the Centers for Medicare & Medicaid Services (CMS), the new reimbursement rate would take effect on March 1, 2026. NACDS is submitted a comment letter objecting to these proposed cuts.
Finally in Indiana, the Family and Social Services Administration (FFSA) Health Coverage Programs (IHCP) provided updates approved by Drug Utilization Review Board at the August 2025 meeting.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Kansas
The legislative research department issued an agenda for special interim committee meeting to discuss the 340B drug program and PBMs.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Louisiana
The Department of Health (LDH) issued an Informational Bulletin 25-27 on revisions being made to align with CMS 2434-F 2024 Final Rule on 340B.
Also in Louisiana, effective October 1, the Medicaid program will phase out its single Pharmacy Benefit Manager (PBM) and return to managed care organizations (MCOs) to manage its own pharmacy services—including prior authorizations, claims processing and prescription coverage—through its designated PBM. The Department of Health provided a list of the new PBMs for Medicaid Health Plans. This change does not apply to fee-for-service (FFS) members or members who have behavioral-health only coverage through their Medicaid health plan.
Also in Louisiana, Walmart pharmacist Inga Collins volunteered to serve on the Louisiana Rural Health Transformation Task Force representing chain pharmacies.
Finally in Louisiana, Act 711 of the 2024 Regular Session authorizes pharmacists to initiate HIV PrEP and PEP, the human immunodeficiency virus (HIV) pre-exposure and post-exposure prophylaxis for individuals aged seventeen and older. A standing order for HIV Pre and Post-Exposure prophylaxis medications has been created by the Department of Health (LDH). In addition, the legislation mandates that pharmacists complete a training program approved by the Accreditation Council for Pharmacy Education (ACPE). This training may take place as a stand-alone course or as part of an equivalent curriculum-based training program offered by an ACPE-accredited college/school of pharmacy.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Maine
On September 12, the state's Center for Disease Control and Prevention (Maine CDC) issued a standing order authorizing qualified health care professionals -̶ including pharmacists -̶ to administer the 2025- 2026 COVID-19 vaccine. The standing order serves as a prescription for all Maine people, allowing them to receive the COVID-19 vaccine at pharmacies, clinics and health care offices across the state. Under the standing order, Maine people no longer need to obtain a prescription through their health care provider to receive the vaccine.
Also in Maine, on September 12, the Maine Bureau of Insurance issued a bulletin to state-regulated health insurance carriers reinforcing that they are required under state law to provide full coverage of the cost of the COVID vaccine when administered consistent with recommendations of the medical academies.
For more information, please contact NACDS’ Mike Sargent at 207-272-6435.
Massachusetts
The Board of Pharmacy shared a reminder that the Opioid Pain Medication Drug Fact Sheet that must be distributed when dispensing a Schedule II or III prescription has been updated to reflect statutory changes. Please also note the change to state law that requires an opioid antagonist (e.g., naloxone) to be offered whenever a Schedule II opioid is dispensed.
For more information, please contact NACDS’ Mike Sargent at 207-272-6435.
Minnesota
The vaccine protocol templates for the COVID-19 vaccine have been updated on Vaccine Protocols. Only minor changes have been made to provide clarity. The protocol content has not been changed.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Missouri
The Department of Social Services, through the MO HealthNet Division, is seeking input on key initiatives and priorities to consider for potential funding for the Rural Health Transformation Program. The deadline to submit comments on this form is September 30. More information is available on the Press Release .
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Montana
Effective October 1, the drug gabapentin will be a Schedule V controlled substance in the state, pursuant to the new law HB 41. Please see the below Fact Sheets for information to help with implementation:
For additional information, contact the Board of Pharmacy at (406) 841-2371 or dlibsdpha@mt.gov, or the Prescription Drug Registry (MPDR) Program at (406) 841-2240 or dlibsdmpdr@mt.gov.
Also in Montana, the Board of Pharmacy cancelled its Full Board Meeting on October 3. The board will meet again on December 5.
Finally in Montana, effective October 1, Bausch Health US, LLC and its subsidiary Salix Pharmaceuticals have terminated their participation in the Medicaid Drug Rebate Program. State Medicaid Programs are prohibited from utilizing federal funds to pay for medications manufactured by companies that don't participate in the Medicaid Drug Rebate Program.
Therefore, several medications, most non-preferred, will no longer be covered by Montana Healthcare Programs. The most notable are Retin-A and Xifaxan. Generic Retin-A will replace the brand as a preferred product. Unfortunately, Xifaxan does not have a generic alternative. The manufacturer has said that they will provide Xifaxan to Medicaid members through a patient assistance program. The application for which can be found here. Please, alert members and their providers so that they can start this process and avoid interruptions in care.
Below is a complete list of labelers whose rebate agreements and coverage will be terminated October 1. For more information, please contact Shannon Sexauer, PharmD, Medicaid Pharmacist, Allied Health Services Bureau, at shannon.sexauer@mt.gov.
| Labeler Code | Labeler Name |
| 99207 | BAUSCH HEALTH US, LLC |
| 68682 | OCEANSIDE PHARMACEUTICALS |
| 68012 | SANTARUS, INC. |
| 66530 | SPEAR DERMATOLOGY PRODUCTS, INC. |
| 66490 | BAUSCH HEALTH US LLC |
| 65649 | SALIX PHARMACEUTICALS, INC. |
| 57782 | BAUSCH & LOMB INC. |
| 25010 | BAUSCH HEALTH US, LLC |
| 16781 | BAUSCH HEALTH US, LLC |
| 13548 | BAUSCH HEALTH US, LLC |
| 00884 | PEDINOL PHARMACAL INC |
| 00187 | BAUSCH HEALTH US, LLC. |
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Nebraska
The Department of Health and Human Services announced CMS approved state Plan amendment 25-0010: Recovery Audit Contractor, waiving the requirement to implement a Recovery Audit Contractor for an additional two years effective December 1, 2025, through November 30, 2027. Neb Rev Stat 68-974(3)(a) excludes Managed Care claims from the scope of the Recovery Audit Contractor. Recall, the state implemented Heritage Health, combining physical health, behavioral health and pharmacy programs into a single managed care system, effective January 1, 2017.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Nevada
After three hours of discussion and debate at the September 4 workshop meeting over the latest draft regulation on pharmacy staffing, the board of pharmacy direct staff to redraft the language for a workshop meeting in Las Vegas on October 16. NACDS will continue to engage on this issue.
Also in Nevada, NACDS submitted the state survey on the Rural Health Transformation Program funds.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
New Mexico
Gov. Michelle Lujan Grisham (D) called lawmakers into a special session starting on October 1 consider a package of measures, including:
- Funding the Rural Health Care Delivery Fund to allow stabilization grants for quality health care providers.
- Taking action to make health insurance premiums more affordable in the marketplace and for New Mexicans losing Medicaid coverage.
- New investments in food assistance for children, senior citizens and families in need.
- Additional resources to help the Health Care Authority prepare for upcoming Medicaid enrollment changes.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
New York
The state's Department of Health updated its Preferred Drug List, effective September 15.
The NYRx Education and Outreach team shared an update to the NYRx Brand Less Than Generic Program Update effective October 1.
- Arnuity Ellipta® and Exelon® patches will be ADDED to the program.
- Apriso®, CellCept® suspension, Retin-A® cream, and Targretin® gel will be REMOVED from the program.
For more information, please contact NACDS’ Mike Sargent at 207-272-6435.
North Carolina
The latest Medicaid Pharmacy Newsletter, dated September 2025, is now available on the NC Medicaid website. In addition to the October 2025 checkwriter schedule, this edition of the newsletter includes the following articles:
- NC Medicaid to Change Coverage for GLP-1 Weight Management Medications
- Mailing and Delivery Fees to Retail Pharmacy Claims
- Reminder: Immunizing Pharmacist Enrollment in NC Medicaid Contraceptives and NRT [Nicotine Replacement Therapy] Protocol Reimbursement to Pharmacies
- Reminder on NC Medicaid Pharmacy Co-payment Requirements
- Children and Families Specialty Plan (CFSP) to launch December 1, 2025
Providers are encouraged to review this important information. The 2025 Medicaid Pharmacy Newsletters can be viewed online.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
North Dakota
Medicaid issued the following updates:
- Dulera is experiencing manufacturing delays. Due to sporadic backorders expected through October:
- The PA requirement for Advair Diskus and Advair HFA will be delayed at this time. Members may continue or switch to Advair Diskus or Advair HFA if Dulera is unavailable.
- The Dulera 200 mcg/5 mcg quantity limit allows one inhaler to be billed as a 60 days supply.
- Asmanex HFA will be allowed concurrently with Dulera 50 mcg/5 mcg. You will need to contact us to request an override for this option.
- Effective October 1: Dulera will be the only ICS/LABA inhaler that does not require PA.
- Advair HFA and Advair Diskus will be non-preferred status and require PA.
- All other ICS/LABA inhalers remain non-preferred status and require PA.
- Please work with prescribers to transition patients now to avoid treatment disruption.
Dulera contains formoterol and can be used for single-inhaler maintenance-and-reliever therapy (SMART) as recommended in asthma guidelines. ND Medicaid allows up to two Dulera inhalers per 30-day supply for SMART use.
- Effective October 1: Steqeyma no longer requires PA.
- Selarsdi and Yesintek remain Step 1 non-preferred status and require PA.
- Stelara and other ustekinumab biosimilars remain Step 2 non-preferred status and require PA.
- Effective October 1: Ozempic and Rybelsus will be preferred status and will not require PA.
- Victoza (brand) and liraglutide labeler 00480 remain preferred status and do not require PA.
- Liraglutide labelers 00143 and 71288 will be non-preferred status and require PA.
- Trulicity remains non-preferred status and requires PA.
- Effective October 1: Clonidine patches will require PA for members 10 years and older.
- Electronic age verification occurs during adjudication at the point of sale.
- See Non-Solid Dosage Forms criteria.
- Effective October 1: The manufacturer of Xifaxan and Trulance will cease participation in the Medicaid Drug Rebate Program (MDRP).
- Xifaxan and Trulance will no longer be eligible for coverage by ND Medicaid.
- Medicaid members may apply to the manufacturer's patient assistance program (PAP) to obtain Xifaxan or Trulance (https://www.bauschhealthpap.com/).
ND Medicaid cannot pay for a drug when the manufacturer does not participate in the MDRP due to federal law, Sec.1927. [42. U.S.C. 1396r-8] (a).
- Manufacturers choose whether they will sign up for the MDRP.
- Manufacturer participation is outside of ND Medicaid's control.
An alternative, participating manufacturer's product or different drug that is covered must be used for Medicaid to be able to pay.
For more information, contact LeNeika Roehrich, PharmD, BCGP.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Oklahoma
On September 9, the Attorney General Gentner Drummond (R) announced a $32.1 million settlement with CVS Caremark, a PBM for the state's HealthChoice plan. The settlement resolves allegations that CVS Caremark withheld millions of dollars in drug rebates intended to reduce healthcare costs for state employees between January 2020 and December 2024. Approximately $27 million, after attorney fees, will be returned to HealthChoice within 30 days to benefit state employees, retirees and their families. The agreement also mandates quarterly rebate reporting, prompt rebate remittance and expanded definitions to ensure transparency and accountability.
Also in Oklahoma, NACDS submitted the state survey on the Rural Health Transformation Program funds.
For more information, contact NACDS’ Mary Staples at 817-442-1155.