AT A GLANCE

This bill requires the Department of Medical Assistance Services to select and contract with a single state pharmacy benefits manager by July 1, 2026, and mandates all Medicaid managed care contracts use it.

AT A GLANCE

This bill makes home education a natural right for parents, allowing an optional declaration only to access public school programs under RSA 193:1-c or upon withdrawal from public school.

The bill requires all MassHealth Managed Care Organizations and Accountable Care Organizations to reimburse pharmacies at the same reimbursement rate as described in the MassHealth Pharmacy Provider Manual.

It amends Section 9C of Chapter 118E of the Massachusetts General Laws by adding this new reimbursement-rate requirement at the end of that section.

To enforce the requirement, the bill directs the Commissioner of the Division of Insurance and the Secretary of Health and Human Services to promulgate regulations implementing and enforcing the act.

AT A GLANCE

This bill eliminates the board’s requirement to submit annual March 15 reports to key legislative committee leaders describing and copying certain subdivision 7 agreements with state agencies and the Department of Information Technology Services.

The bill establishes new duties for the Maryland Department of Health (MDH) regarding an in-State cost-of-dispensing survey for the Maryland Medical Assistance Program and a related fee-for-service professional dispensing fee.

It requires MDH to conduct the in-State cost-of-dispensing survey starting in 2026 and at least once every 3 years. For each year in which a required survey is conducted, MDH must report the survey results to the General Assembly on or before December 1, in accordance with the State Government Article’s reporting statute (§ 2–1257).

Within 6 months after completing each in-State cost-of-dispensing survey, MDH must adopt regulations establishing a fee-for-service professional dispensing fee based on the survey results.

The Act takes effect October 1, 2026.

The bill establishes new requirements for the Maryland Department of Health regarding Medicaid in-State drug dispensing economics and compensation for dispensing professionals.

It adds a new section requiring that beginning in 2026 the Department conduct an in-State cost-of-dispensing survey at least once every three years, with survey results reported to the General Assembly on or before December 1 of each year in which the survey is conducted, in accordance with a specified State Government Article reporting provision.

It also adds a new section requiring that within six months after completion of the in-State cost-of-dispensing survey, the Department adopt regulations establishing a fee-for-service professional dispensing fee based on the survey results.

The measure takes effect October 1, 2026.

AT A GLANCE

This bill requires the Office of the Auditor General to conduct a Medicaid prescription drug management consolidation study and submit a written report with findings and recommendations by March 31, 2027.

AT A GLANCE

This bill requires the Auditor General to study whether consolidating Medicaid prescription drug management would benefit Rhode Island, and to obtain unredacted required information from covered private entities.

The bill amends the Pharmacy Audit Integrity and Transparency Act by expanding the scope of enforcement authority to include specific requirements for Medicaid pharmacy access by pharmacy benefit managers (PBMs). It adds a new subsection requiring a PBM to accept and process Medicaid prescriptions from any pharmacy or pharmacist that is in good standing with the Department and the State Board of Pharmacy.

The added provisions prohibit a PBM from restricting, limiting, or otherwise controlling the selection of pharmacies available to Medicaid patients based solely on the PBM’s private contracting preferences.

The bill takes effect 60 days after enactment.

The document outlines upcoming changes to pharmacy dispensing fees in Nebraska, primarily impacting independent pharmacies and those participating in the medical assistance program. Effective July 1, 2026, independent pharmacies will receive a reimbursement of ten dollars and thirty-eight cents per prescription.

For other pharmacies, the reimbursement will vary based on the volume of prescriptions filled. Pharmacies with fewer than thirty thousand prescriptions per year will also receive ten dollars and thirty-eight cents per prescription. Those filling between thirty thousand and fewer than seventy thousand prescriptions will receive nine dollars and fifty-one cents, while pharmacies with seventy thousand or more prescriptions will receive eight dollars and thirty cents per prescription. Additionally, pharmacies that are the only enrolled pharmacy within a thirty-mile radius will be reimbursed at the rate of ten dollars and thirty-eight cents per prescription.

To ensure fair reimbursement, a cost-of-dispensing survey is to be completed by July 1, 2026, with recommendations for annual adjustments to pharmacy dispensing fees. A preliminary report with recommendations is due by December 15, 2024. These changes aim to provide adequate support for pharmacies involved in the medical assistance program.

AT A GLANCE

This bill requires pharmacy benefit managers and managed care organizations to reimburse community pharmacies at or above the new “fair pharmacy reimbursement” standard, and it prohibits fees or reductions that would cause below-standard net reimbursement.

AT A GLANCE

This bill requires PBMs and MCOs to reimburse community pharmacies at least NADAC (or WAC if NADAC is unavailable) plus a biennially adjusted professional dispensing fee.

The bill establishes additional duties for the Rhode Island Executive Office of Health and Human Services (EOHHS) secretary regarding transparency and cost/behavior constraints for pharmacy benefit managers (PBMs) used in the state Medicaid program, by requiring Medicaid contracts to prohibit “spread pricing” practices.

It also amends the existing statutory “Duties of the secretary” provision in Rhode Island General Laws Chapter 42-7.2 (specifically Section 42-7.2-5) to add new subsection (18) imposing the PBM transparency, anti-spread-pricing, and patient/outcome-improvement contracting requirements.

The bill further contains a general statement of intent focused on protecting Rhode Islanders and the Medicaid program from high prescription drug costs through PBM transparency and accountability, and it sets an effective date of passage.

AT A GLANCE

This bill prohibits pharmacy benefit managers from reimbursing non-affiliated pharmacies or pharmacists less than net effective reimbursement for the same drug or service, including all fees and incentives.

AT A GLANCE

This bill prohibits pharmacy benefit managers from reimbursing non-affiliated pharmacies or pharmacists at lower net rates than affiliated providers for the same drug or service, and bars evasion of these requirements.

AT A GLANCE

This bill requires the Maryland Department of Health to select and contract with a single third-party administrator as the State pharmacy benefits manager by July 1, 2028.

AT A GLANCE

This bill requires the Department of Human Services to competitively select and contract by July 31, 2026 with a single State pharmacy benefits manager and require each Medicaid managed care organization contract to use it.

AT A GLANCE

This bill requires SCHEV to certify biennial performance and, based on that certification, authorize remediation plans and allow withholding or certification adjustments for participating institutions.

The bill adds provisions requiring the Agency for Health Care Administration to conduct a fiscal impact study on implementing discounted drug prices under the 340B Drug Pricing Program. The study must include specific requirements related to drug pricing, rebates, and payments to pharmacy benefit managers, with the results due by January 31, 2027. This change applies to drugs on the Medicaid preferred drug list that are covered under the 340B program. Definitions needed for this provision include the "340B Drug Pricing Program" and the "Medicaid preferred drug list."

AT A GLANCE

This bill requires the Department of Human Services to select and contract by July 31, 2026 with a single third-party State pharmacy benefits manager to administer all Medicaid pharmacy benefits.

AT A GLANCE

This bill requires pharmacy benefits managers to reimburse eligible pharmacies for covered prescription drugs at acquisition cost plus the Georgia Medicaid professional dispensing fee, excluding such payments from effective rate guarantees.

AT A GLANCE

This bill requires managed care organizations and pharmacy benefits managers to use DMAS-set standardized methods to collect and report specified prescription-drug financial and utilization data to DMAS and CMS.

AT A GLANCE

This bill requires the Department of Medical Assistance Services to select and contract with a single state pharmacy benefits manager by July 1, 2026, and require Medicaid managed care contracts to use it.

The bill directs that a previously enacted restriction on the Department of Human Services (Hawaii’s medicaid program administrator for med-QUEST) be removed: it repeals the provision that barred the department from taking any action to remove pharmaceutical benefits management from managed care plans providing health care coverage for Hawaii Medicaid beneficiaries.

Operationally, the change restores the department’s flexibility to assess and implement pharmaceutical benefits management approaches for med-QUEST, reflecting the legislature’s stated goal of enabling modernization and adaptation to evolving pharmaceutical market and health care delivery conditions, with an emphasis on stewardship of public funds.

The bill includes no additional regulatory framework in the provided text beyond the repeal of the cited prohibition, and it states that new effectiveness begins on July 1, 3000.

The document outlines the establishment of a Patient-Centered Care program in Minnesota, designed to enhance health outcomes and reduce healthcare costs. A key feature of the program is the authorization for direct payments to licensed healthcare providers for services rendered to medical assistance and MinnesotaCare enrollees, focusing on individual providers and clinics rather than hospital systems. Additionally, primary care providers will receive compensation for coordinating care, with provisions for patients to select their care coordinators and additional support for clinics serving populations facing health disparities.

To support vulnerable populations, the program includes funding for community health clinics and county-based purchasers to hire community health workers and deliver outreach and care coordination services. The commissioner of human services, in collaboration with the commissioner of health, is also tasked with developing a payment system that provides per-person care coordination payments to licensed health care homes and community health workers, particularly for individuals requiring intensive care coordination.

The document emphasizes the importance of cost neutrality in implementing care coordination payments, with potential reallocations within the healthcare system if initial savings are insufficient. Furthermore, it highlights the need for federal waivers and approvals to implement various health care initiatives, including the expansion of demonstration projects to include more enrollees from medical assistance and MinnesotaCare, as well as Medicare recipients and privately insured individuals.

Integrated health partnerships may be authorized to provide patient incentives for engaging in preventive health measures, fostering ongoing relationships with primary care providers. Overall, these initiatives are expected to significantly impact the healthcare industry, particularly in areas related to care coordination, community health services, and patient engagement strategies.

AT A GLANCE

This bill requires the Chief Procurement Officer for General Services, in consultation with the Department of Healthcare and Family Services, to complete procurement selecting a single State pharmacy benefit manager within one year after enactment.

AT A GLANCE

This bill makes Oklahoma Health Care Authority minimum Medicaid reimbursement rates discretionary, replacing mandatory minimums with “may” authority while maintaining June 2027-based thresholds for participating versus non-participating providers.

AT A GLANCE

This bill requires Mississippi’s Division of Medicaid to provide essential health benefits to eligible ACA-based individuals beginning July 1, 2026, only while the federal matching percentage remains at least 90%.

AT A GLANCE

This bill requires the Oklahoma Health Care Authority to set an appeal-based psychologist reimbursement rate, compensating successful psychologists for appeal hours, and to bar automated review tools for contracted-entity Medicaid appeals.

AT A GLANCE

This bill requires pharmacy benefit managers and covered entities to limit maximum allowable cost lists to FDA Orange Book–eligible therapeutically equivalent and available drugs, removing ineligible items within 3 business days.

AT A GLANCE

This bill requires the Department of Human Services to establish or select and contract with a third-party state pharmacy benefit manager for Hawaii Medicaid by the specified deadline, and it bars PBMs from using spread pricing.

AT A GLANCE

This bill requires Medicaid managed care organizations to cover pharmacy choice for every enrollee and prohibits denying in-state pharmacies contracting participation or dispensing covered drugs under cost or plan criteria.

AT A GLANCE

This bill requires pharmacy services administrative organizations to provide independent pharmacies PBM contracts and reimbursement information within three calendar days of execution or signing, and makes noncompliance an unfair or deceptive act.

The bill repeals two sections of Part FFF of Chapter 56 of the Laws of 2020 that had directed the New York State Department of Health to remove the pharmacy benefit from the managed care benefit package and to instead provide the pharmacy benefit under the fee-for-service program.

The bill provides that the repealed sections—Section 1 and Section 1-a of Part FFF of Chapter 56 of the 2020 laws—are eliminated in their entirety.

The bill takes effect immediately.

AT A GLANCE

This bill bars Michigan Medicaid contracts from relying on a PBM that fails to follow the specified pharmacy reimbursement and transparent pass-through fee requirements, and it limits fee increases and contract terminations for small pharmacies.

AT A GLANCE

This bill requires PBMs and covered entities to remove drugs from a maximum allowable cost list within three business days after the drugs no longer meet the required Orange Book and therapeutic-equivalence criteria.

The document outlines significant amendments to Minnesota Statutes that impact healthcare, environmental services, and child welfare. Key changes include increased licensing and registration fees for health maintenance organizations and new requirements for well disclosure certificates, which mandate property sellers to disclose known well locations. Healthcare providers will face enhanced reporting obligations related to drug pricing and telehealth services, while stricter regulations for occupational therapy and midwifery practices emphasize education and ethical standards.

In the healthcare sector, a county-administered program aims to integrate healthcare and social services in rural communities, improving access to care. Changes to reimbursement structures for various healthcare providers, including adjustments for telehealth and nonemergency medical transportation, are also highlighted. Additionally, the document addresses child welfare reforms that focus on improving support systems for children in foster care and enhancing engagement with noncustodial parents, including detailed transition plans for youth aging out of the system.

The amendments also introduce significant changes to child care and mental health services. Enhanced security measures for licensed child care centers, such as mandatory video surveillance, and regular eligibility assessments for families receiving child care assistance are key highlights. In the mental health sector, initiatives like the Mental Health Collaboration Hub Pilot Project and targeted funding for crisis intervention services aim to improve care pathways for individuals facing mental health challenges.

Further appropriations for health and human services include substantial funding for General Assistance, Emergency General Assistance, and Minnesota Supplemental Aid Grants, with a focus on mental health services, substance use treatment, and public health initiatives. Additional funding is allocated for early childhood education, literacy programs, scholarships, and youth intervention initiatives, as well as emergency medical services to enhance training and operational capabilities.

Overall, these amendments and funding allocations reflect a comprehensive effort to enhance regulatory frameworks, improve service delivery, and address disparities across multiple sectors in Minnesota, with a strong emphasis on accountability, transparency, and the well-being of vulnerable populations.

The document outlines significant amendments to Minnesota Statutes concerning human services, particularly focusing on the procurement and management of a state pharmacy benefit manager. These changes primarily impact the healthcare and pharmaceutical industries, including managed care plans, pharmacy benefit managers, and licensed pharmacies in Minnesota. A competitive procurement process is mandated for selecting a single pharmacy benefit manager, which may alter the operational and financial dynamics of these entities.

Additionally, the amendments empower the commissioner of human services to modify prescription drug coverage to enhance state savings through increased collection of drug rebates. Contracts with managed care plans are required to incentivize cost management and may incorporate provisions for preferred drug lists and prior authorization, potentially affecting drug reimbursement rates and fees.

The document also introduces new disclosure and reporting requirements for state pharmacy benefit managers and managed care plans regarding prescription drug payments and pricing. Pharmacy benefit managers must disclose all payment sources for prescribed drugs and provide quarterly reports detailing negotiated prices, rebates, and savings passed on to managed care enrollees. Managed care plans are similarly required to disclose their administrative costs related to pharmacy services.

Furthermore, the commissioner is granted authority to develop a preferred drug list, negotiate prices with drug manufacturers, and manage a drug formulary for managed care plans. The commissioner may also review contracts between pharmacy benefit managers and pharmacies to ensure compliance with the new regulations.

Overall, these amendments aim to enhance the management of prescription drug costs and improve the efficiency of the pharmacy benefit system within Minnesota's healthcare framework.

The document describes the creation of a prescription drug purchasing program in Minnesota, which will be overseen by the commissioner of human services. The primary goal of this program is to provide medical assistance and MinnesotaCare enrollees with access to prescription drugs at the lowest possible prices. The commissioner will be responsible for negotiating discounts on prescription drugs, maintaining a list of effective medications, and managing the associated benefits.

This initiative is expected to have significant implications for the pharmaceutical industry, particularly affecting drug manufacturers, wholesalers, and pharmacies. The commissioner will negotiate prices and establish a preferred drug list, with pharmacies required to accept the terms set forth to participate as medical assistance providers.

The program's implementation is contingent upon federal approval and is scheduled to begin on January 1, 2027, or upon receiving that approval, whichever occurs later. Furthermore, the commissioner is also tasked with developing recommendations to expand the program to include enrollees from health plan companies, with a deadline for these recommendations set for December 15, 2027.

The document outlines the establishment of a Patient-Centered Care program in Minnesota, aimed at improving health outcomes and reducing healthcare costs. A key feature of the program is the authorization for direct payments to licensed healthcare providers for services rendered to medical assistance and MinnesotaCare enrollees, focusing on individual providers and clinics rather than hospital systems.

The program emphasizes care coordination by compensating primary care providers for their role in coordinating care for enrollees. Patients will have the option to select a primary care provider as their care coordinator, with additional fees allocated to clinics serving populations facing health disparities. Community outreach will be enhanced through grants to community health clinics and county-based purchasers, enabling the hiring of community health workers to deliver essential services to vulnerable populations.

The commissioner of human services, in collaboration with the commissioner of health, will develop a new payment system for care coordination services, which will vary fees based on the complexity of care required. This system aims to address the needs of patients with limited English skills and other barriers to healthcare access while ensuring cost neutrality in its implementation.

Additionally, the document discusses the expansion of health care programs and the establishment of accountable care organizations. The commissioner will seek federal waivers and approvals to implement these initiatives, which include expanding demonstration projects to encompass more enrollees and potentially integrating services for Medicare recipients and privately insured individuals.

Overall, the changes aim to enhance care coordination and access to health services for vulnerable populations, while also incentivizing preventive health measures through integrated health partnerships. The initiatives are expected to significantly impact the healthcare industry, particularly managed care organizations and primary care providers.

The document outlines significant amendments to Minnesota Statutes concerning the management of prescription drug coverage within the state's human services programs. A key change is the requirement for the commissioner of human services to select a single state pharmacy benefit manager (PBM) through a competitive procurement process. This initiative aims to enhance cost savings for the state by increasing prescription drug rebates and effectively managing drug costs.

The amendments will impact several business industries, including pharmacy benefit managers, pharmacies, and health plans. The selected PBM will be responsible for processing all pharmacy claims and managing drug coverage for managed care plans. Pharmacies licensed in Minnesota may encounter new fees and assessments imposed by the PBM, potentially affecting their operational costs and profitability. Additionally, health plans and county-based purchasing organizations will need to comply with the new requirements established in the master contract with the state PBM.

The document also introduces new disclosure and reporting requirements for state pharmacy benefit managers and managed care plans regarding prescription drug payments and pricing. PBMs must disclose all sources of payment for prescribed drugs, including rebates and discounts, and provide quarterly reports detailing negotiated prices, payments to pharmacies, and savings passed on to managed care enrollees. Managed care plans are required to disclose their administrative costs related to pharmacy services.

Furthermore, the commissioner has the authority to develop a preferred drug list, negotiate prices with drug manufacturers, and manage a drug formulary for managed care plans. The commissioner may also review contracts between PBMs and pharmacies to ensure compliance with the new regulations.

These changes are set to take effect in 2024, with the new regulations for disclosure and reporting scheduled to begin on January 1, 2027, or upon receiving necessary federal approvals.

The proposed legislation amends the Oklahoma Medicaid program by establishing capitated contracts for the delivery of Medicaid services, excluding dental and prescription drug services. The Oklahoma Health Care Authority (OHCA) will issue requests for proposals to create public-private partnerships aimed at serving various Medicaid populations, including pregnant women, children, and parents. The new program is set to be implemented by April 1, 2024, with dental services being covered through partnerships with dental benefit managers and prescription drug services transitioning to a fee-for-service model.

Key provisions include requirements for contracted entities to share patient data with providers and to refrain from enforcing restrictive contracting policies. Additionally, minimum reimbursement rates for providers not participating in value-based payment arrangements will be established, ensuring that network providers receive at least 100% of the applicable service fee and non-network providers receive 90%. The Authority will also set minimum rates for Certified Community Behavioral Health Clinic (CCBHC) providers and ensure adequate reimbursement for ground transportation services.

Contracted entities are mandated to offer value-based payment arrangements tied to quality metrics and must allocate at least 11% of total healthcare expenses to primary care services by the end of the fourth year of the initial contracting period. The changes are expected to impact various business industries, including healthcare providers, pharmacies, and behavioral health clinics, with potential financial implications related to reimbursement rates and contractual obligations.

Overall, the legislation aims to enhance the efficiency and effectiveness of Medicaid services in Oklahoma, focusing on provider-led and provider-owned entities while promoting value-based care and improved patient outcomes.