National – The Centers for Medicare & Medicaid Services (CMS) proposed updates and released its 2026 rates:
- CMS proposed updates to the Inpatient Psychiatric Facility Prospective Payment System for fiscal year 2026.
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- These updates include: A 2.4% increase in the Federal per diem base rate
- Higher payments for Electroconvulsive Therapy
- Key adjustments include increased labor-related shares, rural location adjustments, and expanded Diagnosis-Related Groups.
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- CMS issued the 2026 Rate Announcement, finalizing the payment methodologies for Medicare Advantage (MA) and Part D programs for the 2026 plan year. To learn more, check out this fact sheet.
President Donald Trump signed an executive order, Delivering Most-Favored-Nation Prescription Drug Pricing to American Patients aims at lowering drug prices in the United States. This order includes a "most-favored nation" policy, which ties the prices of drugs in the U.S. to those paid by other high-income countries. This policy aims to reduce the cost of medications for American patients, who often pay more than their counterparts in other developed nations. The executive order also seeks to improve drug pricing transparency and reduce the influence of middlemen in the pharmaceutical industry. It mandates greater transparency in drug pricing, requiring pharmaceutical companies and pharmacy benefit managers (PBMs) to disclose fees and costs. Additionally, the order expands Medicare's ability to negotiate drug prices directly with manufacturers, aiming to achieve substantial savings for both the program and its beneficiaries. The order supports state programs to import cheaper medications from other countries, which could save states millions in prescription drug costs. It also provides substantial discounts on life-saving medications for low-income patients and the uninsured, including insulin and injectable epinephrine. To read more check out these articles: Wall Street Journal, STAT, AXIOS, NEWSWEEK, CNN and USA TODAY.
US HR 1227 remains in the House and was referred to both the Committee on Energy and Commerce and the Committee on Ways and Means. As a reminder, HR 1227 aims to amend title XVIII of the Social Security Act to ensure that Medicare Part D beneficiaries have appropriate access to non-opioid pain management drugs. The bill mandates that Medicare Part D plans cover non-opioid pain management drugs, providing alternatives to opioid medications for pain management.
The House Energy and Commerce Committee's reconciliation bill aims to address energy, healthcare, and technology policies. Initiated with the FY 2025 budget resolution, the bill has passed the committee stage and is under further consideration. Key provisions include stricter Medicaid eligibility checks, increased U.S. energy production, and modernization of the Department of Commerce with AI tools. The bill targets a $900 billion deficit reduction through various measures.
Colorado – HB 25-1222 has passed both chambers of the Colorado General Assembly. As a reminder HB 25-1222 aims to preserve healthcare access provided by rural independent pharmacies in Colorado. The bill ensures fair reimbursement rates from pharmacy benefit managers (PBMs), allows the use of private couriers for prescription deliveries, and defines “flex pharmacies” to operate as tele-pharmacies under certain conditions. It also mandates clear audit procedures to protect pharmacies from unfair penalties.
Connecticut – SB 1417 was tabled for the calendar year. As a reminder, SB 1417 aimed to create a board responsible for developing minimum standards for compensation and training for nursing home workers.
Massachusetts – S 2520 was introduced in the Senate. The bill aims to enhance pharmaceutical pricing transparency and improve patient access to medications. The bill would require pharmaceutical companies to provide early notice of new drugs and significant price increases, and to report price hikes exceeding certain thresholds.
Mississippi – Two bills of interest did not advance within the Mississippi legislative session.
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- HB 503 died in committee. As a reminder, the bill aimed to revise the way Medicaid reimburses for durable medical equipment (DME). The bill specifically seeks to update the calculation methods used to determine reimbursement rates for DME under Medicaid. Durable medical equipment includes items such as wheelchairs, hospital beds, oxygen equipment, walkers, and other medical devices that help patients manage their health conditions at home.
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- HB 466 has not been officially marked as dead, but no recent legislative action has been recorded. As a reminder, SB 466 aimed to expand Medicaid eligibility to include individuals who qualify for benefits under the federal Patient Protection and Affordable Care Act (ACA). This bill aims to ensure that those eligible for ACA benefits can also receive Medicaid coverage.
Montana – Two PBM bills are currently in the Montana Legislature:-
- HB 740 proposes changes to the regulation of pharmacies and pharmacy benefit managers (PBMs). The bill mandates that pharmacies receive reimbursement rates above the national average for drug acquisition costs, with dispensing fees aligned to Medicaid rates. It also restricts auditing practices, enhances pricing transparency by requiring PBMs to disclose their pricing sources, and prohibits PBMs from mandating the use of affiliated pharmacies. Additionally, it allows patients using mail-order pharmacies to obtain prescriptions locally under certain circumstances.
- LC 820 died this week. As a reminder, the bill would have revised laws related to pharmacy benefit managers (PBMs). The bill was set to enhance transparency and regulate pharmacy benefit manager (PBM) practices to ensure fair treatment of pharmacies and patients. It specifically addresses PBM reimbursement rates and requires PBMs to disclose pricing
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Texas – SB 1986 was introduced in the Texas State House this month. SB 1986 mandates opioid prescription bottles or containers must have warning labels. These labels will inform users about the addictive nature of opioids and the risks of respiratory depression and overdose. The required label must read: "CAUTION: Opioid. Risk of Addiction, Respiratory Depression, and Overdose." The Texas State Board of Pharmacy must adopt rules for these labels by January 1, 2026, and the new labeling requirements will apply to prescriptions for opioids dispensed on or after March 1, 2026.
SB 493 passed both the House and the Senate. As a reminder, SB 493 is designed to safeguard the ability of pharmacists and pharmacies to communicate openly about prescription drug benefits. The bill would allow pharmacists and pharmacies to discuss cost-saving options and provide patients with information on drug pricing and benefits without fear of retaliation or penalties.
Industry Watch: Healthcare News
SCPC Urges Congress to Include LTC Pharmacy Fix in Reconciliation Package to Save Prescription Drug Access for Seniors in Long-Term CareWashington, D.C (May 15, 2025)– Senior Care Pharmacy Coalition (SCPC) released the following statement regarding the reconciliation package passed by the House Energy and Commerce Committee on May 14. SCPC commends Kentucky Congressman Brett Guthrie and the members of the House Energy and Commerce Committee for their leadership in advancing a reconciliation package that positively addresses many current needs to improve the delivery of health care, including critically needed fixes to Medicare drug pricing provisions in the Inflation Reduction Act (IRA). We are also encouraged by the inclusion of other important policies that prioritize the needs of Medicare beneficiaries, IRA fixes pertaining to orphan drugs, and the long overdue ban on PBM spread pricing in Medicaid. To read the full statement, click here.
SCPC released a statement on Trump Administration’s Executive Order - Delivering Most-Favored-Nation Prescription Drug Pricing to American Patients
Washington, D.C (May 13, 2025) – Senior Care Pharmacy Coalition (SCPC) issued the following statement in response to the Trump Administration’s Executive Order. The May 12 EO, entitled “Delivering Most-Favored-Nation Prescription Drug Pricing to American Patients,” offers less than expectations. The EO notes that, while Americans comprise five percent of the world’s population, American payments for prescription drugs generate 75% of drug manufacturer profits. Despite its title, this EO is less detailed than the first Trump Administration’s efforts to adopt MFN pricing in Medicare and seems less likely truly to impose MFN pricing on any reasonable timeline. The EO is based on the conclusion that other countries and manufacturers are discriminating against American consumers by charging them much higher prices that in other countries, such that Americans pay disproportionately for drug development costs and manufacturer profits. To read the full statement, click here.
NCPA Statement on POTUS Executive Order on Most Favored Nation Drug Pricing
Alexandria, VA (May 12, 2025) - The National Community Pharmacists Association issued the following statement on behalf of CEO B. Douglas Hoey on President Trump’s executive order reviving Most Favored Nation drug pricing: “We need to get more details on the president’s executive order as this will take time to sort out due to the complicated nature of drug pricing in this country. However, we applaud any efforts to rein in pharmacy benefit manager practices that increase drug costs. We urge President Trump to continue to focus on PBM middlemen and the way they artificially inflate the price of prescription drugs to pad their pockets. In fact, it is not a coincidence that the United States pays more for drugs than any other country, and we are the only country in the world in which PBMs are hired to control drug prices. We believe those two facts are directly related. The president correctly pointed out that PBMs are the only link in the supply chain that produces nothing of value for patients. They don’t research, develop, or manufacture life-saving drugs. They don’t diagnose, treat, or counsel patients. They aren’t an access point for life saving drugs and related health care needs that are embedded in their local communities. Click here, to read more!
AAMC Statement on Proposed Cuts to Medicaid in House Budget Reconciliation Bill
Washington, D.C (May 12, 2025) - AAMC (Association of American Medical Colleges) issued the following statement about proposed cuts to Medicaid, as outlined in the House of Representatives Energy and Commerce Committee’s reconciliation bill text:
“The AAMC is deeply concerned that the proposed Medicaid policies included in the House Energy and Commerce Committee’s recently released reconciliation legislation will ultimately limit coverage and access to care for many of the over 70 million Americans — specifically children, older adults, individuals with disabilities, and those in rural and underserved communities — who rely on Medicaid for health care coverage. As the Committee considers its budget reconciliation bill, it is imperative that policymakers prioritize the health of all Americans and soundly reject policies that would specifically lead to the loss of health care coverage for 8.6 million people and undermine the financial stability of safety-net providers. To read more, check out the press release here.
Community Pharmacists Tally Hundreds of Congressional Visits Pushing for PBM Reform
ALEXANDRIA, Va. (May 2, 2025) – Hundreds of independent community pharmacy advocates from across the country came to Capitol Hill this week as part of the National Community Pharmacists Association’s Congressional Pharmacy Fly-In. The message: Congress must act swiftly to finalize and pass robust pharmacy benefit manager reform legislation and push the Centers for Medicare & Medicaid Services to correct course on Medicare Drug Price Negotiation Program implementation. Check out the full article by clicking here.
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