Your 2025 Pharmacy Legislation Update

The last year was a challenging one for pharmacists, who began the year facing cash flow challenges and a DIR hangover and ended it with pharmacy benefit manager (PBM) reform being cut from federal legislation. Between these bookends was the closure of more than 2200 pharmacies, which led to the creation of new health care deserts across the US.¹

But the news wasn’t all bad: Across the country, more than 100 state-level bills were introduced, many of which expanded pharmacists’ scope of practice. In multiple states, pharmacists can now administer all FDA-approved vaccines, test and treat patients for minor illnesses, and prescribe and dispense contraceptives and preexposure and postexposure prophylaxis (PrEP, PEP) for HIV.

Read on for key legislative actions changing pharmacy practice in 2025 and beyond.

In 2024, more than 100 bills focused on pharmacy practice were introduced into state-level legislatures. Some of these bills expanded pharmacists’ scope of practice, allowing these crucial health care providers to administer vaccines and perform test and treatment services for minor illnesses, whereas others focused on contraceptives, HIV PrEP and PEP, and tobacco cessation.^2,3

READ MORE: Keeping Focus on Bottom Line Amid Industrywide Changes in Pharmacy

“Community pharmacies are delighted to see policy catching up with what pharmacists have always been capable of,” noted a National Community Pharmacists Association news release.² “But there must be an understanding that scope cannot be expanded without an adequate way to reimburse pharmacists and ensure access to patients.”

Oregon

SB 1506

Through June 2026, Oregon pharmacists are temporarily allowed to test and treat patients, including through dispensed medications, for SARS-CoV-2. Additionally, state health benefit plans must reimburse pharmacists for testing, prescribing, dispensing, and administrating SARS-CoV-2 treatment.

It took effect on June 6, 2024.

California

SB 339

Preexisting California law authorized pharmacists to provide 30- or 60-day supplies of HIV PrEP, as well as PEP under certain conditions. SB 339 authorizes pharmacists to provide PrEP up to or beyond 90 days if certain conditions are met. Additionally, this bill requires California health plans to cover both the administration of HIV PrEP by a pharmacist and any related services or tests.

It was approved by the governor on February 6, 2024.

Alaska

HB 226

HB 226 establishes several provisions for PBM duty of care to plan sponsors, benefits administrators, and covered individuals, as well as transparency and disclosure requirements. Patients can choose their pharmacy, which limits patient steering, prohibits fees, and requires equal reimbursement between PBM-affiliated and nonaffiliated pharmacies.

It was signed into law on September 12, 2024.

Idaho

HB 527

Idaho pharmacists can now prescribe, distribute, dispense, and administer emergency medications such as naloxone and epinephrine auto-injectors.

It was signed into law on March 18, 2024.

Hawaii

HB 2553

This bill authorizes pharmacists to administer FDA-approved, Advisory Committee on Immunization Practices (ACIP)–recommended vaccines to patients 3 years and older. Additionally, pharmacy interns and pharmacy technicians, working under the direct supervision of a pharmacist and meeting specific requirements, may also administer vaccines.

It was signed into law on June 28, 2024.

Minnesota

HF 5247

This bill allows licensed pharmacists to administer a slate of vaccines to patients. Minnesota pharmacists can now vaccinate patients 3 years and older against COVID-19 and the flu, and patients 6 years and older with all other FDA-approved vaccines—without a prescription. Pharmacists may also order and administer CLIA-waived point-of-care tests for COVID-19 and other minor illnesses.

It was approved by the governor on May 24, 2024.

Nebraska

LB 204

Independent pharmacies with 6 or fewer locations now have a managed Medicaid reimbursement floor based on Medicaid fee-for-service NADAC methodology, plus a professional dispensing fee of $10.38. The Department of Insurance will complete an initial cost of dispensing survey, which will be conducted every 2 years.

It was approved by the governor on April 16, 2024.

Oklahoma

SB 1670 and HB 3376

These bills establish additional oversight of PBMs in Oklahoma. SB 1670 amends the Pharmacy Audit Integrity Act, changing notice requirements of audits and requiring recovered funds to be paid to patients first. HB 3376 is intended to increase PBM transparency and oversight, amending the Patient’s Right to Pharmacy Choice Act, prohibiting PBM gag clauses that prevent pharmacies from educating patients about lower out-of-pocket costs, and allowing the attorney general to subpoena records and levy fines for noncompliance by PBMs.

HB 3376 was approved by the governor on May 15, 2024. SB 1670 was passed on May 22, 2024.

Iowa

HF 2099

Among several provisions, this bill addresses retaliation by PBMs against pharmacies, updates Maximum Allowable Cost list policies, and prohibits various fees, including claim processing, performance-based, network participation, and/or accreditation fees.

It was signed into law on May 1, 2024.

HF 555

A statewide board-approved protocol allows Iowa pharmacists to independently order and administer prescription drugs and biological products.

It was approved by the governor on April 19, 2024.

Illinois

SB 3268

Health benefit plans in Illinois are prohibited from denying pharmacists reimbursement for pharmacist-ordered testing, screening, and treatment that falls within their scope of practice if those services would be otherwise covered when performed by other health care providers.

It was signed into law on June 14, 2024.

Louisiana

SB 444

This bill prevents PBMs from reimbursing pharmacies for less than the acquisition cost of a drug, device, or service. It applies to pharmacies and pharmacists who do not own more than 5 shares or 5% interest in pharmaceutical wholesale purchasing groups or vendors of covered drugs, devices, or services.

It was signed into law on June 19, 2024.

READ MORE: Focus on What Matters: Sustaining Your Pharmacy in 2025

New York

S 9040

This bill addresses PBM gag clauses and prohibits PBMs from penalizing pharmacies that provide customers and patients with information about the costs of their prescription medications and other services.

It was signed into law on September 27, 2024.

Kentucky

SB 188, HB 190

Effective January 1, 2025, these bills require pharmacy reimbursement in the commercial market and most state employee plans of NADAC plus professional dispensing fees. They also address network adequacy, mail-order limits, and retroactive fees and prohibit lower reimbursement to pharmacies not owned by or affiliated with PBMs.

SB 188 was signed into law on April 5, 2024. HB 190 was signed into law on April 18, 2024.

Tennessee

SB 869

Under certain conditions, pharmacists in Tennessee are permitted to dispense antiviral medications for the fl u and COVID-19 following the administration of a CLIA-waived test, PEP for nonoccupational HIV exposure, epinephrine auto-injectors, progesterone-only hormonal contraceptives, and naloxone.

It was signed by the governor on May 1, 2024.

Delaware

SB 194

Thanks to a statewide protocol approved by the Delaware Division of Public Health, pharmacists may now provide both PrEP and PEP for HIV.

It was signed into law on September 24, 2024.

Connecticut

SB 133

Pharmacists in Connecticut are now able to prescribe and administer all FDA-approved, CDC-recommended vaccines to individuals 12 years and older. They can also delegate vaccination administration to an advanced pharmacy technician on staff.

It was signed into law on May 28, 2024.

Florida

HB 159

Licensed Florida pharmacists can now screen adults for HIV and provide the results of those screenings. The bill also creates a process allowing pharmacists to be certified to order and dispense PrEP and PEP via a collaborative practice agreement.

It was approved by the governor on April 26, 2024.

Legislating PBMs

After a yearslong fight, PBM legislation nearly crossed the fi nish line in 2024. A bipartisan end-of-year spending package introduced on December 18 included long-awaited PBM reform; the bill included language prohibiting PBMs from using tactics like spread pricing, unfair contracting, and patient steering, among others.⁴

But following pressure from then–President-elect Donald Trump and others, it was a significantly slimmed-down legislative package that ultimately passed to avoid a shutdown and fund the government through March 2025.⁵ Although nothing is certain, state and federal-level pressure on PBMs will likely continue this year.⁶

To read these stories and more, download the PDF of the Total Pharmacy February issue here.

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References

1. Jolley B. 2275 pharmacies have closed so far in 2024. Ramblings of a pharmacist. September 16, 2024. Accessed January 6, 2025. https://benjaminjolley.substack.com/p/2275-pharmacies-have-closed-so-far 

2. NCPA notched win after win in 2024 state legislatures. News release. National Community Pharmacists Association. December 19, 2024. Accessed January 6, 2025. https://ncpa.org/newsroom/qam/2024/12/19/ncpa-notched-win-after-win-2024-state-legislatures

3. 2024 state wins for community pharmacy. National Community Pharmacists Association. Accessed January 6, 2025. https://ncpa.org/sites/default/files/2024-12/2024-state-wins-for-comm-pharmacy.pdf

4. Nowosielski B. Long-awaited PBM reform included in Congress’ end-of-year spending package. Drug Topics. December 18, 2024. Accessed January 6, 2025. https://www.drugtopics.com/view/long-awaited-pbm-reform-included-in-congress-end-of-year-spending-package

5. Nowosielski B. PBM reform pulled back in late change to spending package. Drug Topics. December 20, 2024. Accessed January 6, 2025. https://www.drugtopics.com/view/pbm-reform-pulled-back-in-late-change-to-spending-package

6. Weixel N, Choi J. Will congress get another shot at PBM reform? The Hill. January 2, 2025. Accessed January 6, 2025. https://thehill.com/newsletters/health-care/5064513-will-congress-get-another-shot-at-pbm-reform/