• Michigan Sues Express Scripts, Prime for Price-fixing
• 26 House Members Advocate for MDPN Program Changes to Protect Pharmacies 
• NCPA Urges Trump Administration to Tailor Pharmaceutical Tariffs
• Indiana Wins Reimbursement Reforms 
• Huge Win in Virginia for a Single PBM in Medicaid
• Thank You to the PAC Telethon Volunteer Callers at Fly-in!
• House Reintroduces ECAPS
• NCPA’s Anne Cassity Named One of D.C.’s “Most Influential People”
• North Dakota Enacts Exemplary PBM Licensure Law
• NCPA Submits Comments on Costs of Dispensing in Alaska
• NCPA State Legislative Activity Update

Michigan Sues Express Scripts, Prime for Price-fixing

In yet another attempt to keep PBMs accountable, Michigan Attorney General Dana Nessel sued Express Scripts Inc. and Prime Therapeutics last week for alleged price-fixing of pharmacy reimbursement rates in the state. The AG’s suit mirrors many of the allegations in the Osterhaus v. Prime lawsuit that recently overcame a motion to dismiss by ESI. General Nessel alleges the PBMs’ anticompetitive behaviors have caused those pharmacies financial harm. 

Prime agreed to adopt ESI reimbursement rates in December 2019, including setting “guardrails” for pricing. ESI controls around 89 percent of the PBM market in Michigan. Michigan is represented in the matter by Natasha Fernandez-Silber of the Edelson law firm. She is NCPA’s counsel in its price-fixing class action against GoodRx.

26 House Members Advocate for MDPN Program Changes to Protect Pharmacies 

A bipartisan list of 26 members of the House of Representatives sent a letter on Tuesday, May 6, to Secretary of Health and Human Services Robert F. Kennedy, Jr. and Mehmet Oz, MD, administrator of the Centers for Medicare & Medicaid Services, outlining their concerns about the implementation of the Inflation Reduction Act Medicare Drug Price Negotiation Program. 

The letter was led by Reps. Buddy Carter (R-Ga.) and Jake Auchincloss (D-Mass.). The following 24 members of Congress co-signed: James Comer (R-Ky.), Richard Hudson (R-N.C.), John Joyce (R-Penn.), Diana Harshbarger (R-Tenn.), Tom Kean (R-N.J.), Nicole Malliotakis (R-N.Y.) Mariannette Miller-Meeks (R-Iowa), Cliff Bentz (R-Ore.), Austin Scott (R-Ga.), Eleanor Holmes Norton (D-D.C.), Raja Krishnamoorthi (D-Ill.), Sanford Bishop (D-Ga.), Michael Cloud (R-Texas), Dan Crenshaw (R-Texas), Vicente Gonzalez (D-Texas), Tim Moore (R-N.C.), Terri Sewell (D-Ala.), Carol Miller (R-W.Va.), John Rutherford (R-Fla.), Joe Wilson (R-S.C.), Claudia Tenney (R-N.Y.), French Hill (R-Ark.), Jeff Van Drew (R-N.J.), and Derek Schmidt (R-Kan.).  

The MDPN program will begin Jan. 1, 2026. For a link to NCPA's talking points on the MDPN program, click here. For previous NCPA advocacy on the MDPN program and the IRA, click here.

NCPA Urges Trump Administration to Tailor Pharmaceutical Tariffs

In comments released yesterday, NCPA urged the Trump administration to ensure any tariffs on the pharmaceutical sector are carefully tailored to avoid further strain on patients and independently owned community and long-term care pharmacies. In comments to the Department of Commerce, Steve Postal, JD, NCPA senior director of policy and regulatory affairs, said pharmacies are “unable to pass these increased costs to patients, as pharmacy benefit managers (PBMs) determine out-of-pocket costs for patients and dictate pharmacy reimbursement for the dispensing of medications.”  

“Should pharmaceutical tariffs be enacted, it is imperative that the administration require PBMs to adjust reimbursements to pharmacies within 24 hours of price increases to account for increased drug acquisition costs should tariffs go into effect,” he wrote.

Indiana Wins Reimbursement Reforms 

Gov. Mike Braun (R) signed into law S.B. 140, PBM reform legislation that, among its provisions, establishes reimbursement floors in the commercial market effective Jan. 1, 2026.  The bill requires reimbursement not less than the greater of 1) the reimbursement level paid to PBM-owned or affiliated pharmacies or 2) one of the following reimbursement schemes dependent on whether pharmacies hold permits to sell liquor.  For pharmacies not holding permits to sell liquor (typically independent), the reimbursement floor is NADAC plus the professional dispensing fee from the Medicaid fee-for-service program.   

For pharmacies holding permits to sell liquor, the floor will be actual acquisition cost plus a “fair and reasonable” dispensing fee.  NCPA was proud to support the Indiana Pharmacy Association with consultation, comment letters, and grassroots action throughout the many twists and turns for this legislation, including a short-lived Senate amendment to prohibit PBMs from operating pharmacies in the state.  NCPA congratulates the IPA for its unwavering advocacy and excellent outcome. 

Huge Win in Virginia for a Single PBM in Medicaid

Gov. Glenn Youngkin (R) signed S.B. 875/H.B. 2610 into law, creating a single PBM to administer the state's Medicaid pharmacy program. The law also establishes fiduciary responsibility for the PBM, requires pass-through pricing, and prohibits spread pricing. Pharmacy advocates worked extremely hard on this legislation and overcame many obstacles, not the least of which was an amendment from Youngkin himself that would have reduced the legislation to a study. 

Virginia now joins Kentucky, Louisiana, Mississippi, and Ohio in having a single PBM policy. Congratulations to Virginia pharmacy advocates on this momentous win!

Thank You to the PAC Telethon Volunteer Callers at Fly-in!

Last week, 10 NCPA members volunteered to continue growing the NCPA PAC during our 2025 Congressional Pharmacy Fly-In by calling their fellow community pharmacists around the country and soliciting investments in NCPA's advocacy efforts. As of the time of writing, over $39,000 has been contributed or pledged to the NCPA PAC, and responses are still coming in! Congratulations to our top fundraiser Corey Furman from Boone, N.C.  

Thanks to the following volunteers: Raymond Carvajal, San Antonio, Texas; David Cippell, Ford City, Penn.; Danny Cottrell, Brewton, Ala.; Corey Furman, Boone, N.C.; Steve Giroux, Middleport, N.Y.; Nasir Mahmood, Pine Plains, N.Y.; Svet Milic, Colonia, N.J.; Amarsena Sappidi, Portage, Mich.; Bruno Tching, Hemet, Calif.; Dean Stone, Metter, Ga.

House Reintroduces ECAPS

On May 1, during the NCPA Congressional Pharmacy Fly-In, Reps. Adrian Smith (R-Neb.), Brad Schneider (D-Ill.), Diana Harshbarger (R-Tenn.), and Doris Matsui (D-Calif.) introduced the Equitable Community Access to Pharmacist Services (ECAPS) Act (H.R.3164). This reintroduction of NCPA priority legislation would ensure Medicare beneficiaries can easily access health care services by authorizing pharmacists to test and treat COVID-19, flu, respiratory syncytial virus, and strep throat.  

These policies recognize pharmacists and the role they have in improving health care access by establishing Medicare Part B direct reimbursement for these pharmacist services. Independent pharmacies have played a large role at both the federal and state levels in testing for COVID-19 and administering COVID-19 vaccines to those in their communities and in long-term care facilities, and this legislation would ensure continued access for patients to services at their local pharmacy. NCPA is proud to support this important bill. 

NCPA’s Anne Cassity Named One of D.C.’s “Most Influential People”

Congratulations to NCPA's Anne Cassity, senior vice president of government affairs, for making Washingtonian magazine's recently published list of this year's 500 most influential people in Washington, D.C.! 

Listed under the health care section, the magazine praises Anne for turning NCPA priorities into action, citing her work to pass pharmacy benefit manager reform. You can read the list here.

North Dakota Enacts Exemplary PBM Licensure Law

Gov. Kelly Armstrong (R) signed into law H.B. 1584, pharmacy benefit manager licensure legislation with many provisions that NCPA considers best practices. While North Dakota already had some excellent protections for pharmacies against egregious PBM business practices, it did not have a complete licensure program and clear authorities for oversight and enforcement by the Department of Insurance.  

H.B. 1584 will apply to all PBMs serving nearly all plans in North Dakota because the state statute’s reference to ERISA (Employee Retirement Income Security Act of 1974) was removed. The North Dakota Pharmacists Association (NDPhA) overcame strong resistance from a long list of powerful opponents, drawing insights from a range of sources such as 8th Circuit Court case law, an opinion letter from Texas Attorney General Ken Paxton (R), and the National Association of Insurance Commissioners.  

H.B. 1584 continues North Dakota’s legacy of strong policymaking that supports independent pharmacies. NCPA congratulates NDPhA for another major achievement!

NCPA Submits Comments on Costs of Dispensing in Alaska

NCPA submitted formal comments on Alaska's proposed State Plan Amendment (SPA) to the Alaska Department of Health, which would significantly lower the cost of dispensing for most of the state's community pharmacies. While recognizing the need for cost management, NCPA emphasized that the Alaska Department of Health must account for critical factors such as fair ingredient cost reimbursement and Alaska's unique freight challenges. NCPA asked the department to withdraw the proposed SPA in its current form and engage in further evaluation to ensure the sustainability of local pharmacy services that Alaskans rely on. 

NCPA State Legislative Activity Update

NCPA tracks state legislation related to our top three state priorities: Medicaid reform, scope of practice and compensation for services, and PBM reform and regulation. Click each issue for a report of bills that have been introduced so far this session specifically dealing with these three issue areas. You can access the individual bill language and basic information on the bill by clicking on the bill numbers in the attached report. Bills that have moved this week are listed at the top in the “Recently Updated” section.

NCPA’s Advocacy Center Update provides a weekly detailed summary of recent and breaking legislative, regulatory, and state developments impacting independent community pharmacy and NCPA’s efforts to affect policies benefitting its membership and the industry. The weekly update is distributed to NCPA leadership, steering committees, allied organizations/stakeholders, and major contributors to the NCPA LDF and PAC. The weekly update is intended exclusively for the recipient and is not for external distribution.