Included in this newsletter
- The Medicare GLP-1 Bridge Program Begins July 1, 2026
- Changes are Coming to iPLEDGE REMS on November 15, 2026
- TrumpRx Announces Expansion, Adding 160 More Drugs
- Under New Law, Florida Vets Must Inform Pet Owners of Right to Choose Pharmacy
- Senator Urges Military to Audit Express Scripts
- Iowa Audit Finds PBMs are Raking It In
- Arizona Pharmacists Can "Test And Treat" Under New Law
- Save the Date: Partnership Series with DocStation Wednesday July 15th @ 2pmEST
- Save the Date: Partnership Series with Atrium24 Wednesday August 19th @11amEST
- Compliance Tip of the Month
The Medicare GLP-1 Bridge Program Begins July 1, 2026
On July 1, 2026, the Medicare GLP-1 Bridge program will open a new pathway for eligible Medicare Part D beneficiaries to access certain GLP-1 medications at a fixed $50 monthly copay. It is planned to run through December 31, 2027 when it will evolve into the BALANCE model. This will require pharmacies to understand eligibility criteria, billing workflows, and management of the pharmacy, prescriber, and patient expectations. Please see the CMS provided Pharmacy Fact Sheet and Prior Authorization Form.
CMS Medicare GLP-1 Bridge Website
Changes are Coming to iPLEDGE REMS on November 15, 2026
iPLEDGE REMS has changes that include action items for pharmacies, effective Nov. 15, 2026:
- Authorized representatives should inform all trained pharmacists interacting with the iPLEDGE REMS system that they should create a personal account by calling the REMS Contact Center.
- Authorized representatives must provide training, at enrollment and annually thereafter, to all staff involved in dispensing isotretinoin annually and maintain records of training.
- Before dispensing each prescription for patients who cannot get pregnant, the iPLEDGE System will verify that the patient is enrolled and that the prescriber is certified in the iPLEDGE REMS. The pharmacist will now be prompted to enter the prescriber’s NPI number to verify that the prescriber is certified in the iPLEDGE REMS to obtain a Risk Management Authorization (RMA).
- Pharmacists will no longer receive a “Do Not Dispense After Date” when obtaining an RMA for a patient who cannot get pregnant. However, if the prescription is returned to stock (not dispensed to the patient), the RMA must be reversed in the iPLEDGE system.
Pharmacies may still only dispense a maximum of a 30-day supply with a Medication Guide. Isotretinoin may only be dispensed with a new prescription (no refills) and a new RMA.
Changes coming to iPLEDGE REMS on Nov. 15 | NCPA
TrumpRx Announces Expansion, Adding 160 More Drugs
On June 5, 2026, President Trump announced an additional expansion of the TrumpRx platform, adding 160 additional prescription medications and bringing the total to more than 800 drugs offered at discounted prices.
TrumpRx platform adds 160 more prescription drugs
Under New Law, Florida Vets Must Inform Pet Owners of Right to Choose Pharmacy
On July 1, 2026, a new Florida law will require veterinarians to inform pet owners that they are entitled to a written prescription they can fill at any pharmacy. The change aims to increase transparency and give consumers the option to seek lower-cost medications outside the vet's office. While veterinarians note that in-office dispensing offers convenience and access to animal-only drugs, many commonly used pet medications are human medicines that may be less expensive at traditional pharmacies. Pharmacists say the shift could help pet owners discover significant price differences. Overall, the law is expected to expand consumer choice and potentially reduce costs while maintaining access to veterinary-specific treatments when needed.
Florida vets must inform pet owners of right to choose a pharmacy under new law in July
Senator Urges Military to Audit Express Scripts
Senator Elizabeth Warren of Massachusetts is urging the Defense Department to audit Express Scripts, the exclusive PBM for Tricare, over concerns that it is overcharging the military and steering beneficiaries toward pharmacies owned by its parent company, The Cigna Group. Citing reports from independent pharmacies that say low reimbursement rates have pushed them out of the Tricare network, Warren argued that Express Scripts' control of benefits for more than 9 million service members and families enables potential self-dealing, and she demanded regular, transparent audits of the company's $4 billion contract, which runs through 2029. Her push comes alongside bipartisan legislation aimed at breaking up corporate consolidation in the health care industry, including a bill that would require companies owning insurers or PBMs to divest from their pharmacy businesses. Speaking at a Senate Armed Services subcommittee hearing, Warren also highlighted claims that Express Scripts charged the Defense Department an average of $484 more per generic drug through its own mail-order pharmacies.
Massachusetts senator urges military to audit Express Scripts | Stars and Stripes
Iowa Audit Finds PBMs are Raking It In
A new report from Iowa Auditor of State, Rob Sand, underscores growing concerns that pharmacy benefit managers are using pricing tactics that drive up costs for taxpayers while squeezing community pharmacies. Although the full financial impact could not be calculated due to withheld data, the report identified approximately $100 million in back-end value tied to these adjustments over a three-year period for just one PBM. Read the report here.
Iowa audit: PBMs are raking it in — and won’t say how much | NCPA
Big Reimbursement Win in Louisiana
Governor Jeff Landry (R) of Louisiana has signed HB 1236 into law. The legislation creates a commercial market reimbursement floor and seeks to prevent PBMs from unnecessarily passing costs to patients. Now known as Act 913, the law requires:
- NADAC as the reimbursement benchmark, but if NADAC is less than what the pharmacy actually paid for the drug, as documented by wholesaler or manufacturer invoice, the PBM must pay the difference up to acquisition cost.
- All PBMs to also include the professional dispensing fee established by the Louisiana Medicaid rate, currently $11.81, in each commercial claim reimbursement.
- That PBMs reprocess all claims between Jan. 1 and June 12, 2026, with the $9.00 dispensing fee per the Department of Insurance’s existing standard.
Other provisions in the Act:
- The PBM is prohibited from amending or changing the amount a prescription drug consumer must pay for an out-of-pocket cost share or expense.
- The bill tightens up the language prohibiting PBMs from passing the dispensing fee onto patients, pharmacies, or pharmacists. Nothing in the act prohibits the PBM from passing this on to the plan or negotiating with the plan.
Big reimbursement win in Louisiana | NCPA
Rhode Island Pharmacies Triumph
Governor Dan McKee (D) signed two PBM reform bills into law in Rhode Island, home state for the corporate headquarters of CVS Caremark. HB 8579/S 3060 is a licensing bill that requires PBMs to obtain a certificate of authority from the Rhode Island health insurance commissioner to operate as PBMs. The bill also contains PBM reporting and enforcement provisions. HB 8582/S 3059 requires PBMs to have reimbursement appeals processes, prohibits gag clauses, and strengthens PBM obligations of "good faith and dealing" with patients, pharmacies, and insurers. The bill assigns to PBMs the cost of enforcement, with specifications that include 150 percent of salaries and benefits of utilized personnel in the Office of the Health Insurance Commissioner.
Rhode Island pharmacies triumph | Jun 25, 2026 | NCPA
Arizona Pharmacists Can "Test And Treat" Under New Law
Governor Katie Hobbs of Arizona has signed into law a measure that allows pharmacists in the state to test for and treat common infections. The "Test and Treat" legislation permits Arizona pharmacists to test and treat for illnesses such as influenza, strep throat, and COVID-19 as well as for any illness associated with an emerging public health threat. Pharmacists are also allowed to prescribe HIV prevention medications. Under the measure, pharmacists must notify a patient’s primary care provider within 72 hours of starting treatment, or within 48 hours if the patient has an adverse reaction to the treatment.
Arizona pharmacists can test and treat infections under new law
Florida to Pull Back Veil on CVS Health
The Florida Attorney General, James Uthmeier, launched an investigation into CVS Health over concerns that the company is using its monopoly power to disadvantage independent pharmacies and restrict consumer choice. It focuses on claims that Caremark steers patients to owned and affiliated pharmacies, reimburses affiliated stores at higher rates than independent pharmacies, imposes audits that result in claw backs, and uses restrictive contract language that squeezes pharmacies. Many of these practices were prohibited by sweeping legislation in 2023 that many have said hasn't been adequately enforced.
The investigation starts with a Civil Investigative Demand (CID), which allows the state to compel the production of documents and sworn testimony before filing any lawsuit or formal enforcement action. The CID seeks information related to reimbursement rates, pharmacy contracts, patient steering practices, audits, rebates, and the treatment of CVS-affiliated pharmacies compared with independent competitors. CVS Health must respond to the CID by July 28.
Florida to pull back veil on CVS Health | Jun 29, 2026 | NCPA
FDA Staff Recommendation Undercuts RFK Jr.'s Push to Expand Peptides
Career scientists at the FDA are not backing HHS Secretary Robert F. Kennedy Jr.'s campaign to clear seven peptides for use in pharmaceutical compounding. Based on documents posted online describing their rationale, staff believe there is insufficient safety and efficacy data to warrant more widespread availability of the products. While they are increasingly marketed for their anti-aging properties and other purported health benefits, medical experts warn that the wellness claims are thus far untested, unsubstantiated, and unapproved by the FDA. The agency's career staffers publicized their lack of endorsement without much fanfare ahead of July's meeting of the FDA's Pharmacy Compounding Advisory Committee, which will weigh the pros and cons of allowing compounding of the peptides. While the FDA typically heeds the recommendations of its advisors, it is not obliged to do so. Observers worry that this could be the case late next month, as Kennedy has populated the panel with like-minded individuals who could override the staff sentiment. At least seven of the appointees have ties to peptide-related businesses and clinics, which has raised the potential for conflicts of interest.
FDA staff recommendation undercuts RFK Jr.’s push to expand peptides - The Washington Post
FDA Staff Question Peptides Backed by Kennedy Ahead of Advisory Panel Review
Medicare Updates Osteogenesis Stimulator Billing Requirements
Effective for dates of service on or after May 18, 2026, the FDA has reclassified osteogenesis stimulators billed under HCPCS codes E0747, E0748, and E0760 from Class III to Class II devices. As a result, claims for these codes should no longer include the KF modifier. Claims submitted with the KF modifier for dates of service on or after May 18, 2026, will be rejected for incorrect billing. Claims with dates of service prior to May 18, 2026 must still include the KF modifier.
For complete billing guidance, visit Noridian's Osteogenesis Stimulator page:
https://med.noridianmedicare.com/web/jadme/dmepos/osteogenesis-stimulator
Save the Date: Partnership Series with DocStation Wednesday July 15th @ 2pmEST
Webinar: Lifting the Veil on Medical Billing How your pharmacy is already billing medically — and how to do more of it Presented by DocStation
We're excited to continue our Partnership Series by bringing together trusted industry experts to share practical solutions that help independent pharmacies grow, remain compliant, and better serve their patients.
Here's something most independent pharmacy owners don't realize: you're probably already doing medical billing. If you've ever billed Medicare directly for a vaccine, a CGM, a nebulizer, or a piece of durable medical equipment, that's medical billing. The question isn't whether your pharmacy can do it — it's whether you're capturing all of it, and whether you have the right infrastructure to grow it.
With 80% of independent pharmacy revenue still tied to prescription dispensing, and margins on that dispensing eroding every year from DIR fees and PBM clawbacks, the urgency to diversify is real. Medical billing — through Medicare Part B, Medicaid, and commercial payers — offers a more stable, scalable revenue stream that your pharmacy is already positioned to pursue. This webinar cuts through the confusion and shows you exactly what that landscape looks like.
We'll cover the full range of medical billing opportunities available to community pharmacies today: products like vaccines, CGMs, and DME; clinical services like MTM, point-of-care testing, and Diabetes Self-Management Training; and emerging opportunities tied to expanding pharmacist provider status. We'll also get practical about what it actually takes to get started — credentials, billing codes, and the right platform.
That's where DocStation comes in. Built specifically for clinical services beyond the dispensing system, DocStation handles medical billing, patient management, clinical workflows, and revenue analytics in one place — and has helped more than 500 pharmacies collect over $30M in clinical revenue.
You'll leave this session understanding:
Save the Date: Partnership Series with Atrium24 Wednesday August 19th @ 11amEST
Just scheduled!! Atrium24 helps independent pharmacies grow through AI-powered tools, strategic purchasing power, expert guidance, and a connected community built for what’s next. More details coming soon.
Compliance Tip of the Month
Always use appropriate Personal Protective Equipment (PPE) and follow safe handling procedures when managing hazardous drugs, even in non-compounding settings, to reduce exposure risk to staff and patients. Ensure staff are trained and practices are documented to meet regulatory expectations. State Boards of Pharmacy and other inspectors are increasingly enforcing USP <800> and citing retail pharmacies for lacking documented HD handling practices and staff training, triggering compliance deficiencies.
