Transcript Highlights:

• Item number two is the December 2025 pharmacy formulary recommendations.
• Next item up is the January 2026 pharmacy formulary recommendations.
• Next item up is the January 2026 pharmacy formulary recommendations.
• Moving to the February 2026 pharmacy formulary recommendations.
• more than we're paying our independent pharmacies within the plan?

Committee: All ALC-STATE INSURANCE PROGRAMS OVERSIGHT SUBCOMMITTEE

Summary: The State Insurance Programs Oversight Subcommittee met to review and approve several Employee Benefits Division (EBD) and pharmacy formulary actions. Grant Wallace, director of EBD and the Office of Property Risk, presented a $280,000 Boston Consulting Group contract to help develop the third-party administration RFP, and the committee approved it. The committee also approved the December 2025, January 2026, and February 2026 pharmacy formulary recommendations, along with February 2026 medical drug recommendations. The formulary changes focused on removing prior authorization for injectable migraine CGRPs, replacing a discontinued capsule with a tablet, updating items for FDA guidance, and leaving some drugs not covered when lower-cost alternatives or insufficient efficacy data existed. For February 2026, EBD recommended removing Skyrizi and Renvoke in favor of lower-cost biosimilars and other alternatives, re-tiering several drugs to encourage generics, adding an anti-seizure medication developed by the Department of Defense, and adding a subcutaneous version of Keytruda for faster administration. The medical drug list similarly shifted toward biosimilars and aligned coverage for Skyrizi and Renvoke across pharmacy and medical settings. Members raised broader questions about the impact of new pharmaceutical discount programs such as Trump RX and Mark Cuban Cost Plus, as well as concerns about PBM compliance and whether Navitus might be violating state law or paying affiliate pharmacies more than independent pharmacies. Wallace said the new programs and their effects were still being studied, that EBD was working with Navitus to evaluate pricing opportunities, and that Navitus had said it was in compliance with Rule 118, though additional research and auditing were underway. All items were approved by voice vote, and the meeting adjourned after no further business.

Transcript Highlights:

• benefit relating to the pharmacy benefit relating to the pharmacy benefit managers.
• Bobby Giles with the Alabama Pharmacy Alabama Pharmacy Alabama Pharmacy Association.
• Pharmacy Association, the Alabama Pharmacy Association, the Alabama Pharmacy Association, the Alabama
• Pharmacy Cooperative, the Alabama Pharmacy Cooperative, the Alabama Pharmacy Cooperative, the Alabama
• Independent Pharmacy Alabama Independent Pharmacy Alabama Independent Pharmacy Association, and all

Bills: HB 10 , HB 12 , HB 147 , HB 1522 , HB 422 , HB 675 , HB 204 , HB 748 , HB 912

Transcript Highlights:

• To promote continued access to high-quality pharmacy benefits while ensuring more effective use of state
• And benefits cost containment proposals.
• For Medicaid, pharmacy as a whole is an optional benefit.
• However, once states choose to offer pharmacy as a benefit, which all 50 states do, most drug classes
• A step back after the stabilization of the pharmacy benefit, after it was carved out from the managed

Transcript Highlights:

• With regard to general eligibility and benefits, thereafter.
• For example, higher pharmacy costs.
• For Medicaid, pharmacy as a whole is an optional benefit, but once states choose to offer pharmacy as
• a benefit, and all 50 states do offer pharmacy as a benefit, most drug classes have to be covered.
• We talked about higher pharmacy costs. There's a piece in there.

Summary: The Assembly Budget Subcommittee on Health held the first of several hearings on the Governor’s May Revision for health care, with opening remarks focused on the state’s projected $12 billion deficit, looming federal Medicaid changes, and the potential impact on Medi-Cal, public health, reproductive health, and safety-net providers. Several members criticized the proposal as balancing the budget on vulnerable Californians, while others defended the need for cost containment and questioned the administration’s assumptions. The chair set ground rules for respectful, focused questioning and outlined three topics: the Medi-Cal proposals, Proposition 35, and Proposition 56. DHCS Director Michelle Baas presented the May Revision’s Medi-Cal package, saying the department’s budget totals $200.6 billion overall, including $45.2 billion General Fund, and that the proposals are intended to address rising caseloads, pharmacy costs, and managed care spending. She described proposed changes for adults with unsatisfactory immigration status, including a freeze on new full-scope enrollment for those 19 and older, $100 monthly premiums beginning in 2027, elimination of adult dental and long-term care coverage, removal of PPS/RAP payments to FQHCs and rural health clinics for that population, and a pharmacy rebate aggregator. Other proposals included eliminating certain OTC drug classes, removing GLP-1 coverage for weight loss, prior authorization and step therapy changes, reinstating the Medi-Cal asset test, eliminating acupuncture as an optional benefit, allowing utilization management for hospice, raising the managed care minimum medical loss ratio to 90%, reducing PACE capitation rates toward the midpoint of the actuarial range, eliminating the skilled nursing facility workforce and quality incentive program, and suspending the SNF backup power requirement. The LAO said the revised Medi-Cal spending estimate is about $2.5 billion higher than the Governor’s Budget in the budget year, and that the increase appears driven more by higher per-enrollee costs than by caseload alone. The LAO said the budget solutions are concentrated in a few areas, are largely ongoing, and should be considered in light of federal uncertainty, but suggested the Legislature could explore alternatives such as more targeted income thresholds for the undocumented expansion and simpler asset-test rules. Department of Finance officials said the proposals are difficult but necessary to address a third consecutive deficit and rising Medi-Cal costs. Members then pressed the administration on the methodology and impacts of the proposals, especially the enrollment freeze, premiums, asset test, hospice controls, PACE reductions, and the elimination of benefits and provider payments. No votes or formal actions were taken at this hearing.

Transcript Highlights:

• of the contract pharmacy.
• of the contract pharmacy.
• that's the benefit of the contract<00:23:54.000><c> Pharmacy</c><00:23:54.880><c> and</c><00:23:55.080
• contract pharmacies.
• contract pharmacies.

Committee: House Judiciary & Hawaiian Affairs

Summary: The committee first heard House Bill 302, which would repeal the requirement that a provider-patient relationship for medical cannabis certification be established in person first. The Department of Health said it supported the House Draft 2 version as a way to expand patient access, and several testifiers from the medical cannabis community and dispensary industry supported the bill, especially for patients on outer islands or those unable to travel. One witness asked that earlier language removed in committee be restored to further improve access. Representative Shimizu asked whether follow-up in-person visits would still occur, and DOH responded that this varies by provider, with some continuing in-person care and others moving to telehealth for chronic conditions. The committee then took up House Bill 712, relating to the federal 340B drug pricing program and contract pharmacies. The Office of Consumer Protection and the Attorney General’s office both said they supported the bill’s purpose but wanted it clarified and possibly moved into a standalone chapter rather than chapter 481B. Supporters, including Hawaii Pacific Health and the Queen’s Health Systems, said the bill is needed to protect safety-net funding and access to discounted drugs, citing large financial benefits from 340B and losses caused by manufacturer restrictions on contract pharmacies. PhRMA opposed the bill, arguing the issue is not access to discounts but accountability and transparency in how contract pharmacies distribute benefits, and said it was willing to discuss amendments. Members asked follow-up questions about whether there was data showing misuse; PhRMA said it did not have numbers, while hospital witnesses said the program is federally audited and used appropriately in Hawaii. Finally, the committee heard House Bill 1482, HD1, which would tighten hemp and controlled-substance definitions to exclude Schedule I cannabinoids from manufactured hemp products and clarify the treatment of artificially derived cannabis. The Department of Health supported the measure, saying it adds clarity to existing prohibitions. Kūre Hawaii and other supporters said it would close loopholes involving Delta-8 and similar products. An individual testifier urged stronger language to also cover compounds such as HHC, THCA, THCP, and THCO. In response to questions about enforcement against mislabeled hemp products, DOH explained that THC percentages are relative to product weight, that some products can remain under the hemp threshold while still containing significant THC, and that hemp flower is already prohibited from direct retail sale, though enforcement can be complicated and involves both administrative and criminal authorities.

Transcript Highlights:

• Allowing pharmacy level substitution of products that have not demonstrated they, Allowing pharmacy level
• So it kind of brings us back into the loop as compared to the pharmacy.
• And so he's somebody that could benefit from lung cancer screening.
• Co-pay accumulators allow insurance and pharmacy benefit managers...
• Co-pay accumulators allow insurance and pharmacy benefit managers to pocket patient assistance intended

Committee: Senate Health

Transcript Highlights:

• modifies the covered entity reporting requirements by specifying that payments made to contract pharmacies
• unless that pharmacy is in a rural county or a medically underserved area.
• What this would do is limit entities that are contracting with additional contract pharmacies to ones
• Again, this program does provide lots of benefits, and one of the areas where we need a lot of help,
• One of my biggest concerns... ...had the ability to contract with additional pharmacies.

Bills: SB5877

Committee: House Health Care & Wellness

Keywords: anesthesiology, medical personnel, surcharges, licensing, healthcare regulations

Transcript Highlights:

• That's generally a higher rate than the pharmacy benefit plan.
• That's generally a higher rate than the pharmacy benefit plan.
• That's generally a higher rate than the pharmacy benefit plan.
• ><00:24:36.440><c> recognize</c> pharmacy benefit plan so I recognize pharmacy benefit plan so I recognize
• </c><00:24:48.520><c> benefit</c> been build under the pharmacy benefit been build under the pharmacy

Committee: Senate Health and Human Services

Transcript Highlights:

• Relative to pharmacy benefit managers, the substitute bill addresses definitions, pharmacy reimbursements
• Restrictions, prohibitions, pharmacy benefit managers, managed care plans, provide for the reduction
• Relative to pharmacy benefit managers, definitions, pharmacy reimbursements, prohibits certain reimbursement
• House Bill 938 by Representative Turner, relative to pharmacy benefit managers, pharmacy reimbursement
• I don't know the pharmacies getting the benefits except being reimbursed right now.

Bills: HR115 , HR116 , HR117 , HR118 , HR112 , HR113 , HR114 , HCR51 , HCR52 , SCR18 , SCR20 , SB14 , SB76 , SB118 , SB142 , SB156 , SB170 , SB197 , SB234 , SB258 , SB287 , SB288 , SB313 , SB315 , SB393 , SB396 , SB426 , SB427 , HCR7 , HB76 , HB84 , HB132 , HB181 , HB210 , HB250 , HB265 , HB275 , HB291 , HB322 , HB342 , HB457 , HB475 , HB477 , HB486 , HB616 , HB635 , HB639 , HB690 , HB740 , HB757 , HB761 , HB766 , HB774 , HB808 , HB855 , HB866 , HB872 , HB883 , HB886 , HB903 , HB949 , HB962 , HB996 , HB1003 , HB1036 , HB1054 , HB1071 , HB1076 , HB1078 , HB1113 , HB1132 , HB1146 , HB1232 , HB1233 , HR15 , HR20 , HCR14 , HCR6 , HCR19 , HCR10 , HR74 , HCR26 , HCR35 , HB98 , HB108 , HB131 , HB151 , HB161 , HB288 , HB294 , HB305 , HB310 , HB320 , HB336 , HB380 , HB392 , HB403 , HB420 , HB459 , HB476 , HB540 , HB615 , HB631 , HB637 , HB648 , HB665 , HB682 , HB789 , HB813 , HB815 , HB835 , HB870 , HB905 , HB915 , HB933 , HB938 , HB987 , HB1040 , HB51 , HB82 , HB143 , HB145 , HB160 , HB180 , HB192 , HB393 , HB430 , HB445 , HB506 , HB515 , HB521 , HB565 , HB590 , HB614 , HB638 , HB670 , HB672 , HB685 , HB692 , HB752 , HB773 , HB781 , HB799 , HB860 , HB874 , HB887 , HB917 , HB937 , HB956 , HB965 , HB972 , HB977 , HB982 , HB1006 , HB1010 , HB1044 , HB1072 , HB1088 , HB1179 , HB1200 , HB81 , HB400 , HB154 , HB410 , HB463 , HB827 , HB868 , HB952 , HB953 , HB140 , HB750 , HB911 , HB52 , HB961 , HB399 , HB401 , HB901 , HB9 , HB58 , HB193 , HB284 , HB570 , HB577 , HB582 , HB605 , HB733

Summary: The House convened with a quorum, opened with prayer by guest minister Reginald Tate, and adopted the journal and several leave requests. The chamber received Senate messages, including concurrence in HCR 44 and Senate adoption of SCRs 19 and 26, and referred a number of Senate resolutions and bills to committee. It also reported and adopted several House resolutions honoring individuals, schools, and organizations, including H.R. 112, 113, 114, and 52, and referred HCR 51 to Appropriations for a study of assessor and clerk compensation. The House then processed many bills on second and third reading, with numerous measures reported favorably or amended and advanced without objection. Topics included criminal justice and public safety (including hit-and-run as a crime of violence, video voyeurism, intentional exposure to HIV, bail conditions for human trafficking defendants, and post-conviction custody rules), health and insurance matters (AI disclosure in health care, hearing aid coverage, anti-cancer medication parity, pharmacy benefit managers, Medicaid/SNAP integrity, and rare cancer treatments), education and governance (special education due process, school funding, campaign finance, public records, and legislative website transparency), and natural resources and transportation items. Several bills were substituted or renumbered, and many were engrossed and passed to third reading. Two floor debates drew extended discussion. HCR 15, urging Congress to pass the SAVE Act and require voter identification in federal elections, passed 65-32 after questions about voter roll purges and documentation requirements. HCR 14, supporting federal efforts to eliminate the U.S. Department of Education, prompted extensive debate over federal education funding, Title I, special education, student loans, land-grant institutions, desegregation oversight, and whether federal functions could be shifted to other agencies; it was adopted 59-28 with 23 coauthors. Later, HB 108, barring persons convicted of violent crimes or sex offenses from jury service, passed 68-32 after debate over jury pool size, second chances, and whether the bill would apply to civil and criminal trials. The House also passed HB 98 on penalties for unlawful release of victim information, HB 131 on custody pending appeal, HB 161 on bail conditions for human trafficking defendants, and HB 288 requiring “miscarriage” to appear alongside “spontaneous abortion” in medical records and billing.

Transcript Highlights:

• I understand the definition of contract pharmacy is different.
• is different can you just Pharmacy is different can you just briefly<00:04:41.560><c> help</c><00:04
• Thank you for that question, because Medicaid can also utilize pharmacy rebates, and then there's the
• </c><00:19:18.320><c> our</c> understand how this is benefiting our understand how this is benefiting
• </c><00:20:01.679><c> and</c> to contract with outside pharmacies and to contract with outside pharmacies

Summary: The House Standing Committee on Health Services met on March 14, 2025, and took up a committee substitute for Senate Bill 153. The substitute deleted the original bill language and replaced it with provisions from Senate Bill 14, aimed at prohibiting pharmaceutical manufacturers from discriminating against 340B covered entities and adding reporting requirements for those entities. The sponsor explained that the protections would sunset after one year, allowing lawmakers to review data by July 1, 2026, and that Kentucky would continue to follow any future federal changes to the 340B program. Members asked several questions about the scope of the reporting, including what “total operating cost” means, how duplicate discounts are prevented, whether the reporting applies only to hospitals and not federally qualified health centers, and who would receive the data. The sponsor said the reporting is intended to help the Cabinet for Health and Family Services and the Office of Health Data Analytics at LRC assess how the program is working, including charity care and community benefits, while preserving protections for rural hospitals and allowing them to continue using contract pharmacies. A representative from LRC confirmed the data would come to the General Assembly through the Office of Health Data Analytics. The committee expressed mixed views about the balance between transparency and potential burdens on hospitals, especially rural facilities. Several members said they were supportive but had reservations about the reporting requirements and the sunset structure, while others noted concerns about unintended consequences and the possibility of changes on the House floor. The committee ultimately adopted the committee substitute, approved a title amendment, and reported Senate Bill 153 with House Committee Substitute 2 favorably. The meeting then adjourned.

Transcript Highlights:

• <c> services</c><01:06:10.400><c> for</c> pharmacy benefit manager services for pharmacy benefit manager
• <01:10:53.440><c> benefits</c><01:10:54.159><c> mand</c><01:10:54.719><c> benefits</c> pharmacy benefits
• mand benefits pharmacy benefits mand benefits procurement<01:10:56.400><c> ever</c><01:10:56.880><c>
• > PBM</c> pharmacy benefit management or PBM pharmacy benefit management or PBM services.<01:11:39.840
• The pharmacy benefit manager. Singular.

Committee: Senate State and Local Government

Transcript Highlights:

• So people are seeing direct benefits at the pharmacy counter.
• It's when you go to the pharmacy.
• At the pharmacy? Yeah, at the pharmacy. Okay.
• At the pharmacy. Yeah, at the pharmacy. Okay.
• Co-pay accumulators allow insurers and pharmacy benefit managers to pocket patient assistance intended

Summary: The Assembly Health Committee heard several measures, beginning with SB 331 by Sen. Menjivar, which would require large-group health plans to cover hearing aids for children. The author and supporters described the bill as a long-running effort to address a developmental emergency and reduce out-of-pocket costs for families, while opponents were absent. Testimony from parents, advocates, medical experts, and organizations emphasized the importance of early access to hearing aids; committee members voiced strong support, and the bill was moved on a do-pass basis to Appropriations, with several members requesting to be added as coauthors. The committee then heard SB 608, also by Sen. Menjivar, to expand access to condoms in school-based health centers and related settings and to prevent barriers such as ID checks. Supporters, including students and school health advocates, argued the bill would improve sexual health and reduce stigma, while opponents from family and faith groups argued it would undermine parental authority and normalize early sexual activity. The bill was supported by committee members and moved forward on a do-pass basis to Appropriations. Next, SB 971 by Sen. Choi proposed community-based healthy aging partnerships for older adults, with testimony from the California Senior Legislature and supporters from aging and dementia organizations. The measure was described as voluntary and focused on connection, independence, and local collaboration; there was no opposition, and the committee moved it on a do-pass basis to Appropriations. The committee also heard SB 869 by Sen. Weber Pierson, which would require warning icons and statements on chain restaurant menus for beverages with very high added sugar content. Supporters framed it as a transparency and public health measure, while restaurant and beverage industry representatives opposed it unless amended, citing cost and menu-space concerns; the bill was nevertheless moved on a do-pass basis to Appropriations after a roll call vote, with some members voting no and the measure placed on call. The committee also considered SB 950 by Sen. Weber Pierson, aimed at ensuring timely coverage of FDA-approved, medically necessary treatments for early-onset Alzheimer’s disease on commercial plans. Supporters, including the Alzheimer’s Association and a patient advocate, said the bill would reduce delays and barriers to care, while health plan representatives opposed it over step therapy and utilization-management concerns. Members discussed the limited treatment window and the need for early access, and the bill was moved on a do-pass basis to Appropriations. In addition, SB 490 by Sen. Umberg would set timelines for DHCS investigations of unlicensed sober living homes and allow counties to assist if the department cannot act in time; supporters from Anaheim and a patient-brokering survivor described serious abuse and oversight gaps, while county behavioral health representatives opposed the county role as an unfunded and potentially liability-creating burden. After discussion, the bill was also moved on a do-pass basis to Appropriations. Finally, the committee began hearing SB 1037 by Sen. Weber Pierson on health insurance affordability and rate review, with supporters arguing it would tie premium increases more closely to affordability targets and public reporting; the transcript cuts off before the committee completed action on that measure.

Transcript Highlights:

• Yet despite these clear benefits, biosimilar uptake remains relatively low.
• And so he's somebody that could benefit from lung cancer screening.
• Co-pay accumulators allow insurance and pharmacy benefit managers...
• Co-pay accumulators allow insurance and pharmacy benefit managers to pocket patient assistance intended
• It's directly between the patient and the pharmacy and the drug company.

Summary: The committee heard several health-related bills, beginning with SB 1124, which would require the California Department of Public Health to create and post lung cancer screening eligibility signage at tobacco point-of-sale locations. The author and supporters said the bill is intended to raise awareness of a screening that many eligible Californians do not know exists; retailers raised concerns about signage size, distribution, and notice to stores. The bill was presented while the committee lacked quorum, so no vote was taken at that time. Members then heard SB 1150, which would require clearer patient notice when cancer cases are reported to the California Cancer Registry. The author and committee chair emphasized patient awareness and privacy, while registry and university stakeholders said they appreciated the amendments and would continue working on the language. SB 1400 followed, proposing changes to Alameda Health System governance to give Alameda County more flexibility and direct oversight; county and labor supporters said the current structure is too rigid for today’s health care environment, and no opposition was heard. The committee also heard SB 1094, which would expand substitution of biosimilars and generics to lower prescription drug costs. Supporters, including health plans and Sharp Health Care, said the bill would reduce premiums and out-of-pocket costs, while opponents from biotechnology and rheumatology groups raised concerns about pharmacist substitution, patient switching, and therapeutic equivalence. After quorum was established, SB 1094 passed 6-0 and was re-referred to Appropriations. The committee then heard SB 1314, which would create a statewide definition for smoke shops, impose a 600-foot buffer from sensitive sites, and restrict nitrous oxide sales; it drew broad support from local government, pediatric, and law enforcement groups and passed 6-0 on call. SB 1309, which would eliminate cost-sharing for medically appropriate lung cancer screening follow-up care, also passed 7-0 and was re-referred to Appropriations after testimony from clinicians, advocates, and insurers. Finally, SB 1199 was introduced to ban copay accumulators, with the sponsor and author arguing it would ensure patient assistance counts toward out-of-pocket maximums and improve medication access.

Transcript Highlights:

• And then you have to try and find an independent pharmacy.
• I have a special-needs child, and not every pharmacy does carry everything.
• And then you have to try and find an independent pharmacy.
• I have a special needs child, and not every pharmacy does carry everything.
• And I've literally gone between two pharmacies on the same street.

Summary: The committee took up a large health and human services agenda and first approved HB 711, the Spectrum Alert bill, which would create a statewide alert system for missing autistic children and require FDLE to coordinate training with state and local agencies. The measure drew a supportive waiver from the Florida Smart Justice Alliance and passed unanimously, 24-0, reported favorably. Members then considered CS for HB 229 on health facilities, which modernizes the Health Facilities Authority Act to allow additional nonprofit health system structures to use tax-exempt financing. Two amendments were adopted: one requiring advance notice, public hearings, and stakeholder notifications before a nonprofit hospital closure, and another removing a property tax exemption for a nonprofit hospital that closes and fails to maintain emergency services for 120 days, applied retroactively to January 1, 2025. The Florida Hospital Association opposed the amendments, citing workforce and nonprofit-status concerns, but the bill as amended passed 24-0. The committee also approved CS for HB 1405 on juvenile justice status offenders, expanding early truancy intervention, parent involvement, and shelter placement review timelines; it passed 24-0. CS for HB 27, joining the Social Work Licensure Interstate Compact, and its linked public records bill CS for HB 29 both passed unanimously after supportive testimony from several advocacy and business groups. The committee then debated HB 111 on out-of-network referrals and HB 1083 on patient access to records. HB 111 would require referring practitioners to inform patients in writing when a referral is out of network and to apply out-of-network payments to deductibles; it drew opposition from medical groups over administrative burden and patient-care concerns, but passed 17-8. HB 1083 would shorten the time for producing medical records to 14 working days and standardize access rules, with amendments clarifying portal access and delaying the effective date to January 1, 2026; despite opposition from some health information and provider groups over HIPAA and access concerns, it passed 19-7 as amended. Later, the committee approved HB 883, allowing autonomous practice for psychiatric nurse practitioners with the required credentials, after strong support from nurse practitioner groups and opposition from psychiatric and medical associations; it passed 23-3. HB 1297, which aligns Florida’s electronic prescribing exceptions with federal law and removes several state exemptions, passed 19-7 despite opposition from hospice, emergency physician, rheumatology, and medical groups concerned about paper prescriptions in emergencies and hard-to-find medications. HB 1353 on home health care services and CS for HB 989 on foster home licensure transfers both passed unanimously after supportive amendments. The committee also heard HB 1505 on parental rights, which would require written parental consent for many health care services, surveys, and biofeedback devices for minors and expand parental access to records; the bill drew extensive support testimony but also questions and concerns about confidentiality, abuse reporting, and existing exceptions, and the transcript ended before a final vote on that bill.

Transcript Highlights:

• Employee Benefits process.
• Benefit mandate is considered a benefit outside of the benchmark plan.
• to a pharmacy, full disclosure, if you... ...pharmacy and consumer being able to go to a pharmacy.
• They talk about cost-benefit analysis, but I didn't really see benefit.
• So that one was, Benefit analysis, but I didn't really see benefit.

Summary: The committee met to review the history and current treatment of North Dakota health insurance mandates, with presentations from Blue Cross Blue Shield of North Dakota, Sanford Health Plan, the Public Employees Retirement System (PERS), and the Insurance Department. The discussion focused on how mandates apply differently to fully insured, self-funded, ACA, Medicaid, and PERS plans; how the state’s benchmark plan and federal essential health benefits affect coverage; and how the existing process requires cost-benefit analysis and, for certain measures, a PERS pilot period before broader application. Presenters also reviewed the long list of existing state mandates, including provider, beneficiary, and coverage requirements, and noted that many were enacted decades ago and have not been revisited despite changes in medical evidence and treatment options. Witnesses from the carriers argued that mandates should be reviewed periodically because some are outdated, can create unintended costs, and may not align with current medical guidance. Examples cited included PSA screening, off-label drug coverage, prior authorization rules, step therapy, and cost-sharing provisions for mental health and substance use treatment. They emphasized that carriers often cover services without a mandate when supported by clinical evidence, and that mandates can shift costs to employers and employees, especially in the fully insured small-group market. They also suggested possible policy improvements such as clearer mandate definitions, better transparency around cost-benefit analyses, a regular 10-year review of mandates, and more timely submission of proposals through the interim process. PERS and the Insurance Department highlighted a recurring tension over what counts as a mandate and when a measure triggers the state’s defrayal obligation under federal law. PERS described its interim committee process, the April 1 deadline for fiscal-impact proposals, and the limited pilot program used for certain measures, noting that only a few bills have gone through the full pilot process. The Insurance Department explained that it views new benefit mandates through the lens of the ACA benchmark plan and essential health benefits, distinguishing true new benefits, such as infertility coverage, from changes to existing benefits, such as telehealth or insulin cost-sharing caps. No votes were taken on policy changes; the meeting was informational, with members asking questions about costs, applicability, transparency, and whether a periodic mandate review should be established.

Transcript Highlights:

• Vision benefit managers and vision benefit plans, to provide for legislative findings, to provide for
• Vision benefits should be simple. Vision benefits should be simple.
• For many small to mid-sized benefits, that may mean leaner benefits for them, or going without coverage
• Nick Waltz, Louisiana Compound Pharmacy Coalition.
• Louisiana Compound Pharmacy Coalition.

Bills: SCR37 , SB145 , SB237

Committee: House Health and Welfare

Keywords: informed consent, healthcare, medical procedures, patient rights, surgeon general, regulatory review, adult residential care, generators, emergency power, health safety, Louisiana Department of Health, compliance, regulations

Transcript Highlights:

• benefit manager license, and updates the pharmacy benefit manager license application form to reflect
• The agency amendment amends Section 23B to add that a pharmacy benefit manager that solely provides services
• benefit manager license, and updates the pharmacy benefit manager license application form to reflect
• The agency amendment amends Section 23B to add that a pharmacy benefit manager that solely provides services
• The agency amendment amends Section 23B to add that a pharmacy benefit manager that solely provides services

Summary: The Administrative Regulation Review Subcommittee met in August with a quorum present and approved the prior meeting minutes without objection. The committee then reviewed several regulations, generally adopting staff-suggested amendments without objection, and heard brief explanations from agency representatives on each item. The Board of Pharmacy regulations would clarify what registered and certified pharmacy technicians may do under supervision and what certified technicians may not do, while updating registration applications. The Board of Cosmetology package included changes to executive director authority, licensure and reciprocity rules, school requirements, training hours, instructor ratios, sanitation and disease-related rules, complaint procedures, and permit terms; members asked about straight razor language and the increase in student-to-instructor ratios, and the board explained that cosmetologists are not permitted to use straight razors and that the higher ratio was intended to give schools flexibility, especially for part-time students and schools with wait lists. The Occupational Therapy emergency compact regulation added four compact rules adopted in April 2025, and Senator West raised a technical question about certification requirements under House Bill 6; the agency said it had been instructed to file the regulation as submitted. The Department for Fish and Wildlife Resources presented a package covering wildlife management area rules, a northern pintail bag limit increase, reportable disease reporting, and a repeal tied to boat registration fees. After a brief explanation of the new wildlife disease reporting rule, the agency requested and received a deferral of 301 KAR 2:031 to avoid a gap while replacement language is finalized. The Economic Development Finance Authority explained an emergency regulation for the Kentucky Entertainment Incentive Program, saying it was needed because the program had become oversubscribed and because administration was shifting to a new film office and council; members also asked about certification issues under House Bill 6, and the agency said it had filed the regulation as directed. The Department of Workplace Standards emergency PPE regulation was also discussed, with members asking about HB 6 certification language, and the agency gave the same response. The Department of Insurance regulation would create a $10,000 registration fee and a $1,000 annual licensing fee for pharmacy benefit manager licenses, with an agency amendment exempting PBMs that solely serve workers’ compensation plans. Members asked how many PBMs would be affected and why workers’ compensation PBMs were carved out; the agency said there were 70 registered PBMs total, four solely workers’ comp, and that workers’ comp rates are set by statute and could not absorb the fee. Finally, the Public Service Commission’s pole attachment regulation was summarized as a broadband-expansion measure that speeds application review, increases the number of poles allowed in a single application, and shortens dispute timelines; the commission explained it grew out of earlier legislative direction and subsequent emergency amendments, and the committee adopted the staff amendment.

Transcript Highlights:

• The increase in fiscal year 2027-28 reflects the addition of new pharmacy benefit manager data to the
• Trust Fund, the Pharmacy Benefit Manager Fund, some federal reimbursement and a small portion from data
• SB 41 builds upon the previously established pharmacy benefit manager...
• SB 41 builds upon the previously established pharmacy benefit manager licensure requirements enacted
• It just seems to me, you know, pharmacy benefit managers are supposed to be adding such a great service

Summary: The Assembly Budget Subcommittee on Health heard updates on five health-related budget items. First, members reviewed state support for distressed hospitals and health facilities. The California Health Facilities Financing Authority and HCAI described the Distressed Hospital Loan Program as a lifeline for 16 hospitals, many of which remain financially strained and are expected to seek loan forgiveness rather than repayment. Speakers cited reduced contract labor, new service lines, strategic partnerships, and the reopening of Madera Hospital as signs of progress, but also warned that federal policy changes under H.R. 1 will likely increase uncompensated care and pressure emergency departments. Public commenters from hospital, dental, and consumer groups supported additional funding, including a request to refresh the program with another $300 million. The committee then heard HCAI’s update on the California Rural Health Transformation Program, a five-year federal initiative funded at $233.6 million for California. HCAI said the program will focus on rural care models, workforce development, and health technology, with grants to be rolled out on a fast timeline and all funds obligated by October 30, 2026. Members raised concerns about rural provider capacity to apply for grants, and HCAI said it will use a third-party administrator, a technical assistance center, webinars, and other supports to help applicants. HCAI also presented its budget request for the health care payments database, seeking ongoing non-General Fund support to continue operations and expand data, including pharmacy benefit manager data. The Emergency Medical Services Authority presented three budget change proposals: funding to replace disaster medical services fleet vehicles, funding for IT security work, and additional positions for HR, enforcement, and legal workload. A member also raised concern that EMSA has not yet completed the annual ambulance rate reporting required by AB 716, and EMSA said it remains committed to the requirement but lost prior funding through later budget reductions. Covered California reported that it is still finalizing its own budget, but expects a lower operating budget due to efforts to reduce baseline costs and align spending with actual expenditures; it also projected enrollment declines tied to the expiration of enhanced premium tax credits, H.R. 1, and federal rule changes, while noting that revenues may still rise because premiums are expected to increase. Finally, the Department of Managed Health Care outlined budget proposals tied to menopause coverage and education, PBM licensure and enforcement under AB 116 and SB 41, credentialing reforms under AB 1041, and prior authorization reporting under SB 306. Public testimony generally supported the menopause and PBM proposals, while also urging clearer language and attention to Medi-Cal parity. The hearing concluded after public comment, including additional advocacy for sickle cell services and rural health workforce funding.

Transcript Highlights:

• We're a pharmacy benefit manager operating and headquartered out of the state of Minnesota. proceed thank
• </c><00:48:25.079><c> benefit</c> Therapeutics we're Pharmacy benefit Therapeutics we're Pharmacy benefit
• PCMA is the national trade association representing America's pharmacy benefit managers, otherwise known
• <00:54:25.880><c> benefit</c><00:54:26.400><c> managers</c><00:54:26.880><c> otherwise</c> Pharmacy benefit
• managers otherwise Pharmacy benefit managers otherwise known<00:54:27.400><c> as</c><00:54:27.680><c

Committee: Senate Commerce and Consumer Protection

Transcript Highlights:

• the pharmacy benefit pathway, which supports timely medication administration.
• to also cover it under their pharmacy benefit.
• Health plans and insurers distinguish between medical and pharmacy benefits based on how and where a
• Generally, pharmacy benefits are for medications people self-administer, while medical benefits cover
• there, which is when the drug is covered under the pharmacy benefit.

Committee: Senate Health