Policy Watch: August 2026
Welcome!
Navitus is pleased to share the August edition of The Beacon: Policy Watch, our monthly update to inform our clients and consultants about legislative and regulatory developments affecting pharmacy benefits. We’re here every month to share thoughts, informed by the Navitus Government Relations and Legal teams. Our goal is to help you stay prepared and ahead of change.
Legislative updates
Alaska
- Effective January 1, 2027:
Alaska will require health insurers and self-insured government plans to reimburse telehealth services at the same rate as comparable in-person care. Plans may apply geographic payment differentials for out-of-state providers.
What it means for you:
This change reflects continued expansion of telehealth access and reimbursement parity. Plan sponsors may want to evaluate how telehealth utilization, provider contracting strategies and benefit designs could be affected by the new requirements.
Delaware
- Effective July 23, 2026:
Delaware permitted insurers to require members to try AB-rated generic equivalents, interchangeable biologics or biosimilars before covering corresponding brand-name products.
What it means for you:
The law supports broader use of lower-cost treatment alternatives and may create additional opportunities for formulary strategies that promote generics and biosimilars while managing overall drug spend.
Illinois
- Effective July 31, 2026:
Illinois extended provisions governing third-party administrators through January 1, 2037, repealed the Health Care Group Purchasing Act and updated PBM reporting requirements. PBMs must submit annual reports in a format specified by the Department of Insurance. - Effective January 1, 2027:
- Minors will have independent authority to consent to contraceptive services and supplies. Pharmacists may dispense contraceptives to minors consistent with their scope of practice.
- Pharmacists may add certain missing ancillary devices or durable medical equipment to a prescription when necessary to support appropriate clinical use of a medication.
- By January 1, 2028:
Illinois will require certain developers of advanced artificial intelligence systems to establish, publish and regularly review AI governance and safety frameworks, including transparency reporting requirements.
What it means for you:
Illinois continues to expand oversight across pharmacy, health care administration and artificial intelligence. Plan sponsors should monitor evolving compliance expectations related to reporting, reproductive health access, pharmacy practice and AI governance.
Massachusetts
- Effective July 1, 2026:
Massachusetts required Medicaid plans to incorporate enhanced PBM transparency provisions into contracts. Beginning February 5, 2027, PBMs must disclose revenue sources and financial benefits associated with their services, including rebates, discounts, fees and other forms of compensation.
What it means for you:
The legislation continues the trend toward greater transparency and reporting. Organizations participating in Medicaid programs should expect increased scrutiny of financial arrangements and contractual practices.
Missouri
- Effective August 28, 2026:
Missouri enacted protections for 340B covered entities, prohibiting certain reimbursement differentials, network restrictions and other practices related to 340B participation. Violations may be subject to regulatory penalties. - Effective August 28, 2026:
Missouri enacted several health coverage and reporting changes, including new Medicaid subrogation requirements, expanded reporting obligations for multiple-employer self-insured health plans and additional coverage requirements. - Effective January 1, 2027:
Health plans covering self-administered hormonal contraceptives will have to allow members to obtain up to a one-year supply. Plans also will have to cover medically necessary home blood pressure monitors for pregnant and postpartum women. - Effective July 1, 2028:
Carriers will have to implement electronic prior authorization capabilities integrated with e-prescribing and electronic health record systems, including real-time patient cost information. Carriers that fail to maintain these capabilities may lose the ability to require prior authorization for prescription drugs.
What it means for you:
Missouri continues to be highly active in pharmacy and health care regulation. The state’s actions reflect growing emphasis on electronic prior authorization, reproductive health access and protections for 340B providers. Plan sponsors should evaluate the potential impact on administration, network management and compliance strategies.
New Hampshire
- Effective August 31, 2026:
Health plans must provide 60 days’ notice before formulary removals, unless the U.S. Food and Drug Administration determines a drug is unsafe. Plans must also maintain records documenting formulary and maximum allowable cost (MAC) list changes. - Effective January 1, 2027:
- Entities regulated by the Insurance Commissioner must respond to document requests within 10 working days or face potential penalties. Utilization review entities must provide prior authorization information upon request.
- New pharmacy contract requirements establish standards related to claim adjudication, utilization review compliance, MAC list administration and pharmacy audit procedures. Penalties for violations may reach $5,000 per occurrence.
What it means for you:
These changes reinforce transparency and accountability across formulary management, utilization review and pharmacy contracting. Organizations should evaluate notice procedures, recordkeeping practices and pharmacy network agreements to ensure readiness.
Regulatory Updates
Colorado
- Effective September 30, 2026:
Carriers must cover FDA-approved PrEP medications and related services without member cost sharing. The regulation also limits the use of utilization management tools, including prior authorization and step therapy, which could restrict access to PrEP therapies.
What it means for you:
The rule supports expanded preventive care access and may require benefit design adjustments to ensure compliance with coverage and utilization management requirements.
Kentucky
- Effective June 16, 2026:
Kentucky established standards governing interchangeable drugs and biologics, prescription refills and pharmacist authority to dispense preferred therapeutic alternatives in certain circumstances. The regulations align substitution practices with FDA-recognized Orange Book and Purple Book designations.
What it means for you:
The updates may influence formulary administration, pharmacy operations and member access to therapeutically equivalent lower-cost treatment options.
Maine
- Effective July 19, 2026:
Maine expanded health care claims reporting requirements by adding pharmacy-related data fields, including indicators for mail-order pharmacies and pharmacy affiliations.
What it means for you:
Health plans should evaluate data collection and reporting processes to ensure compliance with new submission requirements.
Massachusetts
- Effective July 31, 2026:
MassHealth plans must respond to durable medical equipment prior authorization requests within 15 calendar days.
What it means for you:
The requirement reinforces timely prior authorization decision-making and may require workflow adjustments for organizations supporting Medicaid populations.
Mississippi
- Effective August 1, 2026:
Mississippi revised Medicaid program integrity regulations, authorizing suspension of provider payments when credible allegations of fraud exist.
What it means for you:
The regulation highlights continued emphasis on program integrity and fraud prevention efforts within Medicaid programs.
Nevada
- Effective July 1, 2026:
Nevada expanded its list of Schedule I controlled substances to include certain synthetic opioids and related compounds.
What it means for you:
Organizations should monitor formulary, compliance and utilization management considerations related to evolving classifications for controlled substances.
Ohio
- Effective August 1, 2026:
Ohio updated workers’ compensation pharmacy regulations to establish formulary-based reimbursement standards and permit reimbursement of certain initial medication fills before eligibility determinations are finalized.
What it means for you:
The changes are intended to improve timely access to appropriate medications while maintaining formulary oversight within the workers’ compensation system.
Oklahoma
- Effective September 1, 2026:
Use of certain 340B-purchased drugs for Medicaid members is restricted in specific circumstances. These include selected high-cost therapies and drugs subject to value-based arrangements.
What it means for you:
Organizations serving Medicaid populations should review 340B-related operational and reimbursement considerations associated with these restrictions.
Oregon
- Effective in July and August 2026:
Oregon adopted multiple regulatory updates affecting Medicaid prior authorization requirements, language access reporting, health plan standards, hormone therapy coverage requirements and PBM licensing administration.
What it means for you:
The state’s continued activity reflects a broad focus on access, transparency and regulatory oversight. Plan sponsors should monitor operational impacts related to reporting, benefit administration and pharmacy management.
West Virginia
- Effective June 30, 2026:
West Virginia adopted new plan documents and summary plan descriptions for the state employee health plan.
What it means for you:
While focused on the state employee program, the update illustrates the ongoing evolution of plan governance and member communication requirements.
Legal Updates
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What it means for you:
Other Updates
Continued state focus on transparency and PBM oversight
States continue to advance policies governing reporting, formulary management, 340B participation, electronic prior authorization and member access to preventive and reproductive health services. Several states are also addressing emerging technologies such as artificial intelligence through governance and transparency requirements.
What it means for you:
Plan sponsors should expect continued regulatory momentum around transparency, reporting obligations and technology-enabled benefit administration. Maintaining flexibility in compliance, contracting and operational processes will remain important as state requirements continue to evolve.
Closing thought
State policymakers continue to shape the future of pharmacy benefits through expanded oversight, transparency initiatives and access-focused reforms. The pace of change remains significant. Navitus remains committed to helping you navigate this complexity with clarity and confidence. If you’d like to discuss how any of these updates may affect your plan or members, please contact your Navitus representative.
Thank you for reading The Beacon: Policy Watch. We’ll see you next month.
This newsletter is for educational purposes only, and it may not contain all laws enacted throughout the country. It should not be used as a primary source, and it is not legal advice intended to substitute for legal counsel. Please seek appropriate legal or other professional advice before taking any actions related to subject matter discussed here.
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