Policy Watch: September 2026
Welcome!
Navitus is pleased to share the September 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
California
- Effective January 1, 2027:
California enacted legislation that aligns the state’s scheduling of testosterone and dihydrotestosterone with federal controlled substance classifications. If federal authorities move these drugs to a less restrictive schedule, California’s classification will automatically follow.
What it means for you:
The change is intended to maintain consistency between state and federal controlled substance requirements. Organizations should monitor any future federal reclassification activity, as it could affect prescribing, dispensing and formulary management practices for these therapies.
Delaware
- Effective August 31, 2026:
Delaware now requires health plans to cover medically necessary HIV prevention medications, including pre-exposure prophylaxis (PrEP)and post-exposure prophylaxis (PEP), without member cost sharing. The law also limits the use of prior authorization, step therapy and other barriers that could delay access.
What it means for you:
This legislation reflects a broader trend toward expanding access to preventive therapies. Health plans may need to review benefit designs and utilization management programs to ensure compliance with the new requirements.
Illinois
- Effective August 7, 2026:
Illinois enacted new protections for entities covered by the Medicaid 340B pricing program as well as those entities’ contract pharmacy arrangements. The law limits restrictions related to participation in 340B contract pharmacy networks and places guardrails around certain data requests, inventory management requirements and reporting obligations.
What it means for you:
The legislation continues a growing national focus on the 340B program and pharmacy access. Organizations participating in or interacting with 340B entities should evaluate potential impacts on pharmacy network strategies, reimbursement arrangements and compliance processes.
Regulatory Updates
Kentucky
- For plan years beginning on or after January 1, 2027:
Kentucky established a minimum pharmacy dispensing fee of $16.31 for ambulatory pharmacies.
What it means for you:
The regulation may affect pharmacy reimbursement costs and network economics within Kentucky. Plan sponsors should consider potential impacts on pharmacy contracting and overall pharmacy benefit expenditures.
New Mexico
- Effective September 1, 2026:
New Mexico clarified that Medicaid transportation benefits generally will not cover travel to pharmacy locations, with limited exceptions for certain individuals recently released from jail or prison.
What it means for you:
While the change primarily affects Medicaid administration, organizations serving Medicaid populations may want to monitor whether transportation limitations create additional access considerations for affected members.
Virginia
- Effective September 23, 2026:
Virginia expanded its list of Schedule I controlled substances to include several additional compounds, including Nitrazolam and Methylclonazepam.
What it means for you:
Organizations should remain aware of evolving controlled substance classifications, which can influence formulary management, compliance activities and utilization oversight.
West Virginia
- Published August 21, 2026:
West Virginia updated regulations governing pharmacy reimbursement practices to align with recently enacted legislation. The rules reaffirm reimbursements tied to the National Average Drug Acquisition Cost (NADAC) and extend the regulatory framework through August 1, 2032.
What it means for you:
The changes provide additional certainty around pharmacy reimbursement requirements in West Virginia and reinforce the continued use of NADAC-based reimbursement standards.
Wisconsin
- Effective October 1, 2026:
Wisconsin designated additional synthetic opioid-related substances as Schedule I controlled substances.
What it means for you:
The update reflects ongoing efforts by states to address emerging substances of concern. Organizations should continue monitoring controlled substance scheduling changes that may affect utilization management, formulary reviews and compliance requirements.
Closing thought
States continue to play an increasingly influential role in shaping pharmacy benefit policy. From preventive care access and 340B protections to pharmacy reimbursement and controlled substance oversight, policymakers remain active in areas that can affect plan sponsors, members and pharmacy partners. Navitus is committed to helping clients and consultants understand these developments and prepare for what comes next.
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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