The FDA recently limited COVID-19 vaccine eligibility to adults 65+ and younger people with qualifying conditions, while disbanding the CDC's advisory committee. States are responding differently: Massachusetts, Nevada, and New Mexico restrict pharmacy access to FDA guidelines only, while Pennsylvania and New York expanded access through state orders. California, Oregon, Washington, and Hawaii formed the West Coast Health Alliance for independent guidance. Florida plans eliminating all vaccine mandates, including childhood school requirements.

Eleven states considered facility fee legislation in 2025 as hospital ownership of outpatient settings expands. These charges cover costs beyond provider billing but have drawn criticism from insurers as unfair markups for consumers in non-hospital settings. Key legislative trends include requiring health systems to report facility fee data to state agencies, prohibiting or limiting certain facility fees, and establishing consumer notice requirements. The push reflects growing state concern over billing practices as hospital systems increasingly acquire physician practices and outpatient facilities.

Three years after Dobbs overturned Roe v. Wade, reproductive health policy continues evolving rapidly in 2025. Missouri successfully placed a ballot measure to overturn voter-enacted abortion protections on the 2026 ballot, while Montana failed to achieve the two-thirds vote needed for fetal personhood. Interstate legal battles intensified as Texas and Louisiana attorneys general pursue cases against a New York doctor prescribing abortion pills across state lines. Emergency abortion policies split along partisan lines, with red states clarifying ban exceptions while blue states codify EMTALA protections into state law.

Oregon enacted comprehensive behavioral health reform legislation, with Governor Kotek signing bills that allocate $65.7 million for provider capacity, establish workforce recruitment programs, broaden civil commitment standards, and create youth substance use prevention strategies. Meanwhile, New Jersey focused on protecting patients from predatory practices by criminalizing patient brokering as a third-degree offense with mandatory $50,000 penalties and prohibiting deceptive marketing by addiction treatment providers. Both states' approaches reflect growing concerns about behavioral health access and quality care standards.

Alaska enacted comprehensive prior authorization reforms establishing determination timelines and 12-month approvals for chronic conditions. Illinois prohibited AI use in mental health decision-making to protect consumers and providers. Maryland's PDAB determined diabetes drugs Farxiga and Jardiance create affordability challenges and may consider upper payment limits. Massachusetts strengthened shield law protections for physicians providing abortion and gender-affirming care, preventing data disclosure and blocking cooperation with federal investigations. New Hampshire set out-of-network ambulance reimbursement at 325% of Medicare for two years.

Secretary Robert F. Kennedy Jr. canceled approximately $500 million in federal mRNA vaccine research funding, halting 22 active projects amid safety and necessity concerns from supporters. Scientists and public health leaders warn the cuts will weaken pandemic preparedness and push research talent overseas. The federal action follows state legislative trends in Kentucky, Iowa, Idaho, and Florida targeting mRNA technology restrictions, with Florida enacting protections against mRNA vaccination discrimination. Additional similar state legislation is expected in 2026 as the policy debate continues.

States are pursuing extensive pharmacy benefit manager reforms beyond traditional gag clause prohibitions and reporting requirements. Key strategies include delinking PBM compensation from drug prices (Colorado), requiring rebate pass-throughs to consumers (Utah), establishing fiduciary duties to health carriers (North Carolina), and prohibiting PBM pharmacy ownership (Arkansas). Colorado's delinking reform takes effect January 2027, while Arkansas faces legal challenges over its pharmacy ownership ban. These comprehensive approaches represent escalating state efforts to curb PBM practices.

Four governors signed significant PBM reform legislation in recent weeks, with North Carolina, Connecticut, Illinois, and Louisiana enacting comprehensive measures including rebate pass-through requirements, spread pricing prohibitions, and enhanced transparency reporting. However, legal challenges are mounting against state PBM laws. Arkansas faces three lawsuits over its pharmacy ownership ban, Iowa's reform law was temporarily blocked by federal court, and the Supreme Court declined to hear Oklahoma's case, leaving a restrictive appellate ruling in place that could impact future state PBM regulation.

States incorporated significant healthcare reforms into budget bills as sessions concluded and the new fiscal year began July 1st. California's $321 billion budget freezes Medicaid enrollment for undocumented adults starting 2026, while Minnesota eliminated coverage for approximately 15,000 undocumented adults. Florida boosted Medicaid rates for long-term care facilities by $286 million, Ohio established automatic Medicaid expansion termination if federal match drops below 90%, and Wisconsin raised hospital provider taxes to generate $1.5 billion in additional Medicaid funding.

Connecticut Governor Lamont signed comprehensive healthcare reform including mental health parity reporting and step therapy prohibitions. Iowa and Montana submitted federal waivers for Medicaid work requirements, seeking 100 and 80 monthly hours respectively. Oklahoma's Governor Stitt issued an executive order implementing "Make America Healthy Again" initiatives, including SNAP waivers to exclude soft drinks and ending public water fluoridation endorsements. Maine's legislature passed PDAB expansion legislation, but Governor Mills postponed her decision until January 2026.

Legislative sessions concluded across most states this past month, with significant healthcare legislation passing nationwide. Texas enacted bills expanding healthcare cost disclosure, modifying prior authorization, and clarifying abortion exceptions. Oklahoma's legislature overrode gubernatorial vetoes on 340B, scope of practice, and breast cancer imaging coverage. Connecticut's budget included provisions creating CDC/FDA advisory committees, codifying fluoride requirements, and limiting generic drug price increases to inflation rates.

Twenty-seven bills in fourteen states have introduced Medicaid work requirements in 2025, with Idaho, Indiana, Kentucky, and Montana enacting legislation. The House-passed reconciliation bill mandates 80-hour monthly work requirements for Medicaid expansion populations by December 2026. Five states have submitted federal waivers for approval, while Georgia seeks renewal of its existing program. The Trump administration's support has emboldened state action on this budget-cutting measure.

Arkansas faces a third lawsuit challenging its law prohibiting PBMs from owning pharmacies, with the PBM trade group PCMA joining CVS and Express Scripts in federal court challenges. Louisiana scrapped similar legislation in favor of a study bill after last-minute opposition, prompting an attorney general investigation into CVS's text messaging campaign. California and Illinois are advancing PBM reform to address budget deficits, with both states banning spread pricing and requiring rebate pass-throughs on state health plans.

The U.S. Senate is reviewing budget reconciliation legislation that would cut federal Medicaid funding to states by $800 billion over 10 years. Key provisions include work requirements, more frequent eligibility checks, and provider tax caps. The CBO estimates 7.6-10.3 million people could lose coverage, forcing states to choose between cutting services or finding alternative funding.

Following a 2024 federal court decision finding EPA's fluoride levels pose unreasonable risks to children's IQ, several states are banning water fluoridation. Utah became the first state to enact a statewide ban in March, followed by Florida in May. Additional legislation is pending in Nebraska and Louisiana. Meanwhile, over sixty communities serving 9 million people have ended fluoridation programs, despite continued support from dental and public health organizations.

State legislatures remain deeply divided on reproductive health policy in 2025. Following 2024 ballot measure victories for abortion protections in seven states, Republican lawmakers in Montana and Missouri are pushing counter-measures. States are clarifying emergency abortion exceptions amid legal challenges, while blue states codify EMTALA protections. Medication abortion faces ongoing restrictions in red states and protective measures in blue states.

States Expand Prescription Drug Affordability Boards to Combat Rising Costs

Eleven states have established Prescription Drug Affordability Boards (PDABs) to address prescription drug costs, with four states authorizing upper payment limits (UPLs) though none implemented yet. Virginia's governor vetoed PDAB legislation for the second consecutive year, while Maryland expanded UPL authority. Colorado's PDAB survived a constitutional challenge from a drug manufacturer, with the court dismissing the case in March 2025.

The ruling is significant as it maintains the viability of PDABs and UPLs as a policy solution for states to address prescription drug costs. PDABs in Colorado, Maryland, Minnesota, and Washington have UPL authority, and as they move through the process of implementing UPLs, other states will be monitoring the impact and whether it is an effective approach to lower prices for consumers.

As legislative sessions wind down across the country, attention turns to the executive branch as governors make decisions on bills passed by the legislature. In the past month, various governors have taken action on significant healthcare legislation by signing, vetoing, or allowing bills to become law.

Legislation we’re watching this month, including Certificate of Need in Mississippi, facility fees in Oregon, Medicaid reform in Indiana, and more.