State health policymakers advanced drug cost and Medicaid reforms this month. Colorado received FDA authorization to import prescription drugs from Canada, projecting $46 million in savings over three years. Indiana partnered with CMS to deploy AI for pre-payment Medicaid fraud detection. Iowa auditors found PBMs collected $100 million through clawback arrangements from 2019-2021. North Carolina repealed certificate-of-need laws for rehabilitation facilities, while Tennessee's pharmacy-PBM separation law faces multiple constitutional challenges.

Congress passed comprehensive PBM reforms requiring 100% rebate pass-through to ERISA plans, detailed disclosure requirements, and Medicare Part D compensation limits to bona fide service fees. California and Colorado already adopted delinking practices, while New Jersey and Virginia introduced similar legislation. Ten states have introduced rebate pass-through bills, with federal transparency standards potentially becoming state-level requirements.