CMS released an interim final rule requiring Medicaid beneficiaries ages 19-64 to complete 80 hours monthly of work or qualifying activities starting January 1, 2027. While exemptions exist for pregnant individuals, caregivers, and medically frail beneficiaries, experts warn the narrower medical frailty definition could cause coverage losses. The rule is effective July 31, 2026, with public comments accepted through that date.

Nine states have established Prescription Drug Affordability Boards to control drug costs, but implementation has proven complex and lengthy. Virginia's Governor Spanberger vetoed PDAB legislation citing ineffectiveness and high costs. Maryland, Colorado, Washington, and Minnesota have authority to set upper payment limits, though none have taken effect. Colorado finalized its first UPL in October 2025, effective January 2027. New Hampshire repealed its PDAB, while Louisiana passed limited transparency-focused legislation.

Colorado's Prescription Drug Affordability Board became the first state to set an upper payment limit on prescription drugs, establishing a $600 cap per unit for Enbrel effective January 2027. The state reviewed five drugs, finding three unaffordable. Nine states now have PDABs, with four authorized to set payment limits. The action faces ongoing litigation challenging constitutional grounds, with outcomes potentially impacting other states' affordability programs.

Attorneys general are expanding their influence over health policy through opioid settlements, PBM reform, and Medicaid oversight. The Purdue/Sackler settlement yielded $7.4 billion effective May 1. Bipartisan coalitions of 39 and 45 attorneys general advocated for PBM reforms. Republican attorneys general challenged FDA mifepristone regulations, with Louisiana's litigation prompting Fifth Circuit action. Texas and Florida launched Medicaid fraud investigations and task forces.

Nebraska became the first state to implement Medicaid work requirements on May 1, 2026. North Dakota's 340B pharmacy law was ruled unconstitutional, the second such ruling favoring drug manufacturers. Tennessee enacted legislation allowing Ballad Health's Certificate of Public Advantage to expire in June 2028 despite FTC warnings. Virginia legislators unanimously rejected Governor Spanberger's amendments delaying Medicare Maximum Fair Price controls.

The U.S. Supreme Court will decide by May 14, 2026, whether to reinstate mifepristone's in-person dispensing requirement nationwide, potentially reversing the FDA's 2023 change allowing telehealth prescriptions and mail distribution. Louisiana's lawsuit challenges this change, with courts finding the state likely has standing. Republican attorneys general from multiple states have filed cases targeting the FDA and out-of-state abortion medication providers, intensifying conflicts with Democratic states' shield laws.

Tennessee's HB 1959, prohibiting PBM pharmacy ownership, passed the House Insurance Committee 16-3 and advances to Government Operations Committee. House Speaker Cameron Sexton co-sponsored the bill citing anti-competitive concerns. Oklahoma's HB 3538 unanimously passed committee with similar restrictions but includes exceptions for rare and orphan drugs, awaiting full House vote. Similar legislation is pending in seven additional states.

Virginia's Senate passed legislation to establish a Prescription Drug Affordability Board with upper payment limit authority, with similar House legislation pending under new Governor Abigail Spanberger. Four states currently have PDABs with UPL authority. Colorado became the first to set a UPL in October, effective January 2027, using Medicare's maximum fair price as the benchmark, though legal challenges remain ongoing.

Despite a December 2025 White House Executive Order threatening to cut BEAD Program funding for states with comprehensive AI oversight, nine states including Alabama, Hawaii, Indiana, Mississippi, Oklahoma, Rhode Island, Tennessee, Virginia, and Vermont have introduced 2026 legislation restricting insurers' use of AI in coverage decisions, with federal review expected by mid-March.

States enacted significant pharmacy benefit manager reforms in 2025, with Arkansas implementing the nation's first PBM-pharmacy ownership ban despite facing legal challenges. Massachusetts passed comprehensive licensing requirements, while Colorado and California adopted "delinking" laws prohibiting PBM compensation tied to drug prices. Utah mandated rebate pass-through mechanisms. These diverse approaches reflect growing bipartisan momentum toward curbing PBM practices affecting independent pharmacies and drug pricing transparency.

Following September 2025 federal restrictions limiting COVID-19 vaccine eligibility to adults 65+ and high-risk individuals, 18 states implemented protective measures including executive orders allowing pharmacy administration without prescriptions. Regional alliances like the West Coast Health Alliance and Northeast Public Health Collaborative emerged, while Florida moved to eliminate school vaccine mandates. The bipartisan Governor's Public Health Alliance launched October 15 with 15 governors coordinating responses.

Texas and Louisiana pursued legal action against out-of-state abortion providers while enacting laws allowing private citizens to sue those providing abortion medication. Six blue states responded with protective measures allowing facilities rather than individual clinicians on prescription labels. Emergency abortion clarifications passed in Arkansas, Kentucky, Tennessee, and Texas, while Colorado, New York, Washington, Massachusetts, and Connecticut codified federal emergency care protections into state law.

Delaware legislators introduced SB 213 eliminating hospital budget oversight authority, while Florida faces court-ordered Medicaid termination pauses after constitutional violations. North Carolina's certificate of need laws face ongoing legal challenges, and New York Governor Hochul proposed $71 million in healthcare investments including mental health licensing reforms. Utah became the first state implementing AI prescription renewals for chronic conditions.