Weekly StateVitals Update: Volume 28 (July 14, 2025)

California

• Assembly Committee Passes PBM Reform. This past week, the Assembly Health Committee voted 14 to 0 to pass SB 41. The measure would establish a licensure requirement for all pharmacy benefits managers (PBMs) operating within the state and require them to disclose certain information about their business practices. The bill would also prohibit PBMs from steering patients to affiliated pharmacies, prohibit spread pricing, require that the PBM pass through all negotiated drug rebates to payers or patients, prohibit PBMs from negotiating exclusive arrangements with manufacturers, and establish limitations on fees for services, among other provisions. The California Pharmacists Association is the primary driver of the measure and the measure is now set to be considered before the Assembly Judiciary Committee. The bill previously passed the full Senate in late May. 

Florida

• Governor Vetoes Nursing Education Measure. Governor Ron DeSantis (R) recently vetoed HB 1427, citing it as an administrative and bureaucratic overreach. Notably, the bill would have authorized the state’s Board of Nursing to approve and provide oversight of nursing education programs. For instance, the bill authorizes the Board of Nursing to take adverse actions against programs in the United States when making decisions about program approvals. Such adverse decisions also would have implicated students with degrees from those institutions who may be subject to further review upon licensure application. In his veto message, the Governor noted that he believes such a policy will deter acceptance rates into programs, diminish training quality and hinder the state’s ability to recruit and maintain the necessary nurse workforce. 

Missouri

• Circuit Court Judge Reimposes Preliminary Injunction on State’s Abortion Restrictions. Jackson County Circuit Judge Jerri Zhang issued a new order recently that provides a preliminary injunction on the state’s abortion ban and a hold on various other laws related to abortion. Such laws have been the center point of litigation after Missouri passed a constitutional amendment protecting access to abortion services in 2024. Some of the author laws that have an injunction placed on them include a 72-hour waiting period for abortion care, abortion facility licensure requirements, and a requirement that physicians performing abortions have privileges at certain hospitals within a specified distance or time of where an abortion is provided. Notably, the Circuit Court had to reimpose these injunctions after the Missouri Supreme Court in May found the wrong standard had been applied when issuing the original injunctions. Of note, the preliminary injunction did not apply to medication abortions.  

Montana

• SCOTUS Declines Petition from Montana on Parental Consent Law. This past week, the Supreme Court of the United States (SCOTUS) declined a petition from the state of Montana which sought to revive a 2013 law that required minors seeking abortion services to obtain parental consent. In its two-page decision, the Court noted that it declined to take up the petition due to technicalities in procedure and not due to the substantive argument itself. The 2013 law was originally declared unconstitutional by the Montana Supreme Court in 2024 citing minors’ privacy rights. It was originally a unanimous supreme court ruling at the state level. However, in its decision, SCOTUS noted that this case is merely a poor vehicle to determine the question at hand as to whether states may require parental consent prior to the performance of abortion services and this should not be considered a closed door to consideration of a future argument. 

• DPHHS Initiates Public Comment Period on Proposed Concept for 1115 Application for Work Requirements. The Montana Department of Public Health and Human Services (DPHHS) has initiated a state public comment period on a proposed concept for a 1115 Medicaid Demonstration Waiver application that would seek to implement community engagement and cost sharing requirements for the state’s Medicaid expansion population. While the application has yet to be drafted, it intends to implement requirements in accordance with state law passed in 2019.  If the application adheres to the 2019 law, it would for work requirements entail 80 hours of community engagement activities each month for individuals between the ages of 19 and 55, with a broad exemption list from those requirements. For cost-sharing requirements, it would establish a requirement of an annual premium that is capped at 2 percent of an enrollee’s income in the first two years and increased by 0.5% in each subsequent year to achieve a maximum of 4 percent. DPHHS intends to submit a draft application for a 30-day public comment period at the state level beginning in mid-July. 

New York

• Governor Hochul’s Administration Announces New Network Adequacy Rules are Effective. Effective at the beginning of July, new network adequacy rules will go into effect that have significant implications for commercial insurers and their enrollees. Notably, the new regulations:

  • Establish standard wait times of 10 business days or less for initial appointments, in addition to other appointment wait time standards for behavioral health services. 

  • Requires insurers to assist enrollees in accessing in-network providers or allow enrollees to access an out-of-network provider who can meet certain standards, inclusive of the in-network cost-sharing rate. 

  • Requires insurers to maintain updated directors, inclusive of information pertaining to provider affiliations with facilities and their scopes of services. 

  • Requires insurers and Medicaid MCOs to submit to the state an annual certification regarding their access plan that includes a collection of data and monitoring of its behavioral health network.

  The Department of Health has finalized identical regulations for HMOs, inclusive of Medicaid MCOs and similar goes into effect as of this July. As highlighted in the FY26 budget, the Governor successfully received an investment of $1 million for implementation into these and other regulations that intend to add new surveillance and monitoring of insurers.  

Maine

• Governor Opts to Hold Enrolled Healthcare Bills Until Next Session. Governor Janet Mills (D) has opted to postpone her decision on whether to sign or veto 61 bills that the Legislature enrolled this past session. The Governor can hold onto these bills until lawmakers reconvene in January 2026. When they do, the Governor will have three days to either sign, veto or allow the bills to become law without her signature. As part of the 61 bills, a few healthcare bills of note are included. For instance: 

  • LD 245: Implementing recommendations of a blue ribbon commission to study emergency medical services in the state. 

  • LD 587: Requiring school boards to adopt a policy on automated external defibrillator access at school-sponsored athletic events.

  • LD 697: Directing the Maine Prescription Drug Affordability Board to assess strategies to reduce prescription drug costs and take steps to implement reference-based pricing in the state. 

  • LD 858: Ensuring that behavioral and mental health services are available to students by providing grants to schools that contract for those services. 

North Carolina

• Governor Signs PBM Reform into Law. This past week, Governor Josh Stein (D) signed SB 479, the Supporting Community Retail Pharmacies and Improving Transparency (SCRIPT) Act, into law. The bill takes a number of steps to limit certain practices by pharmacy benefits managers (PBMs) and enhance oversight of authorized practices. Notably, the bill will require the licensing and regulation of pharmacy services administrative organizations, require PBMs to act as a fiduciary in all of their contractual dealings, requires consistent reimbursement levels for affiliated and non-affiliated pharmacies, and ensure that pharmacy of choice provisions in existing law for consumers apply to PBM activities, among other provisions. The bill also places a requirement on drug manufacturers to notify interested parties about price increases. The bill had passed unanimously through both chambers on its final version.

Texas

• Governor Issues Special Session Agenda. This past week, Governor Greg Abbott (R) issued a necessary proclamation that identifies the 18 agenda items that the Legislature will consider when they convene for a special session on July 21. Related to healthcare, the Governor has listed “legislation further protecting unborn children and their mothers from the harm of abortion.” It’s possible the Governor wants to have the Legislature reconsider SB 2880 that failed to advance at the end of session this year. The bill would have expanded existing law that provides for a private enforcement mechanism against anyone that mails or distributes abortion pills within state or through state boundaries, inclusive of manufacturers. Under this bill, it would have allowed a private right of enforcement to sue for up to $100,000 for anyone who manufactures, mails or delivers abortion pills to or for someone in Texas. Notably, the bill also would have extended the statute of limitations for an abortion-related wrongful death case to six years and place legal liabilities on both the court system and petitioning attorneys for challenging the law. 

  The Governor has also authorized the issue of prohibiting the use of taxpayer funded organizations to hire lobbyists to lobby the Legislature to be up for consideration. While past efforts in Texas have been focused on local governments and school districts, it’s unclear whether such eligibility would also apply to organizations whose membership largely accepts Medicaid dollars. 

Wisconsin

• Governor Evers Signs Budget into Law with Healthcare Implications. Heading into the July 4th Holiday, Governor Tony Evers (D) signed the state budget into law with some noted partial vetoes. The $111 billion spending plan for the next two fiscal years was a compromise largely reached between the Legislature and the Governor’s office despite 4 republicans and 10 senators in the Senate voting against the final package. From a healthcare perspective, the significant inclusion was an increase in the state’s hospital provider tax on hospitals from 1.8 percent to 6 percent with the intent to draw down additional federal Medicaid funds prior to federal limitations on provider taxes taking effect in future years. It’s expected to raise $1.5  billion additional Medicaid dollars.