According to a report by the National Conference of State Legislators, “Last year, state legislators across the nation introduced at least 875 prescription drug-related bills,”.

The NCSL lists four of the major legislative trends and top on the list is reforming the 340B Drug Pricing Program. This effort is designed to provide safety nets to public hospitals and clinics that serve local low-income patients, by giving them access to manufacturers’ discounts on outpatient medications. Some 19 states enacted 22 bills related to this program in 2025, according to the NCSL. At least 13 more may be taking actions in 2026.

Writes the NCSL, legislative actions on this front, include:

• Ensuring patients have access to 340B pharmacies. For example, according to the report,  “Maine and Oklahoma now require that pharmacies participating in 340B receive the same reimbursement amounts as nonparticipating pharmacies. In addition to network protections, Arizona prohibits third parties from imposing additional fees, assessments or clawbacks on 340B pharmacies. Rhode Island banned pharmacy network exclusion based on 340B participation.”

• “Participating 340B pharmacies may dispense medicines to patients and extract savings from either 340B discounts or Medicaid rebates, but not both. To demonstrate program compliance, 340B pharmacies must report certain cost and pricing data to the Centers for Medicare & Medicaid Services through state agencies. CMS then conveys that information to manufacturers for Medicaid rebate disbursement, and to ensure duplicate discounts do not occur.”

• “To ensure 340B entities are provided up-front discounts, supply chain entities in New Mexico and South Dakota may no longer require 340B claims or utilization data before providing reimbursement. Bills in at least 11 states so far this year propose similar restrictions.”

Other issues that the NCSL points to as centerpieces of many state legislative agendas include: improving transparency and oversight; reforming pharmacy benefit managers and lowering consumers out-of-pocket costs.

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