November 2025 Pharmacy Policy Updates

Independent Pharmacy Groups Support Iowa’s PBM Regulation in Federal Court

Independent pharmacy trade groups are rallying behind Senate File 383, Iowa’s recently enacted law aimed at regulating pharmacy benefit managers (PBMs), as the measure faces legal opposition in federal court.

On October 6, 2025, the National Community Pharmacy Association, the Iowa Pharmacy Association, the American Pharmacists Association, and the Independent Pharmacy Cooperative filed an amicus brief in the US Court of Appeals for the Eighth Circuit supporting the state’s authority to regulate the PBM market.

The law, backed by Iowa’s insurance commissioner, is blocked by a lower-court injunction. It is being challenged by employer and insurance entities that contend the legislation is preempted by the federal Employee Retirement Income Security Act of 1974 (ERISA), which governs employee benefit plans. The pharmacy groups argue that PBMs act as third-party administrators rather than benefit plans themselves and thus remain subject to state oversight.

The outcome of this case will likely carry implications beyond Iowa, as numerous states have introduced or enacted laws targeting PBM business models that critics say squeeze independent pharmacies and limit patient access. The Eighth Circuit’s decision could clarify the scope of state regulatory authority in the evolving pharmacy benefits ecosystem.

REFERENCE

Independent pharmacy groups back Iowa PBM regulation in federal court. News release. American Pharmacists Association. News release. October 6, 2025. Accessed October 24, 2025. https://www.pharmacist.com/APhA-Press-Releases/independent-pharmacy-groups-back-iowa-pbm-regulation-in-federal-court

Pharmacy Sector Coauthors Guiding Principles to Streamline State Vaccine Policy for Pharmacy Personnel

On October 16, 2025, the Pharmacy-based Vaccine Access Work Group, a coalition representing 12 to 13 national pharmacy organizations, released a policy framework intended for lawmakers, regulators, and pharmacy stakeholders.

The document underscores that pharmacists, pharmacy technicians, and interns are central pillars of vaccine delivery across communities, yet in many jurisdictions, their authority remains tethered to external federal advisories, such as the CDC or FDA. Such linkage, the coalition argues, can result in legal ambiguity, reduced flexibility, and delays in state-level vaccine provision, thereby hindering timely access for patients.

Key recommendations in the guiding principles include authorizing pharmacists to prescribe, order, and administer all vaccines and to delegate administration to properly trained technicians or interns under pharmacist supervision. The document also encourages states to avoid rigid statutory references to specific vaccine schedules, calling instead for evidence-based practice empowered by the clinical judgment of pharmacy personnel. It emphasizes that eligibility definitions should be broad and age restrictions should be removed.

Another significant element of the framework deals with payment and coverage. The authors call for parity in reimbursement: Pharmacists providing vaccine services should receive payment equivalent to other health care providers, and claims should be shielded from retrospective denial when services are delivered in compliance with evidence-based standards.

REFERENCE

Pharmacy profession unites to publish guiding principles for state policy on pharmacy personnel–administered vaccines. News release. American Pharmacists Association. October 16, 2025. Accessed October 27, 2025. https://www.pharmacist.com/APhA-Press-Releases/pharmacy-profession-unites-to-publish-guiding-principles-for-state-policy-on-pharmacy-personnel-administered-vaccines

Most Favored Nation Drug Policy Aims to Lower Costs but Raises Concerns Over Access and Innovation

The Trump administration’s bid to deploy a Most Favored Nation (MFN)–style pricing model for US prescription drugs represents a watershed moment in pharmaceutical policy. Signed in May 2025, the policy directs US drug manufacturers to align prices for certain medications with those charged in other developed countries—an effort to clamp down on higher US drug costs by harnessing “global reference pricing.”

At the same time, the administration has floated sweeping enforcement tools, including tariffs and heavy negotiating leverage, with an early landmark deal struck with Pfizer to avoid full tariff exposure while agreeing to MFN-style pricing terms.

The implications fall into 2 major categories: access and innovation. On the access front, aligning US prices with lower prices abroad could deliver cost savings for payers and patients. Still, it raises concerns about downstream consequences such as supply constraints or delayed launches of medications in the US.

On the innovation side, pharmaceutical companies argue that the US market has historically shouldered higher prices in part to underwrite early-stage and high-risk drug development. Compressing US pricing toward global averages may reduce the effective returns on investment, potentially dampening the incentive to launch new therapies or invest in certain disease areas.

The MFN policy’s ambiguous design could yield meaningful price relief but also presents significant trade-offs for supply dynamics and innovation trajectories. How regulators calibrate rollout, manage manufacturer responses, and monitor real-world impacts will likely determine whether the policy enhances access while preserving a vibrant pipeline of new therapies.

REFERENCE

Nowosielski B. The Most Favored Nation drug policy’s impact on access, pharmaceutical innovation. Drug Topics. October 10, 2025. Accessed October 27, 2025. https://www.drugtopics.com/view/the-most-favored-nation-drug-policy-s-impact-on-access-pharmaceutical-innovation