Friday, December 5, 2025

ASSOCIATION NEWS

“The proposal, as drafted, could inadvertently restrict [patient] access and lead to higher long-term costs of care,” TPA wrote. “We strongly recommend a comprehensive discussion before the rule advances.”

The draft rule reduces the expectations placed on managed care organizations (MCOs) at a time when HHSC’s own reports reflect worsening network compliance and rising total cost of care. TPA asserted that MCOs should be increasing their efforts to enroll Texas pharmacies to improve their members’ access to health care in every county, and maintain fidelity to their contractual expectations.

“We are concerned that the proposed changes will result in more stores closing or, at minimum, fewer pharmacies serving Medicaid customers,” TPA wrote, noting that Medicaid patients “may face substantial delays in obtaining medications and basic health care support, running counter to both state and national conversations about strengthening rural care infrastructure.”

Additionally, TPA is securing meetings with state legislators and other elected officials to share these concerns, especially since the proposed rule appears to thwart the legislative intent of SB 760, passed by the 84th Legislature (2015), meant to strengthen network adequacy requirements and ensure enforcement.

The 2025 Symposium, titled “Health Optimization 2.0: Equity through Innovation,” brought together thought leaders to explore timely and forward-looking issues in managed care pharmacy. The event featured expert discussions, emerging research, and interactive dialogue that inform and inspire innovation in patient care and pharmacy benefit design.

The groups requested and provided proposed language that adds clarity and conciseness to the Draft Amendment to explicitly exclude from the U&C price calculation all “discounts” not determined or set by the provider pharmacy that may adjust the price for cash-paying customers, such as third-party discount cards and manufacturer coupons. The letter explains that the significant increase in discount card volume has led to substantial financial losses for pharmacies. "This trend is expected to worsen if these losses must be factored into Medicaid reimbursement rates, further limiting the availability of discounts for some of the most vulnerable uninsured and underinsured consumers," the letter says. 

On June 12, 2024, an appeals court recognized “pharmacy membership programs and third-party discount programs create their own price lists and structures and are only available to those who take affirmative action to participate in those programs and be bound by their terms and conditions.” Pharmacy groups believe the final rule must explicitly reflect this distinction.

Did you miss GivingTuesday a few days ago? Don't worry—it's not too late to participate in Funding the Future of pharmacy by supporting the Texas Pharmacy Foundation and its mission of advancing the profession of pharmacy through research and scholarships. For more than five decades, the Foundation has promoted the interests of Texas pharmacy. Donate today, then encourage your colleagues, peers, friends and family to donate as well.

The World Health Organization has issued its first guidelines for the use of GLP-1 medications such as semaglutide, liraglutide and tirzepatide for obesity management, recommending long-term use in combination with lifestyle changes. The WHO highlights challenges including cost, supply and access, urging countries to prioritize those with the highest medical need.

"These drugs are revolutionary," said TPA Past President Jobby John during an interview with Fox 7 News in Austin. "They're going to change the entire landscape, I believe, of health care."

STATE NEWS

Over the last year, most monkeypox cases in Texas have occurred in the largest metropolitan areas. However, more recent data trends suggest the spread of monkeypox virus (MPXV) to other parts of the state, including areas that had not had recent cases. Given these trends, the Texas Department of State Health Services (DSHS) is urging providers to remain vigilant in diagnosing and reporting cases. 

Texas Department of State Health Services (December 1, 2025) Shetty, Varun

The Texas Health and Human Services Commission observed National Rural Health Day by highlighting initiatives that strengthen health care in rural communities. HHSC applied for federal funding through the Rural Health Transformation Program. The program is allocating $50 billion over five years to approved states. States expect to receive notification of funding amounts on Dec. 31.

Texas Insider (November 24, 2025) Rodriguez, Gilbert

Governor Greg Abbott on Wednesday announced Stephanie Muth as the new Executive Commissioner for Texas Health and Human Services (HHS) effective January 3, 2026 upon retirement of the current HHS Commissioner for a term set to expire on February 1, 2027. Muth has served in various senior executive positions at the Texas Health and Human Services Commission (HHSC).

Office of the Texas Governor (December 3, 2025) Abbott, Greg

Texas’ massive new abortion law taking effect this week could escalate the national fight over mailing abortion pills. House Bill 7 represents abortion opponents’ most ambitious effort to halt telehealth abortions, which have helped patients get around strict bans in Texas and other states. The law, which went into effect December 4, creates civil penalties for health care providers who make abortion medications available in Texas.

The 19th (December 1, 2025) Luthra, Shefali

A new law that took effect Thursday will change how some Texans access certain medications. Among the measures going into effect is House Bill 25, which makes ivermectin—a drug once at the center of COVID-19 controversy—available over the counter without a prescription. “I do think it will have an effect in East Texas, because there is a very large population here that leans more into alternative medicine,” said Katelin Nuon, a pharmacist at Tyler Rx Pharmacy.

KYTX-TV (December 3, 2025) Aird, Auyana

NATIONAL NEWS

Legislation introduced yesterday by Senate Finance Committee Chairman Mike Crapo (R-Idaho) and Ranking Member Senator Ron Wyden (D-Ore.) would require accountability of pharmacy benefit managers that are systematically raising drug prices for patients and causing pharmacy deserts to expand. The PBM Price Transparency and Accountability Act contains the same key reforms that nearly passed last December but were stripped out at the last minute.

Senate Finance Committee (December 4, 2025)

Medicare announced negotiated price cuts for 15 high-cost prescription drugs starting in 2027, including Ozempic and Wegovy, through the Inflation Reduction Act's drug price negotiation program. The new prices, which are far lower than current list prices, are expected to save taxpayers about $12 billion and reduce out-of-pocket costs for Medicare enrollees by $685 million.

Centers for Medicare & Medicaid Services (November 25, 2025)

Pharmacies say they are worried that the Medicare Drug Price Negotiation Program may leave them with late or insufficient manufacturer refunds, and industry groups warn that reimbursement problems could push already struggling independent and rural pharmacies to cut staff, close stores or avoid stocking the negotiated drugs. Lawmakers and advocacy groups are urging the CMS and Congress to address these issues to avoid disruptions in access.

Stat (November 28, 2025) Ramachandran, Sujith

On December 1, President Trump signed H.R. 2483, which includes a critical provision permitting the American Pharmacists Association (APhA) and the Accreditation Council for Pharmacy Education (ACPE) to offer 8 hours of continuing pharmacy education training for pharmacists. This training will fulfill requirements for prescribing buprenorphine, an essential medication for treating OUD, and will ensure pharmacists maintain their DEA registration.

American Pharmacists Association (December 2, 2025)

Drastic overhauls of U.S. vaccine regulations proposed by top FDA official Vinay Prasad, M.D., have drawn harsh pushback from 12 former commissioners of the agency. The proposed changes, as laid out in a leaked memo to staffers at the agency’s Center for Biologics Evaluation and Research, would “disadvantage the people the FDA exists to protect, including millions of Americans at high risk from serious infections,” the 12 former FDA leaders wrote.

Fierce Pharma (December 4, 2025) Liu, Angus

The U.K. has secured a 0% tariff rate for all U.K. medicines exported to the U.S. for at least three years, officials said Monday, in return for the U.K. spending more on new medicines. Under the deal, the U.S. agreed to exempt U.K.-origin pharmaceuticals, pharmaceutical ingredients, and medical technology from import taxes. The Trump administration said in return U.K. drugs firms committed to invest more in the U.S. and create more jobs.

Associated Press (December 2, 2025)

More than 25,000 cases of whooping cough have been recorded in the U.S. so far this year, updated federal data shows. This marks the second year in a row with higher than usual cases, according to data from the Centers for Disease Control and Prevention (CDC). At the same time this year, around 33,000 cases reported. Cases are well above pre-pandemic levels. In 2019, about 18,600 whooping cough cases were recorded, CDC data shows.

ABC News (November 24, 2025) Benadjaoud, Youri and Kekatos, Mary

Breakthroughs in weight-loss medicine are presenting state Medicaid officials with what looks like a sure bet: Spend big now to cover the drugs and reap savings when diabetes, heart disease and cancer rates drop. States are hesitating to take it. The few states that have decided to cover GLP-1 drugs to help the nearly 40 percent of patients who are obese in the state-federal program for low-income people are finding they’re blowing holes in their budgets.

Politico (December 2, 2025) Hooper, Kelly

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Source

The content of the PTCB Billing and Reimbursement Exam will be updated on January 5, 2026. PTCB conducted a job analysis this year to identify key changes in pharmacy billing and reimbursement practice. The new exam has a greater emphasis on medical billing services offered by pharmacies, and enhanced detail and more specific examples across knowledge areas.

Pharmacy Technician Certification Board (November 25, 2025)

TRENDING NEWS

Small and mid-sized pharmacy benefit managers sense an opportunity to grow market share headed into the new year. CVS Caremark, and Express Scripts have an iron grip on the pharmacy benefits landscape, but have been embattled by government agencies, lawmakers and customers. Amid this, new PBMs and other companies have emerged promising alternatives to the standard PBM model that’s been criticized as opaque and ineffective.

Modern Healthcare (December 2, 2025) Tong, Noah

A new analysis warns that the Inflation Reduction Act could briefly boost pharmacy profits on Medicare-negotiated drugs, but those gains will disappear once drugmakers cut list prices to match the new maximum fair prices. List-price reductions will lower 340B contract pharmacy fees, weaken hospitals' objections to a 340B rebate model, and make fewer Medicare Part D prescriptions eligible for 340B pricing.

Drug Channels (December 2, 2025) Fein, Adam

The flu season is starting earlier than usual, and health experts are raising concerns about the potential for a rapid increase in cases as people gather for the holidays. The CDC reports 650,000 flu cases so far, with 7,400 hospitalizations and 300 deaths. Doctors are urging people to get vaccinated as soon as possible to mitigate the risk. The majority of flu circulating so far this season in the U.S. is the H3N2 strain, according to the CDC.

NBC News (November 24, 2025) Edwards, Erika and Ozcan, Kaan

Eli Lilly & Co. is cutting the price for introductory doses of its weight-loss drug Zepbound again, as competition heats up with rival Novo Nordisk A/S. Effective December 1, the lowest dose vial will cost $299 a month for those who pay cash, Lilly said in a statement, a discount of about $50. The next higher dose will cost $399 a month, roughly 20% less than the previous self-pay price. Lilly is also slashing the cost of higher doses by about $50.

Bloomberg (December 1, 2025) Muller, Madison

Millions of people use injectable drugs like Wegovy to reach a healthier weight. But the weekly injections aren't for everybody — or every wallet. That's why experimental pills that could achieve similar results are drawing so much attention. The medicines haven't yet won approval from the Food and Drug Administration, but the first one could get the green light by the end of the year.

National Public Radio (November 25, 2025) Lupkin, Sydney

Weight-loss drugs are coming for a new kind of customer. “You don’t need to be obese to start a GLP-1,” reads an ad from a telehealth startup, the words scrawled in icing on a cake. Another one features a slender woman excited to lose a little weight before her wedding. Yet another says patients can drop 17 pounds in two months by microdosing copycat Ozempic. They’re part of a marketing blitz that’s ramped up in recent months.

Bloomberg (November 24, 2025) Nix, Jessica and Muller, Madison

Eli Lilly and Co. has become the first health care company to reach a $1 trillion market capitalization, driven by strong sales of diabetes and weight loss drugs Mounjaro and Zepbound. The stock has risen more than 36% this year, with Mounjaro generating $6.52 billion and Zepbound $3.59 billion in the third quarter. Eli Lilly is the second nontechnology company to reach that market cap milestone in the U.S. after Warren Buffett’s Berkshire Hathaway.

CNBC (November 21, 2025) Constantino, Annika Kim and Pramuk, Jacob

In a recent large analysis, researchers found that physical side effects, including quick weight gain, significantly increased heart rate or elevated blood pressure, may be more common than once thought, depending on the drug. The review analyzed results from 151 clinical trials and 17 reports from the Food and Drug Administration, involving about 30 different prescription drugs used to treat depression, anxiety, and bipolar and panic disorders.

NBC News (November 30, 2025) Cox, David

The FDA has taken notice: direct-to-consumer (DTC) telehealth companies like Hims & Hers, Ro, and Curology are changing how patients learn about and access prescription medications. Patient prescriptions are usually filled by compounding pharmacies that partner with the DTC platform and mail personalized products directly to patients. Discussing these platforms with patients can improve patient education and reduce the risk of polypharmacy.

Vaccine Advisor (November 18, 2025) Halpern, Seraphina

Nearly one in ten U.S. adults have been diagnosed with cancer in their lifetime, a new high in Gallup's surveys dating back nearly two decades. Cancer death rates have declined in recent decades, along with incidences of certain types of cancer like lung cancer. But other cancers, notably those associated with obesity, have seen an uptick. 

Axios (November 24, 2025) Lotz, Avery

Texas Pharmacy Today
Editor: Brian Sparks, Division Director, Communications and Marketing
(512) 615-9140 • bsparks@texaspharmacy.org

Texas Pharmacy Association
RoxAnn Dominguez, Pharm.D., Chief Executive Officer
(512) 615-9147