February 13, 2026

We now have 445 bills in the House and 308 bills in the Senate, for a total of 753 bills introduced so far in 12 legislative days. We continue to monitor bills that could affect your practice.

Catch the short legislative updates in our social medica stories on most in-session days: 

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Bills We're Watching

SB20/HB51, Elliott/Givens, Assault in the Second Degree
These bills add public officials to current law related to assault. The updated version inadvertently removed several healthcare providers from the language, including pharmacy, but APA worked with the bill sponsors to correct the omission. SB 20 was amended in committee two weeks ago, and the amended version passed favorably out of committee. It is now awaiting a final vote in the Senate. HB51 carried over in committee and is most likely dead this session. Pharmacy will maintain existing protections if neither bill moves. No changes since the last Advocate email.

HB146, Rigsby, Ivermectin Standing Order
This legislation would allow a prescriber to provide a pharmacist with a standing order to dispense ivermectin to a patient. The standing order would contain a protocol for the pharmacist with guidelines for providing ivermectin to individuals who request it. A public hearing was held on January 28 and the bill was carried over on February 4 as work continues on this legislation. No changes since the last Advocate email.

SB100, Kelley, Board of Pharmacy Sunset Bill
This bill provides continuance to the Alabama Board of Pharmacy for one more year, until October  of 2027. The only major change transfers the at-large member nomination from APA to the two schools of pharmacy.  The bill has passed both houses and is awaiting the Governor's signature.

SB38, Givhan Governor may remove the Executive Officer of a State Board or Agency
This legislation would allow the Governor to remove from office and discharge from employment, with or without cause, any individual who is serving in the position of executive officer of an occupational or professional licensing board, except those individuals subject to the state merit system. The bill came out of committee favorably and is awaiting a vote in the full Senate.

HB220, Pringle, Appointment of Board Members
This bill essentially gives the Governor, Speaker of the House, and President Pro Tempore of the Senate the authority to replace any board member over whom one of those officials has the appointing authority. In other words, the person that appoints you can remove and replace you on a Board. The bill has passed in the House and is awaiting final vote in the Senate.

HB127, Chip Brown, Off Label Use Protection for Pharmacists and OTC Ivermectin and Hydroxychloroquine
This bill prevents retaliation against a pharmacist for dispensing or recommending a medication for off-label use. This legislation already exists for physicians and would align pharmacy protections with the medical version. The 2026 version also allows ivermectin and hydroxychloroquine to be sold OTC. Awaiting action in the house. No changes since the last Advocate email.

SB256/HB372, Beasley/Rigsby, Department of Insurance: Pharmacy Benefits Manager Division
This legislation allows the DOI to adequately staff two positions with the PBM division of the DOI. SB 256 is awaiting committee action in the Senate. HB 372 passed favorably in committee and is awaiting passage in the House.

SB247/HB391, Jones/Pringle, Insurance: to allow reorganization of a nonprofit health care service corporation under the control of a nonprofit holding company
This legislation would essentially sallow a company like BCBS to acquire a Blue plan in another state. Both have passed committee in their respective chambers but the House version was amended to restrict the holding company from purchasing a health care provider.

New Bills to Watch

SB278, Singleton, Influenza Vaccination
Requires private health insurance and Medicaid to pay or reimburse for influenza vaccinations. It is pending committee action in the Senate

On February 3, President Trump signed meaningful federal reforms to pharmacy benefit managers (PBMs) practices. The measures are part of a Department of Health and Human Services funding bill. The new law, when it goes into effect, will require the Centers for Medicare & Medicaid Services (CMS) to define and enforce “reasonable and relevant” Medicare Part D contract terms, and will give enforcement authority; promote transparency by allowing CMS to track payment trends to pharmacies and pharmacy inclusion in PBM networks; and will prohibit PBM compensation in Medicare Part D from being tied to the manufacturer’s list price of a drug in an effort to reduce drug prices and provide cost savings to patients. 

A shift in Independent and Specialty Pharmacies' favor

Fairer contract standards. PBM terms must be "reasonable and relevant," limiting take-it-or-leave-it contracts.
Network access protections. PBMs must justify exclusions and allow appeals, especially for specialty pharmacies.
More scrutiny of reimbursement. Regulators will track pharmacy payment trends, making abusive clawbacks and hidden fees harder to defend.
Timeline. PBM provision enactment will happen in steps over the next few years. Medicaid-related pharmacy pricing transparency measures are slated to start in about six months. Certain Medicare Part D contract changes will kick in for the 2028 plan year or later. 
See the full text. The section on pharmacy and pharmacy benefit managers, including the timeline for related actions can be found on pages 494-565.
The bottom line. This is the strongest federal action yet that pharmacy access and sustainability matter.

The law won't cap drug prices or outlaw PBMs. Instead, it:

• Attacks misaligned incentives
• Forces sunlight into PBM economics

The questions asked, the requirements and goals of the study, and the stakeholders involved were decided by LSA.  This study provides a mass amount of data related to independent  pharmacies but does not include much information from other stakeholders such as chain pharmacies, PBMs, payers, employers, or insurers.

What the Study Is

Alabama’s LSA commissioned an independent study to assess how Pharmacy Benefit Managers (PBMs) affect drug costs, patient access, and pharmacy viability—and to inform implementation and next steps around SB 252 (the Community Pharmacy Relief Act).

Why It Matters

The report finds that the goals of PBMs can diverge from best patient/public outcomes in a highly concentrated, vertically integrated market—creating risks of opaque pricing, access issues, and pharmacy destabilization, especially in rural areas.

Alabama Access Picture

• Alabama licensing/mapping analysis identifies substantial “pharmacy desert” risk:
• 48% of Alabama ZIP codes have no community pharmacy.
• About 1.26 million residents (~25%) live in ZIP codes with 0 or 1 pharmacy of any type (the report’s “pharmacy desert” definition).
• 415,026 residents live in ZIP codes with ≥1 pharmacy but 0 or 1 physician location, underscoring pharmacies’ role when physician access is thin.

What Alabama Community Pharmacies Reported

Using a large, validated response set, the report finds strong, consistent reports of reimbursement stress and greater vulnerability among rural pharmacies.

• 98% reported situations where reimbursement is below acquisition cost.
• Rural vs. urban comparisons suggest lower volume and lower margin dynamics for rural pharmacies, making closures more likely when reimbursement tightens or fees increase.

SB 252: Early Read and Key Tradeoff Flagged by the Report

The report treats early observations as preliminary (timing overlaps implementation). Still, it highlights a key dynamic: if dispensing fees rise, PBMs may offset by lowering other reimbursement components—potentially limiting net relief and shifting costs elsewhere.

• The report estimates SB 252’s dispensing-fee change as roughly an $8–$10 increase per eligible Rx (effective Oct. 1, 2025) and models large annual revenue impacts depending on volume.
• Although pharmacies expect an increase in dispensing cost reimbursements, the report does not take into account decreases in drug product reimbursements associated with cost being reimbursed at Alabama’s Average Acquisition Cost (AAC). This inclusion is likely to see only a $1-$3 increase per eligible RX rather than the reported $8-$10. 
• Tradeoff: higher pharmacy payments can improve local access/viability, but may increase premiums and/or patient cost-sharing if costs are passed through. 

What the report recommends Alabama do next

1. Run a claims-based impact evaluation of SB 252 (e.g., using PEEHIP/SEHIP) to measure changes in reimbursement, dispensing fees, patient cost sharing, and access outcomes. Pharmacies can analyze their own data through this app.
2. Monitor pharmacy deserts and closures semiannually, including post-closure surveys to determine drivers and access impacts.
3. Targeted relief (not broad subsidies): tax credits/incentives aimed at pharmacies providing high access value (especially rural/sole-provider areas).
4. Increase PBM transparency + strengthen enforcement mechanics (complaints, timelines, penalties) so requirements are measurable and enforceable.
5. Address vertical integration / steering concerns via disclosures and oversight; ensure fair access to PBM-affiliated purchasing terms where appropriate.

Bottom line

APA's Legislative Priorities

The FAIR Meds Act, House Bill 238, Representative Rigsby

This legislation passed out of the House Insurance Committee with a unanimous favorable vote on March 6th before the legislature went on spring break this week. The movement on this bill has created a media firestorm of misinformation and outright lies by the opposition, along with personal attacks on Representative Rigsby and Insurance Committee members. Please let Representative Rigsby and the Insurance Committee Chair and members know how much you appreciate them for standing up for access to care for the patients in their districts and the pharmacies that serve them.

SB15/HB52 Beasley/Rigsby

This legislation allows the Board of Pharmacy to adopt rules to correct the compounding pharmacy technician ratio to match the current technician ratio allowed in other pharmacy settings. This is considered a technical fix that is necessary because the technician ratio for compounding pharmacies is currently defined in law. HB52 has passed in the House and is awaiting committee action in the Senate. The Senate version, SB15, has passed through committee in both chambers awaiting a vote in the House.

APA's Legislative Reception: A Chance to Tell YOUR Story

Combat the misinformation being spread by the opposition! Register now for the APA Legislative Reception and tell your story directly to your legislators.

Your participation and involvement directly impact our success on the Hill. To have a fighting chance, we need YOU there educating lawmakers on the TRUTH of HB238, the FAIR Meds Act. It's imperative that they interact with and hear from their own constituents, not just APA leadership. You can play a vital role in the health and well-being of your patients by being there and telling your stories.

Register now and bring the fight for patient access and open communication to Montgomery on Tuesday, March 19, 2024!

Doing My Part

In 2018, APA launched the Doing My Part Campaign with the goal of reaching a half-million dollar balance in the APA PAC each four-year election cycle. This level of funding would put us on par with the other influential healthcare organizations in our state. Please help us meet our goal and consider an ongoing gift to the APA PAC!

The FAIR Meds Act

This legislation is expected to be introduced in the House this coming week. Community Pharmacy is at a crossroads in Alabama and the FAIR Meds Act attempts to resolve the issue of pharmacies not being paid the cost of the prescriptions they are expected to dispense. There is not a business in this nation that can sell a product or provide a service at a loss and expect to remain in business. As pharmacies close, patients are losing access to the medications and the pharmacists they know and trust. The goal of this legislation is fairness and access.

What does the FAIR Meds Act do?

The items of highest priority are:

• Cost defined as an indexed based average and reimbursements based on that price plus a dispensing fee.
• ERISA exemptions removed from the current Act and this legislation would apply to all claims.
• Improved authority of the Department of Insurance to enforce the Audit Integrity Act.
• Prohibit fees associated with network participation, adjudication of claims, or change of ownership.
• Reduced restriction on communication between a pharmacist and patient.

SB15/HB52 Beasley/Rigsby: