On September 18, 2025, Governor Gavin Newsom signed AB 144, a landmark piece of legislation designed to safeguard vaccine access in California. At its core, this law establishes stability and clarity around vaccine coverage, even as federal recommendations evolve.

For independent pharmacies, AB 144 is more than just another regulation. It directly affects day-to-day operations, billing practices, patient counseling, and long-term business planning. In this article, we’ll break down what the law does, what it means for pharmacies, and the practical steps you can take now to adapt.

Key Provisions of AB 144

1. Baseline Vaccine Coverage

Insurance providers in California are now required to cover vaccines listed on the Advisory Committee on Immunization Practices (ACIP) schedule as of January 1, 2025.

2. State Authority to Supplement Recommendations

The California Department of Public Health (CDPH) has the power to modify or supplement the baseline schedule. Recommendations may come from organizations like the American Academy of Pediatrics (AAP), American College of Obstetricians and Gynecologists (ACOG), or American Academy of Family Physicians (AAFP).

3. Liability Protections

Providers—including pharmacists—who administer vaccines according to CDPH recommendations are granted liability protections through January 1, 2030.

4. Clarity and Stability

The law establishes legal certainty: vaccines covered under California law remain covered, even if federal guidance shifts.

What This Means for Pharmacies and Pharmacists

Independent pharmacies are on the front lines of vaccine delivery—whether flu, COVID-19, RSV, or new immunizations. AB 144 introduces both opportunities and responsibilities:

Insurance Coverage

• Insurers must cover vaccines on the January 2025 ACIP schedule and any CDPH modifications.
• Pharmacies should:
  • Keep billing staff updated on covered vaccines.
  • Monitor CDPH announcements for changes.
  • Confirm insurers’ compliance.
  • Adjust inventory to align with covered vaccines.

Protocols & Clinical Practice

• Flexibility is greater: CDPH can update vaccine guidance.
• Pharmacies should:
  • Subscribe to CDPH bulletins.
  • Update internal protocols regularly.
  • Train staff on newly adopted vaccines.
  • Document which recommendations they follow.

Liability and Legal Risk

• Pharmacists gain protection if they administer vaccines per CDPH rules.
• Best practices:
  • Retain vaccine records, consents, and lot numbers.
  • Update consent forms with CDPH compliance language.
  • Train staff on what “in accordance with recommendations” means.

Patient Communication & Counseling

• Patients may be confused about why certain vaccines are newly covered.
• Pharmacies should:
  • Explain the baseline ACIP requirement and California’s guarantee.
  • Share clear educational materials.
  • Set expectations around coverage and copays.

Inventory, Supply, and Planning

• Vaccine demand may increase as coverage expands.
• Pharmacies should:
  • Audit inventory against the January 2025 ACIP schedule.
  • Work with suppliers on new vaccines.
  • Plan for storage, cold chain, and staffing needs.

Billing & Reimbursement

• Insurers must comply with AB 144.
• Pharmacies should:
  • Update billing codes to align with new coverage.
  • Be prepared to appeal denied claims citing AB 144.
  • Ensure proper documentation of administration fees.
  • Train billing staff on reimbursement procedures.

Regulation & Oversight

• CDPH may introduce oversight or reporting requirements.
• Pharmacies should:
  • Keep complete, accurate records.
  • Engage with pharmacy associations for updates.
  • Anticipate audits or compliance checks.

Practical Steps for Pharmacies Now

1. Audit your vaccine offerings against the January 2025 ACIP schedule.
2. Assign staff leads to track CDPH announcements.
3. Update consent forms to reference CDPH compliance.
4. Communicate with insurers to confirm vaccine coverage.
5. Train pharmacists and technicians on schedule changes and billing updates.
6. Engage with associations like the California Pharmacists Association for toolkits and guidance.

Possible Challenges Ahead

• Implementation delays from insurers.
• Ambiguity in how CDPH supplements are enforced.
• Provider scope barriers if CDPH expands eligibility.
• Supply chain constraints for newly covered vaccines.
• Reimbursement disputes requiring appeals.
• Patient confusion, especially when federal and state guidance differ.

The Bigger Picture: Why AB 144 Matters

AB 144 represents more than a regulatory change. It’s a commitment to ensure stable, predictable vaccine access in California, regardless of shifting federal policy.

For pharmacies, it means:

• Greater certainty around reimbursement.
• Reduced liability risk.
• A stronger role in public health.

For patients, it ensures vaccines remain accessible, affordable, and guided by science.

AB 144 marks a turning point for California pharmacies. By guaranteeing vaccine coverage, empowering CDPH to adapt quickly, and protecting providers, the law positions pharmacies as key players in safeguarding public health.

Independent pharmacies that adapt quickly—by updating billing practices, training staff, and aligning with CDPH guidance—will not only stay compliant but also strengthen their role as trusted healthcare providers.Want to learn how to streamline billing, improve workflows, and maximize opportunities under AB 144? Schedule a demo with RxBB and discover how we can help your pharmacy thrive in a changing healthcare landscape.