This is NOT a Messaging Bill

Symbolic, perennial, "messaging bills" are introduced in order to make a political statement, draw awareness to an issue, or appease a constituent, all without any real intention of the bill passing.

 

When advocating for accessible labeling bills be clear with the sponsor that this is NOT a messaging bill.  Eleven accessible prescription labeling state laws have been passed and every state should follow suit, because this is a life saving human rights bill. 

 

On average it has taken three introductions for bills of this nature to get passed.  If a state is on it's forth or fifth attempt, it might be time to make it clear that this is not just to make a political statement, but real change is needed.  

 

It might be time to discuss with the sponsor the barriers that are in the way so it can pass.  That may mean finding a new sponsor, or co-sponsors that have a bit more clout, talking to the committee chair directly, forming a coalition of like minded organizations in disability rights, health equity, language access, and literacy and bringing the pharmacy lobby to the table for discussions.

 

Many pharmacists and legislators initially feel like providing accessible labels is doing blind patients a favor, and it should not be mandated, especially an unfunded mandate.  But the ADA makes it clear that the government does not pay you to not discriminate.  And basic access to health information is not a favor.  

 

For a more in depth look at the "basic access is not a favor" argument read about the 2024 legislative hearing in Colorado.  https://www.staysaferx.org/2024/03/basic-access-is-not-favor-colorado-hb24.html

 

  

 

 

 

Join En-Vision America for a webinar on August 11th at 11am Eastern highlighting advocates for accessible prescription labeling, their stories, successes, and challenges. Get ideas on how to help your organization or clients get the accessibility they need. 

To Register and Learn more about the Panelists Visit:  

https://us02web.zoom.us/webinar/register/9717816433448/WN_Mc_DscjySjmMhWFLKBTTNg 

 

 

New Iowa Law Requires Audible Notifications of Accessible Labels

 

After a few amendments removing references to insurance reimbursement, the Iowa prescription labeling bill was renamed HF 2585, passed both chambers and was signed by Governor Kim Reynolds on May 19, 2026.  

 The new law states that persons who are blind, have a visual impairment or other print disability may request from their pharmacy accessible prescription drug labels, bag tags and medical guides. 

• The pharmacy will either provide access or refer patient to a pharmacy that can. 
• Accommodations must be provided at no additional cost to consumer 
• Pharmacies are allowed a reasonable development period after which they must provide access within a time frame comparable to other consumers. 
• Each April the Board of Pharmacy will publish a list online of pharmacies that provide accessibility measures
• During the adoption of rules, persons who are blind, visually impaired or print impaired must be consulted. 
• Rules should comply with the US Access Boards Best Practices.
• Rules must include provisions requiring pharmacies to give notice to the public of the accessible measures available in an audible format
• The Board must report back to the general assembly and governor after a year

  This is the first state law to specifically require audible public notice of accommodations. We don't know what that will look like when regulations are created, but most likely will mean an automated phone message, in-store overhead speaker notifications, or verbal notification at the counter.  

It is the second state law (the other being Nevada) that allows pharmacies to refer people to another pharmacy. Pharmacies will want to proceed with caution and consult with their legal counsel to make sure they are in compliance with sometimes more restrictive federal ADA and ACA Section 1557 laws as well. 

Reasonable Alternatives and Civil Progress

A patient gets a Lyft to a store with their guide dog, walks up a ramp designed for wheelchairs, enters through automatic sliding doors, into a space with overhead lighting to make it easier for people to see, with cameras that track customers and their shopping habits in aisles wide enough for a wheelchair.  

They navigate to a bathroom with a Braille sign, use a handicap stall with handrails and extra space, and finish up by washing with automated water, soap and paper towel dispensers.

Finally, the patient goes to the pharmacy counter.  There they are handed prescription medications that can either save their life, or kill them, in bottles and with paperwork they cannot read. 

There's so much right, but what's the one thing wrong with this scenario?

Since the ADA was passed in 1990 accessibility in the built environment has been integrated into the design of buildings and workflows because building codes require it and inspectors make sure the codes are implemented.

Over the last decade the pharmacy industry has implemented a variety of regulations to monitor prescribing and opioid use per customer, cleanliness and safety in compounding, and automated fill machines with inspection processes to assure their implementation.  

Why has the creation of regulations and implementation of accessible prescription labels been so slow in comparison? 

The commonly cited issue from pharmacists is the time plus money versus patients in need ratio. Even when pharmacies in Missouri and Colorado were offered grant monies to get set up to provide accessible labels, many declined saying it would disrupt their work flow or that they didn't have enough patients in need to make it worthwhile.

I think this warrants a recap of some of the civil rights principals enacted in the Americans with Disabilities Act.  Civil Rights are human rights granted to people through the civic adoption of the principals of inclusion. By definition, all civic participants need to be a part of this process for it to work. It's work we all do to make our whole society better for everyone. That being said, there are some limitations built into the ADA.

Let's look at some of these limitations.

1) Accommodation requests must be a reasonable solution to the barrier to services or full participation. The reasonability clause is always in reference to how well the accommodation overcomes the barrier; it's never about time, money or staffing.  Giving someone who says they can't see print Braille may not be reasonable if they never were taught Braille. Perhaps large print or audible labels would be more reasonable for them. A patient that is deaf-blind may need information accessible through Braille or electronic Braille display. 

2) Businesses do not need to change the fundamental nature of their business. Certainly, sending a staff member to a patient’s home to read medication labels to them would not be a reasonable accommodation. That would be a change in the fundamental nature of pharmacy services, which do not usually include home health care.  However, regular pharmacy services include, by law, the labeling of every medication bottle, so requesting an alternative accessible style label is not a fundamental alteration of services. 

3) If the accommodation requested presents an undue hardship, alternative accommodations must be provided. Undue hardship is determined on a case-by-case basis, looking at income, assets, staffing, other locations or parent company assets, etc. If the accommodation requested by the patient is reasonable, and is fundamental to the nature of their business, but the business believes it is an undue hardship, they must still provide some other reasonable alternative accommodation.  Not providing them with an accommodation that gives them equal access to the business and its services is in violation of the ADA.  If the business receives federal funds for the patient (Medicare), they are required by section 1557 of the Affordable Care Act to provide the reasonable accommodation that was requested by the patient. There is no undue burden clause in the Affordable Care Act. 

Pharmacies in states where state statute allows them to refer a patient to another pharmacy should be aware that referrals may be considered refusals to accommodate according to federal law even if they are acceptable to the state. State policy makers should take federal regulations into consideration when drafting state bills, regulations, and guidance.

Just as curb cuts, grab bars and elevators have become industry standards over the last 35 years, it's time to see accessible prescription labels standard practice in every pharmacy.  Reasonable alternatives lead to civil progress.

 

Aurora, Colorado Residents Help Create Accessible Prescription Drug Label Law

There's a new state law in Colorado that makes reading prescription drug labels easier and safer. Curtis and Peggy Chong of Aurora, Colorado helped push for the legislation, but it benefits everyone from seniors to those who speak another language. 

Is Something Better Than Nothing?

Iowa's 2026 accessible labeling bill has passed committee with some amendments and has been renamed HF 2585.  It will be eligible for a floor vote beginning Feb 24th.  

The bill requires the Board of Pharmacy to annually publish a list of pharmacies that provide accessible prescription labeling, require pharmacies to let patients know accessible labels, guides and bag tags are available, and to either provide the labels, guides and bag tags in accessible format or refer patient to another pharmacy (on the list) that can do so. The amended version took away pharmacy reimbursement by insurance and reference distance in the referral clause. 

There is one issue with this state bill: it contradicts the federal Americans with Disabilities Act which requires every business to provide equal access to services and has no provision for referring patrons to another establishment that is already providing accessibility. 

Furthermore, this bill, if passed as written, will be hard for the Iowa Board of Pharmacy to enforce.  Who will be required to provide labels and who will be allowed to refer to another pharmacy?  Either the rule will be unfairly enforced or not enforced at all. 

Those who are blind or visually impaired are already limited in their choice of pharmacy due to driving restrictions. They need to use a pharmacy that is within walking or public transportation distance or provides free delivery to obtain prescriptions independently. 

Iowans must ask themselves if they want to accept "something is better than nothing" and be told where to go?  Or fight for access for everyone at every pharmacy?  

Read ADA compliant copy of bill here:  HF2585

Find your Iowa Legislator here:  https://www.legis.iowa.gov/legislators/find

Missouri, what are we waiting for?

 

Disability rights advocates in Missouri say five to eight years is about the average time it takes to get a disability bill passed in Missouri. Could the introduction of Missouri House Bill 3211 be the ticket to accessible prescription labeling in Missouri this year?  

Representative Yolanda Young (D) has sponsored an accessible prescription labeling bill for the last five years but in a state where there is a Republican majority in both chambers it has been hard to move the bill beyond committee.  

The ADA was passed 36 years ago and the technology to do this has been around for over 25 years.  So consumers want to know: Missouri, what are we waiting for? 

 

Iowa HF 2033 Includes Health Carrier Reimbursement

Iowa General Assembly, Health and Human Services Vice Chair, Brett Barker (R, Dist 51) has introduced a new accessible prescription labeling bill HF 2033.  

HF2033 has some significant differences from the previous 2024 and 2025 accessible labeling bills which address pharmacy concerns about redundancy, timing and reimbursement:

• Allows pharmacies to refer patients to another pharmacy within a reasonable distance to provides accessible labels, bag tags and medical guides already.  
• Provides "a reasonable development period" for pharmacies before the requirement to provide accessible labels in a comparable time frame to other patients.
• The Board of Pharmacy must annually publish a list of pharmacies that provide accessibility measures on their website.
• Health Carriers/Insurance shall pay an enhanced dispensing fee to reimburse the costs associated with accessibility measures under this section

The idea of health carrier reimbursement is also a key component of Ohio's current bill HB374.

Maryland Adopts Regulations for Accessible Prescription Labeling

Effective November 24, 2026, pharmacies in Maryland will have to provide audio, digital, Braille or large print prescription labels for anyone who is blind, visually impaired or print disabled. The regulations also require pharmacies to alert patients and the public that accessible options are available.  

COMAR 10.34.43, which was finally adopted in October 28, 2025 and recently published in the Register is the end result of Maryland HB456 and SB940 (codified as Maryland statute,
Health Occ. Sec. 12-505.1 ) which passed by the legislature in 2023.  The bill was backed by the National Federation of the Blind of Maryland.

Title 10
MARYLAND DEPARTMENT OF HEALTH
Subtitle 34 BOARD OF PHARMACY
10.34.43 Prescription Labeling for Blind, Visually Impaired, and Print Disabled
Individuals

.01 Definitions.

 A. In this chapter, the following terms have the meanings indicated.

B. Terms Defined.

(1) “Bag tag” means a receipt that may contain patient demographic information, drug information, and cost which is affixed to the bag containing the prescription drug vial or package.
(2) “Blind” means:

(a) A visual acuity not exceeding 20/200 in the better eye with corrective lenses; or
(b) A visual field of which the widest diameter subtends an angle of not more than 20 degrees.

(3) “Board” means the State Board of Pharmacy.
(4) “Medical guide” means a medication guide approved by the Food and Drug Administration (FDA) as part of the prescription drug labeling for certain drugs when the FDA determines that:

(a) Patient labeling could prevent serious adverse reactions;
(b) The drug has serious risks that could affect the patient’s decision to use, or to continue to use, the product; or
(c) Patient adherence to the directions for use is crucial to the drug’s effectiveness.

(5) “Pharmacy” means an establishment holding a permit under Health Occupations Article, §12-401, Annotated Code of Maryland.
(6) “Prescription label” means a label affixed to a prescription drug vial or package that contains the information required
by State and federal laws, including any warnings or other information contained in auxiliary labels.
(7) “Print disabled individual" means an individual who cannot effectively read print because of a visual, physical,
perceptual, developmental, cognitive, or learning disability.
(8) “Visually impaired individual” means an individual who has difficulty seeing even when wearing glasses,

.02 General Requirements.

A. A pharmacy shall adopt policies and procedures necessary to ensure that a blind, visually impaired, or print disabled
individual has appropriate access to prescription labels, bag tags, and medical guides:

(1) At no additional cost to the individual;
(2) In a format through which the information is fully accessible to the individual;
(3) Within a timeframe comparable to the timeframe within which the information is provided to an individual who is not
blind, visually impaired, or print disabled; and
(4) That contains the same information provided in a standard print prescription label, bag tag, or medical guide.

B. A prescription labeling, bag tag, or medical guide alternative provided under this chapter shall be in addition to the
standard print prescription labeling, bag tag, or medical guide dispensed with a prescription drug.

.03 Prescription Labeling, Bag Tag, and Medical Guide Alternative—Requirements.

A. A pharmacist shall, upon request, provide at least one o f the following alternative formats consistent with the needs of the
blind, visually impaired, or print disabled individual:

(1) Audio;
(2) Braille;
(3) Digital format; or
(4) Large print.

B. A pharmacy shall implement policies and procedures to ensure that pharmacy staff provide verbal notice to any patient who
may be blind, visually impaired, or print disabled that alternative prescription labeling, bag tags, and medical guides are
available at no additional cost.

C. Notification Requirements.

(1) A pharmacy shall notify the public that alternative prescription labeling, bag tags, and medical guides are available for
blind, visually impaired, or print disabled individuals at no additional cost.
(2) A pharmacy shall provide the information required by §C(1) of this regulation by:

(a) Posting signage in a conspicuous location;
(b) If applicable, including the information in the pharmacy’s telephone recording; and
(c) If applicable, including the information on the pharmacy’s website .

D. The Board may take disciplinary action against a pharmacy or pharmacist for a violation of this chapter.

For Full Text: https://health.maryland.gov/regs/SiteAssets/Lists/Accordion/NewForm/10.34.43%20Maryland%20Register.pdf 

Steve's Story

 

From Arrival to Aisles: Pharmacy Support for Newcomers

 

The Minnesota Center of Excellence in Newcomer Health and doctors from the University of Minnesota presented a helpful overview and case study information to help pharmacists and providers address common medication challenges when caring for newcomers. 

Topics include:

• The triple trauma paradigm and trauma informed care 
• Building trust and understanding in western medicine practices
• Addressing potential misunderstandings though patient education
• Potential issues with as-needed medications
• Potential issues with chronic medications
• Working as a provider-pharmacy team
• Making every encounter an opportunity to educate
• Educating using prescription bottles
• Educating using pictures & videos
• Educating using teachback
• Educate using talking labels, translated labels, stickers, language line, pill boxes.

Recording

From Arrival to Aisles: Pharmacy Support for Newcomers (YouTube)

Slides

From Arrival to Aisles: Pharmacy Support for Newcomers (PDF)

ToolKit:

Improving Well-Being for Refugees in Primary Care: A toolkit for Providers
https://healtorture.org/improving-well-being-for-refugees-in-primary-care-a-toolkit-for-providers/

 

 

October is Medication Label Safety Awareness Month

October is Medication Label Safety Awareness Month.  Head over to the campaign landing page to get resources and ideas on how to get involved in this year's campaign. https://mailchi.mp/envisionamerica/mlsa2025 

The overall theme this year is "Medication Labels are not one size fits all" with weekly themes emphasizing a particular kind of accessible prescription label.   

• Week One (Oct 1-4): Medication labels are not one size fits all!
• Week Two (Oct 5-11): This label is too small! - Font Size Matters
• Week Three (Oct 12-18): I like texture! - Braille Labels Feel Great
• Week Four (Oct 19-15): Is this label too loud? - Adjustable Sound & Video
• Week Five (Oct 26-31): Lost in Translation? Not anymore! 

Medication Labels Are Not One-Size-Fits-All

 

 

 

Equitable Healthcare Through Language Access in Kansas

Earlier this year Alce Su Voz published "Enhancing Infrastructure for Equitable Healthcare Language Access Services in Kansas." This white paper gives insight into the current state of language access in Kansas hospitals and proposes several actions that state agencies.  Its suggestions and framework on how to improve language access in Kansas serves as a model for other states as well.

Here are some of the suggestions:

• Support development of institutional language access policy and procedures
• Provide reimbursed for interpreting services that are not covered under the MCOs,
• Assess the accessibility and quality of the interpreting services funded by the MCOs
• Gather data on needs and demographics using local health departments
• Create culturally-responsive educational materials
• Promoting the availability in the community of language access services at health
• fairs and community events
• Educate healthcare providers on the unique needs of specific cultural and linguistic groups present in their region
• Oversee state Medicaid and contracted MCOs compliance with the new Section 1557 regulations including Section 1557 coordinators, information in the top fifteen languages, and providing qualified interpreters.
• Expand outreach to Medicaid enrollees about the availability of language services
• Provide financial support for interpreter training and certification
• Programs to build a statewide workforce of qualified interpreters so jobs stay local,
• Ensure language access for speakers of less common languages and dialects

Read the full white paper and learn more about Alce Su Voz, their work, and resources here:
https://alcesuvoz.com/2025/02/26/read-our-white-paper/

Thanking Your Evergreen Bill Sponsors

If you find a sponsor and your bill goes nowhere, even multiple years in a row, do not give up hope. Like an evergreen tree, your bill being introduced again and again and your efforts to talk to legislators year after year, is slowly building awareness and a culture of accessibility. The most important thing you can do is thank all your sponsors at the end of the legislative session. 

What was once a novel idea slowly becomes a common place idea, and eventually will seem like something logical that should have been done a long time ago. You will get to the point where people say, "Oh, I thought that was already a law."

Getting a law passed usually requires a lot of preparatory work and several introductions.  Forming relationships, educating legislators, and influencing public opinion over many months or, more often, years, is usual.  

With some exceptions, most states only pass a few hundred of the thousands of bills introduced.  Unless you are in a state with a high passage percentage, you probably should expect to have to try several times to make progress. 

Sometimes more pressing priorities are to blame, for example, a lot of bills during COVID were put on the back burner as states rushed to pass appropriations and health safety laws. In 2025 we see a lot of states trying to shore up certain rights and appropriations that are effected by federal regulation changes.

Other times party politics are at play. A majority may simply not allow a minority sponsored bill to get to committee.  Finding another sponsor may or may not be the right solution.  If your sponsor is offended they could end up actively working against your bill when introduced by someone else. You might be able to find out who they work well with on the majority side or find a majority member to introduce a mirroring bill in the other chamber.

No matter what happens, relationship building is key and thanking your sponsors, regardless of outcome, is the best relationship builder you can perform! Use your thank you note to remind them of the importance of the cause and your hope that they will continue to pursue it in the following year.  If there was a particularly meaningful conversation or testimony, comment on what that did for you and the cause. Make them feel good about the work they did and present opportunities for future involvement with your organization or events.

Don't forget to thank your grassroot members too!  Their calls always help to build awareness and support.  

 

 

 

Reprint of NFB Colorado Press Release

  

  

ACCESSIBLE PRESCRIPTION LABELS
THE LAW OF THE LAND IN COLORADO

The National Federation of the Blind of Colorado, through its statewide office and local chapters, is eager to work with local pharmacies to help in the implementation of Colorado's accessible prescription labels law, HB24-1115. Starting July 1, 2025, pharmacies in Colorado are required to provide patients who have difficulty seeing or reading standard labels on a prescription drug container with an accessible method to read the information on the prescription drug label free of cost to the patient.

A system called ScripTalk, available from En-Vision America, places critical prescription drug information onto an RFID label that can be read out loud, either with a talking smartphone or an easy-to-operate, dedicated reading device that reads and speaks the information on the RFID label. Compared to other systems, ScripTalk is the simplest to operate and the most universally accessible. Smartphone users find ScripTalk to provide the broadest accessibility. For example, for someone who cannot hear what is spoken, the smartphone can also send spoken information to a connected refreshable Braille display. For customers who do not use a smartphone, the same information is also available using a dedicated reading device that is available to the customer on indefinite loan. This reading device is easy to learn and use.

The ScriptAbility suite of software is the heart of the system that enables pharmacies to produce accessible labels. The suite encompasses Audible, Dual Language/Translation, Large Print, Controlled Substance Safety (CSSL) and Braille labels. It is an all-in-one interface that requires minimal setup. Contact ScriptAbility at 800-890-1180.

There is an up-front cost to pharmacies to acquire and integrate the technology that creates accessible RFID prescription labels. The Colorado Department of Health and Environment operates the Prescription Accessibility Grant Program, which can award up to $1,500 to individual pharmacies. Information is available online by searching Google for "Prescription Accessibility Grant Program." To answer additional questions about this grant program or to obtain assistance, please email Maisey Lyons de Valle at maisey.lyonsdevalle@state.co.us.

Members of the National Federation of the Blind of Colorado stand ready to help pharmacies and their customers to make effective use of the ScripTalk system. Our blind members can contact patients and walk them through the use of the ScripTalk app or the ScripTalk reader. We also would welcome the chance to visit pharmacies throughout Colorado and offer free demonstrations to everyone who has an interest in ScripTalk.

For further information, contact me:

 Jessica Beecham, President

National Federation of the Blind of Colorado
2233 West Shepperd Avenue
Littleton, Colorado 80120
Phone: 303-778-1130, Extension 219
Email: JBBeecham@gmail.com

 

Outreach Ideas:

1. Hand carry the flyer to our pharmacy.
2. Hand carry the flyer to our doctors and dentists.
3. Email the flyer to our doctors and dentists.
4. Hand carry the flyer to our local Senior centers and facilities. Ask them to post it on their bulletin boards and ask to speak at any meetings at the centers to educate and explain what access to prescriptions means.
5. Submit the flyer or an article based on the flyer to 55 plus community newsletters.
6. Hand carry the flyer to organizations, non-profit organizations, and government programs that work with non-English speaking populations.
7. Hand carry the flyer to Urgent Care facilities.
8. Ask our pharmacies to let us have a table for a few hours to show off our ScripTalk and other options.
9. Email the flyer to our “sighted” friends and family who may need a little more help reading the prescription labels on their medications.
10. Reach out to the deafblind community about the new law and provide information about how people who are deafblind can get Braille information from the ScripTalk system even though speech is the primary way in which it provides information.
11. Send the flyer to other disability advocates.
12. Send the flyer to our state legislators.
13. Send the flyer to independent living centers and other Assisted Living facilities.
14. Send and hand carry the flyer to Immigration Assistance programs.
15. Send the flyer to our city council members and mayor and ask to present at the next city council meeting.
16. Bring the flyer to your church and ask for it to be distributed to all parishioners.