States Remain the Drivers of New Drug Pricing Legislation As Washington Weighs In
51 min read
State legislatures continue to push forward on drug pricing with legislation designed to reduce the cost of prescription drugs. Recent steps across a number of states include laying the groundwork for effective drug-importation programs and increasing drug-pricing transparency. Change at the federal level may be coming as well, as both the White House and Congress ramp up their attention to drug pricing.
Since our last update, states remain at the forefront of new drug-pricing legislation. In 2021 alone, states debated more than 650 proposed laws (some carried over from 2020) and passed more than 30 such laws. These new state laws establish novel drug-importation programs, require pricing transparency from pharmaceutical manufacturers, mandate disclosures from pharmaceutical benefit managers (PBMs) and insurers, cap consumer cost-sharing on certain drugs, and curb discriminatory contracting in the 340B program, among other changes.
Notable among state efforts is the development of drug importation programs. For example, New Hampshire recently passed a bill that establishes a wholesale-importation program for prescription drugs from Canada to reduce the cost of prescription drugs.2 This comes two years after Colorado established its own Canadian prescription drug-importation program and is now eying additional proposals to allow the importation of prescription drugs from other countries.3 Similarly, Florida submitted its Section 804 Importation Program (SIP) to HHS in connection with its Canadian prescription drug importation program in November 2020.4 Upon receipt of FDA approval, Florida's Agency for Health Care Administration expects to start importing prescription drugs, completing the required testing, and fulfilling state agency orders. Initiatives like these will inform the legality of permitting the importation and supply of lower-cost prescription drugs from outside the United States. Industry groups, such as the Pharmaceutical Research and Manufacturers of America (PhRMA), have already sued HHS to block such drug imports.6
States have also focused on lowering the cost of prescription drugs through increased regulation of PBMs.7 In 2021, 42 states introduced more than 100 separate bills regulating PBMs. Montana, for example, passed a new law that places PBMs under additional oversight, requiring PBMs to obtain a state license and to report publically on how much money they receive from aggregate rebates in connection with certain prescription drugs and fees from manufacturers or wholesale distributors.8 Other measures regulating PBMs focus on increasing transparency, preventing certain types of spread pricing, ensuring consumers are not overpaying at the point of sale, and changing the way states contract with PBMs.9
At the federal level, recent actions by both the President and lawmakers support some of the states' initiatives and suggest momentum may be gathering for more sweeping changes. President Biden's July 9, 2021 Executive Order on Promoting Competition in the American Economy supports the importation of drugs from Canada and calls on the FDA to work with states seeking to import drugs from outside the United States. The Order also directs HHS to develop within 45 days of the release of the Order a plan to address drug pricing and includes provisions meant to increase the availability of generics and biosimilars.
President Biden re-emphasized his focus on drug pricing in an August 12, 2021 speech outlining his priorities. In that speech, he called for ending the prohibition that prevents Medicare from negotiating prescription drug prices (with a 95% excise tax to encourage manufacturer cooperation) and allowing employer-based health plans access to the prices negotiated by Medicare. He also directed the FDA to work with states and tribes to import prescription drugs from Canada safely, instructed the FDA to get generic drugs to consumers faster, and proposed spending $6.5 billion through the Advanced Research Project Agency at NIH to help accelerate cutting-edge research on how to detect, treat, and cure some diseases.10
Similarly, on Capitol Hill, lawmakers have been more active on pharmaceutical pricing issues. For example, in a July 26, 2021 letter to HHS Secretary Becerra, Senator Amy Klobuchar (D-MN) and a group of bipartisan senators called for the implementation of a Canadian importation program, stating that the safe importation of drugs from Canada "can serve as a critical solution for reducing the amount Americans pay for their prescription drugs."11 On July 29, 2021, the Senate Judiciary Committee unanimously voted to advance four bills that would make significant changes to U.S. antitrust laws. The four bills seek to prevent pharmaceutical companies from filing "sham" citizen petitions with the FDA, prohibit so-called "product hopping," target "pay-for-delay" settlements, and instruct the FTC to study the role of intermediaries, such as PBMs.12
It remains to be seen whether these recent efforts at the federal level will result in meaningful changes on drug pricing. In the meantime, state efforts to address drug pricing likely will continue. As has been the case, these state level changes increase the compliance burdens and challenges for pharmaceutical manufacturers, PBMs, and others in the distribution and payment chain.
As a continuation of previous alerts, White & Case's Pharmaceuticals & Healthcare Group has been identifying, tracking, and evaluating recent state legislation regarding drug pricing and has updated the state-by-state chart below.
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State |
Legislative Target(s) |
Category |
Act Title |
Summary of Law* |
Link to Law |
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e.g., Pharmacy Benefit Managers ("PBMs"), Pharmaceutical Company, Pharmaceutical Manufacturers, Pharmacists, Insurers, Canadian Drug Importation |
e.g., Drug Price, Transparency, Drug Affordability Review, Study, Coupons, Licensing, Substitutions |
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*These summaries do not cover every provision contained in the laws listed below. Each bill should be consulted for its full text. |
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Alabama |
PBMs |
Licensing, Drug Price, Transparency |
SB 73: Alabama Pharmacy Benefit Manager Licensure and Regulation Act |
Requires PBMs to register with the Department of Insurance and be licensed by January 1, 2020, to conduct business in the state. Prohibits PBMs from preventing pharmacies and pharmacists from disclosing the amount an individual would pay for a drug without insurance. PBMs may not require a plan member to pay more than either the contracted co-payment amount or the cash retail value, whichever is less. |
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Alabama |
PBMs |
Drug Price, Transparency |
SB 227/HB 492: An Act Relating to Healthcare |
Prohibits PBMs from engaging in certain activities, including preventing a pharmacist from sharing cost information with consumers; charging a pharmacy a point-of-sale or retroactive fee or otherwise recouping funds from a pharmacy in connection with claims for which the pharmacy has already been paid; or reimbursing pharmacies less than similarly situated PBM affiliates. This measure requires PBMs to be licensed and to prepare an annual report that discloses aggregate rebate information and whether the PBM engages in spread pricing, if requested by a health insurer client. |
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Arizona |
PBMs, Insurers |
Coupons (restricts copay accumulators) |
HB 2166: An Act Relating to Insurance Cost Sharing |
Requires PBMs and Insurers to include in any cost-sharing requirement the amount paid by either the enrollee or another person on behalf of the enrollee (e.g., through a coupon) for drugs (1) without a generic equivalent or (2) where the enrollee has authorization to use the drug instead of the generic equivalent. |
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Arizona |
PBMs |
Transparency |
HB 2285: An Act amending Section 20‑3321, Arizona Revised Statutes |
Requires PBMs, among other things, to update their maximum allowable cost (“MAC”) lists in a timely manner, to share with pharmacies the sources used to determine MAC pricing, and to establish an appeal process by which pharmacies can appeal MAC pricing reimbursement. It further bars PBMs from, among other things, prohibiting retail pharmacies from dispensing 90 prescription refills if certain conditions are met, or prohibiting retail pharmacies from offering mail delivery of drugs as an ancillary service. |
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Arizona |
PBMs |
Other |
SB 1356: Prohibition against claim adjudication process fees; civil remedies |
Prohibits a PBM from directly or indirectly, on behalf of a plan sponsor or insurer, charging or holding a pharmacist or pharmacy responsible for a fee for any step of or component or mechanism related to the claims adjudication process. |
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Arkansas |
Pharmacists |
Substitutions (biosimilars) |
HB 1269: An Act to allow Pharmacists to Make Biological Product Substitutions; And for Other Purposes |
Allows pharmacists to substitute an interchangeable biosimilar product under specified circumstances when the substitution would result in cost savings to the patient. Notice to the prescriber of the substitution within five business days is required, if requested. |
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|
Arkansas |
PBMs |
340B-covered Facilities |
HB 1881: An Act to Establish the 340B Drug Pricing Nondiscrimination Act; And For Other Purposes |
Prohibits PBMs and health plans from discriminating against 340B-covered entities and their contract pharmacies. The bill also prohibits drug manufacturers from discriminating against 340B contract pharmacies by denying access to the manufacturer’s drugs or by denying the pharmacy access to 340B pricing. |
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Arkansas |
PBMs |
Transparency, Drug Price, PBM Spread Pricing |
SB 520: An Act to clarify the State Insurance Department’s Regulatory and Enforcement Authority Concerning Pharmacy Benefit Managers; to Modify Arkansas Pharmacy Benefit Manager Licensure Act; and For Other Purposes |
Amends the required appeal process for pharmacies to challenge plan reimbursements. Directs PBMs to reimburse pharmacies at rates no less than specified benchmarks and limits retroactive and certain other adjustments to pharmacy claims. Prohibits spread pricing by PBMs. Requires PBMs to report certain rebate and other information to the Insurance Commissioner quarterly. |
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California |
Pharmaceutical Manufacturers, Insurers |
Drug Price, Transparency |
SB 17: An Act relating to Health Care |
Imposes several new disclosure requirements, including requiring Insurers to provide annual reports on the 25 most frequently prescribed drugs, the 25 most costly drugs, and the 25 drugs with the highest year-over-year increases in price. It further requires drug manufacturers to provide notice if they intend to introduce a new prescription drug at a cost that exceeds the threshold set out in Medicare Part D to be designated a “specialty drug” under federal law. |
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|
California |
Pharmaceutical Manufacturers |
Patent Settlement |
AB 824: An Act to add Division 114.01 to the Health and Safety Code, relating to Business |
On October 7, 2019, California became the first state to enact legislation—Assembly Bill 824—rendering certain pharmaceutical patent litigation settlement agreements presumptively anticompetitive. |
Link; see also Link (White & Case’s antitrust team outline of potential effects of this law). |
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California |
Pharmaceutical Manufacturers |
Cost Regulation |
SB 852: An act to add Chapter 10 (commencing with Section 127690) to Part 2 of Division 107 of, and to repeal Sections 127694 and 127695 of, the Health and Safety Code, relating to health care |
Requires the California Health and Human Services Agency (CHHSA) to enter into partnerships to produce or distribute generic prescription drugs and at least one form of insulin. CHHSA required to submit a report to the Legislature on or before July 1, 2023, that assesses the feasibility and advantages of directly manufacturing targeted generic drugs. |
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Colorado |
PBMs |
Transparency |
HB 1078: Pharmacy Benefit Management Firm Claims Payment |
Prohibits PBMs from retroactively reducing payment on a clean claim submitted by a pharmacy. The measure also prohibits a PBM from reimbursing a pharmacy in an amount less than the amount the PBM reimburses any affiliate for the same pharmacy services. |
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|
Colorado |
Canadian Drug Importation |
Transparency |
SB 19-005: Dr. Irene Aguilar Canadian Prescription Drug Importation Act |
Creates a program to allow the importation of prescription drugs from Canada to Colorado, subject to regulatory oversight and approval from the federal government. |
|
|
Colorado |
Pharmaceutical Manufacturers |
Drug Price, Transparency |
HB 19-1131: An Act concerning a Requirement to Share the Wholesale Acquisition Cost of a Drug when sharing Information concerning the Drug with another Party |
Requires pharmaceutical manufacturers who market to prescribers to disclose a drug's wholesale acquisition cost as well as the names of up to three generic drugs in the therapeutic class, should they exist. |
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|
Colorado |
Insurers |
Cost Regulation, Drug Price |
HB 19-1216: An Act concerning Measures to reduce a Patient's Cost of Prescription Drugs, and in connection, therewith, making an Appropriation |
Requires Insurers to cap the cost of insulin for covered plan members at no more than $100 per 30-day supply, regardless of the amount of insulin a patient needs. The Act also requires the Department of Law to investigate insulin prices and present its findings in a report no later than November 1, 2020. |
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Colorado |
PBMs |
Drug Price |
HB 1237: An Act Concerning The Creation of a Competitive Pharmacy Benefits Manager Marketplace |
Requires the State Employees Group Benefit plan to use a reverse auction to contract with a PBM in its selection of PBM, sets criteria for payment reconciliation and market checks on PBM performance and creates a pathway for self-funded health plan participation in future reverse auctions. |
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Connecticut |
PBMs |
Drug Price, Transparency |
SB 445: An Act concerning Contracts between a Pharmacy and a Pharmacy Benefit Manager, the Bidirectional Exchange of Electronic Health Records and the Charging of Facility Fees by a Hospital or Health System |
Imposes new restrictions on available terms in contracts between PBMs and pharmacies, including (1) PBMs may not prevent pharmacists from disclosing the costs of alternative medication, and (2) PBMs cannot require an individual to pay an amount that would exceed the individual’s copayment for the medication, the allowable claim amount for the medication or the amount the individual would pay without insurance. |
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Connecticut |
PBMs, Health Carriers, Pharmaceutical Manufacturers |
Transparency |
HB 5384: An Act concerning Prescription Drug Costs |
Creates a number of new reporting requirements, including that (1) beginning March 1, 2021, PBMs must file an annual standard-form report outlining, among other things, the dollar amounts of all rebates received from pharmaceutical manufacturers concerning drug formularies managed by the PBM, and (2) pharmaceutical manufacturers of pipeline drugs that, according to Office of Health Strategy’s study and annual reports starting from March 1, 2020, may have a significant impact on state expenditures for outpatient prescription. The standard form must lay out, among other things, all factors that caused the increase in the wholesale acquisition cost of the relevant outpatient prescription drugs and aggregate research and development costs, as well as such other capital expenditures.
The law also requires the Insurance Commissioner to publish an annual report, including a statement disclosing whether, and describing the manner in which, health carriers made rebates available to individuals at the point of purchase. |
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|
Delaware |
PBMs, Insurers |
Drug Price |
HB 24: An Act to amend Title 18 of the Delaware Code relating to Copayment or Coinsurance for Prescription Drugs |
Prohibits Insurers and PBMs from imposing a copayment or coinsurance requirement for a prescription drug that exceeds the price of that prescription drug, the contract price for the drug or the copayment that would exist notwithstanding this law, whichever is less. |
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|
Delaware |
PBMs |
Transparency, Drug Price |
HB 194: An Act to amend Title 18 of the Delaware Code Relating to Pharmacy Benefits Managers |
Along with other reporting requirements, this Act requires that PBMs utilize an appeal process for pharmacies to challenge plan reimbursements. |
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|
Delaware |
Insurers |
Coupons/Cost Sharing |
HB 263: An Act to Amend Title 18 and Title 29 of the Delaware Code Relation to Cost Sharing in Prescription Insulin Drugs |
Requires that individual, group and state employee insurance plans cap the amount an individual must pay for insulin prescriptions at $100 a month and must include at least one formulation of insulin on the lowest tier of the drug formulary developed and maintained by the plan. |
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|
Florida |
Pharmaceutical Manufacturers, Canadian Drug Importation |
Importation |
HB19: Canadian Prescription Drug Importation Program |
Creates the program to allow the importation of prescription drugs from Canada to Florida, subject to regulatory oversight and approval from the federal government. |
|
|
Georgia |
Pharmacists |
Other; Patient Data Privacy |
HB 233: Pharmacy Anti-Steering and Transparency Act |
Prohibits pharmacies from sharing patient or prescriber identifying data for any commercial purpose outside the scope of serving patients. |
|
|
Georgia |
PBMs |
Transparency |
HB 323: An Act relating to Regulation and Licensure of Pharmacy Benefit Managers |
Requires PBMs to report annually the total amount of rebates received from pharmaceutical manufacturers that the PBM did not pass on to its clients. |
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Georgia |
PBMs |
Drug Price |
HB 946/SB 313: Insurance; extensive revisions regarding pharmacy benefits managers |
Revises regulation of PBMs to (1) require PBMs to use CMS’s national average drug acquisition cost (NADAC) as a point of reference for the ingredient cost component of pharmacy reimbursement for drugs appearing on the NADAC list; (2) prohibit PBMs from engaging in any practice that includes imposing a point-of-sale fee or retroactive fee or deriving any revenue from a pharmacy or enrollee in connection with performing PBM services; (3) require PBMs to offer 100 percent pass-through of manufacturer rebates to health plans; (4) require PBMs to offer a health plan the option of charging the health plan the same price for a prescription drug as it pays a pharmacy for the drug (to eliminate spread pricing), unless the PBM is contracted with the state, in which case the PBM will be required to charge a plan the same price for a drug as it pays a pharmacy; (5) require PBMs to report certain manufacturer rebate information and certain spread pricing information to health plans; and (6) require PBMs to include copay and other consumer cost-sharing assistance towards the consumers out-of-pocket maximum deductible or copayment responsibility. |
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Hawaii |
No Recently Enacted Legislation Applicable |
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Idaho |
PBMs |
Legislation, Drug Price |
HB 386: An Act relating to Pharmacy Benefit Managers |
Adds to existing law regulating PBM activities to: prohibit PBMs from limiting pharmacist’s ability to provide cost-sharing information or clinical efficacy of more affordable alternatives to consumers, provide certain requirements for MAC pricing and appeals and prohibit the retroactive denial or reduction of a claim in certain instances. |
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|
Illinois |
PBMs |
Drug Price, Transparency |
HB 465: An Act concerning Regulation |
Provides that a contract between a health insurer and a PBM must: (1) require the PBM to update maximum allowable cost pricing information and maintain a process that will eliminate drugs from maximum allowable cost lists or modify drug prices to remain consistent with changes in pricing data; (2) prohibit PBMs from limiting a pharmacist's ability to disclose the availability of a more affordable alternative drug; and (3) prohibit PBMs from requiring an insured to make a payment for a prescription drug in an amount that exceeds the lesser of the applicable cost-sharing amount or the retail price of the drug. |
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|
Illinois |
Insurers |
Drug Price |
SB 667: An Act concerning Regulation |
Among other details, this measure provides that insurers must limit the total amount an enrollee is required to pay for insulin to $100 per 30-day supply, regardless of the type and amount needed. It also directs the Department of Insurance to issue a report by November 1, 2020, regarding insulin pricing practices and recommendations to control and prevent overpricing of insulin. |
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Indiana |
PBMs, Insurers |
Drug Price |
HB 1207: An Act to amend the Indiana Code Concerning Professions and Occupations |
Provides that a state employee plan, a health maintenance organization, an insurer or a PBM may not require a pharmacy or pharmacist to collect a higher copayment for a prescription drug from a covered individual than the health plan provider allows the pharmacy or pharmacist to retain. Requires an insurer to provide 60 days’ notice to specified insured consumers and opportunity for appeal when removing a prescription drug from the insurer’s formulary or changing the applicable cost sharing requirements. |
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Indiana |
PBMs, Insurers |
Licensing, Other |
SB 241: An Act to amend the Indiana Code Concerning Insurance |
Prohibits PBMs from reducing pharmacy payments to an effective rate of reimbursement or from reimbursing PBM-affiliated pharmacies at a rate greater than other pharmacies in the PBM’s network. Establishes guidelines for how PBMs can set MAC pricing and sets up an appeals process for pharmacies to dispute MAC rates. Requires PBMs to disclose, upon request to their health plan customers, actual amounts paid by the PBM to any pharmacy. Creates licensing and reporting requirements for PBMs, including required reporting starting June 1, 2021, of certain rebate and administrative fee information. |
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Iowa |
PBMs |
Transparency |
SF 563: An Act relating to PBMs and Information Related to the Management of Prescription Drug Benefits, and including Applicability Provisions |
Requires each PBM to submit an annual report to the Insurance Commissioner that includes, among other things, aggregate rebate amounts and administrative fees received from prescription pharmaceutical manufacturers and the amount of those rebates and fees that were not passed through to the PBM’s health plan clients. |
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Kansas |
No Recently Enacted Legislation Applicable |
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Kentucky |
PBMs |
Other |
SB 50: An Act relating to Pharmacy Benefits in the Medicaid Program and Declaring an Emergency |
Requires the Department for Medicaid Services to contract with a PBM to be the state’s PBM and for each managed care organization contracted for Managed Medicaid to use the state’s PBM. For Managed Medicaid, the state’s PBM is (1) required to use pass-through pricing, as well as specified preferred drug lists and reimbursement methodologies; and (2) prohibited from using spread pricing or from reducing pharmacy payments to an effective reimbursement rate or imposing certain other pharmacy limits/restrictions. |
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Louisiana |
Insurer, Pharmacists, PBMs |
Drug Price, Transparency |
HB 436: An Act relative to Coverage of Prescription Drugs |
Prohibits entities that administer prescription drug benefit programs in Louisiana from prohibiting a pharmacist from informing a patient of “all relevant options” and their cost and efficacy. Also prohibits PBMs from reimbursing pharmacies less than the amount paid to the PBM’s affiliates for the same service. |
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Louisiana |
PBMs |
Licensing, Drug Price, Transparency |
SB 41: An Act relative to Regulation of PBMs |
Large-scale reform of PBM requirements in Louisiana, which, among other things, requires PBM registration and regulation by certain state agencies and prohibits “spread pricing” without providing the required notice. |
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Louisiana |
Pharmacists, PBMs |
Other |
HB 433: An Act relative to Business Practices of Pharmacists, Pharmacies, and PBMs |
Provides new regulations governing the interactions between pharmacists and PBMs, including prohibiting PBMs from reimbursing its affiliates more than non-affiliated pharmacies and subjecting those who violate the law to actions and penalties provided for in the Unfair Trade Practices and Consumer Protection Law. |
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Louisiana |
PBMs |
Licensing, Coupons |
SB 239: An Act relative to the Medicaid Prescription Drug Benefit Program |
Among other things, this law authorizes the Louisiana Department of Health to remove pharmacy services from Medicaid managed care organization contracts and assume direct responsibility for such Medicaid pharmacy services. |
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Louisiana |
PBMs |
Drug Price |
SB 180: Provides relative to state procurement of certain services by use of reverse auction technology. |
Authorizes the Department of Health and the Office of Group Benefits to procure and negotiate PBM contracts through the use of a reverse auction. |
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Maine |
Insurers, Pharmacists, PBMs |
Drug Price, Transparency |
LD 6: An Act to prohibit Insurance Carriers from Charging Enrollees for |
Prohibits Insurers or PBMs from requiring a copayment or other charge that exceeds the claim cost of a drug. It further prohibits Insurers or PBMs from penalizing pharmacists for disclosing costs or efficacy information to patients. |
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Maine |
PBMs, Pharmaceutical Manufacturers |
Transparency |
LD 686: An Act To Increase Prescription Drug Pricing Transparency |
Revises the Maine Health Data Organization’s authority to request and publish a list of the prescription drugs for which the manufacturer has: (1) increased the wholesale acquisition cost (WAC) of a brand-name drug by more than 20 percent per pricing unit; (2) increased the WAC of a generic drug that costs at least $10 per pricing unit more than 20 percent per pricing unit; or (3) introduced a new drug with a WAC that exceeds the threshold for a specialty drug under the Medicare Part D Program (currently $670). The law also revises the process for disclosures by manufacturers, wholesale drug distributors and PBMs and updates the confidentiality provisions applicable to information provided. |
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Maine |
Pharmaceutical Manufacturers |
Drug Price, Transparency |
LD 1162: An Act to further Expand Drug Price; Transparency |
Manufacturers must provide annual drug price reports to the Maine Health Data Organization. The annual reports must notify the Organization if the manufacturer has (1) increased the wholesale acquisition cost of a brand-name or generic drug by more than 20 percent; or (2) introduced a new drug for distribution that has a cost greater than the threshold for being designated a “specialty drug” under Medicare Part D. If the Organization requests information relating to a specific prescription drug, the manufacturer must provide the Organization with the price per unit within 60 days. Failure to comply can result in monetary fines. Effective January 30, 2020. Requires the Maine Health Data Organization to publish an annual report on the information from the Manufacturer reports with various privacy protections. Effective November 1, 2020. |
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Maine |
Pharmaceutical Manufacturers |
Importation |
LD 1272: An Act to increase Access to Low-cost Prescription Drugs |
Provides for the Department of Health and Human Services to adopt rules to work to establish a program to import Canadian drugs. By May 1, 2020, the Department will submit a request for approval of the drug importation program to the Federal Department of Health and Human Services. Effective January 1, 2020. |
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Maine |
N/A |
Drug Affordability Review |
LD 1499: An Act to establish the Maine Prescription Drug Affordability Board |
Establishes the Maine Prescription Drug Affordability Review Board, which is authorized to determine spending targets on certain specific drugs that may cause affordability challenges to enrollees in a public payor health plan and provide a number or other broad powers, including the ability to establish a common formulary for all public payors, enter into bulk purchasing agreements and negotiate certain rebate amounts. |
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Maine |
Pharmaceutical Manufacturers |
Drug Price, Transparency |
LD 1406: An Act to promote Prescription Drug Price; Transparency |
Empowers the Maine Health Data Organization to develop a plan to collect data from manufacturers related to the pricing of drugs. |
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Maine |
PBMs |
Licensing, Other |
LD 1504: An Act to protect Consumers from Unfair Practices Related to Pharmacy Benefits Management |
Prohibits “spread pricing” by PBMs absent notice to the State. Requires PBMs to have a license to operate in the state and to apply a single maximum allowable cost list. Effective January 1, 2020. |
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Maine |
Insurers |
Other |
LD 1928: An Act to prohibit Health Insurance Carriers from Retroactively Reducing Payment on Clean Claims Submitted by Pharmacies |
Prohibits insurers (or their intermediaries) from charging a pharmacy or holding a pharmacy responsible for any fee related to a clean claim that is not apparent at the time the claim is processed that is not reported on the remittance advice or that is applied after the initial claim is adjudicated. |
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Maine |
Insurers |
Drug Price |
LD 2096: An Act to save Lives by Capping the Out-of-pocket Cost of Certain Medications |
Restricts insurers providing prescription insulin drug coverage from imposing any deductible or other cost-sharing requirement that results in out-of-pocket costs that exceed $35 per prescription for a 30-day supply, regardless of the amount of insulin needed to fill the enrollee’s insulin prescriptions. |
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Maryland |
PBMs |
Transparency |
HB 1150: State Health and Welfare Benefits Program- Maryland Competitive Pharmacy Benefits Manager Marketplace Act |
Authorizes the Department of Budget and Management to procure and negotiate PBM contracts through the use of a reverse auction and sets forth certain parameters related to that process. |
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Maryland |
PBMs |
Transparency |
HB 1307: Credentialing and Reimbursement |
Creates certain limits on PBMs’ pharmacy credentialing requirements and prohibits PBMs from charging a fee for initial credentialing or renewal. Also prohibits PBMs from reducing pharmacy reimbursement under a reconciliation process. |
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Maryland |
Pharmacy Services Administrative Organizations |
Other |
SB 915: Pharmacy Services Administrative Organizations- Regulation |
Increases regulation of pharmacy services administrative organizations, including requiring registration with Maryland Insurance Commission and creating filing disclosure obligations. |
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Maryland |
Pharmaceutical Manufacturers |
Drug Price |
HB 631: An Act concerning Public Health- Essential Off-Patent of Generic Drugs- Price Gouging- Prohibition |
This price gouging law would have prevented manufacturers from implementing “unconscionable” price increases on certain drugs. In 2018, a Federal appellate court held the law is unconstitutional because it regulated commerce outside of Maryland's borders. Leave to appeal to the Supreme Court of the United States was denied in February 2019. |
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Massachusetts |
N/A |
Drug Affordability Review, Transparency |
H 4000: An Act Making Appropriations for the Fiscal Year 2020 for the Maintenance of the Departments, Boards, Commissions, Institutions and Certain Activities of the Commonwealth, for Interest, Sinking Fund and Serial Bond Requirements And for Certain Permanent Improvements |
Among other provisions, this law requires certain pharmaceutical manufacturers to disclose certain information regarding drug prices, price increases and research and development spending to the Executive Office of Health and Human Services. Based on the submitted information, the Executive Office of Health of Human Services may identify and negotiate supplemental rebates for drugs with total annual costs exceeding certain thresholds. If a supplemental pricing rebate is not agreed on, the Manufacturer may be subject to further disclosure requirements. |
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Michigan |
PBMs |
Drug Price, Other |
SB 139: Appropriations; health and human services; department of health and human services (provide for fiscal year 2019-2020) |
Starting February 1, 2020, this law prohibits the Department of Health and Human Services from entering into contracts with Medicaid managed care organizations that use PBMs that fail to utilize certain reimbursement methodologies and fail to agree to move transparent pass-through pricing. |
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Minnesota |
PBMs |
Transparency |
HF 2128: Omnibus health and human services policy and finance bill |
Prohibits PBMs and health plans from imposing contract terms that prevent pharmacists from sharing with insured consumers the pharmacy's acquisition cost for a drug, the amount the pharmacy is being reimbursed by the PBM. Also prevents PBM contract terms that prevent pharmacies from discussing with health plans the reimbursement amount paid by a PBM or the pharmacy’s acquisition cost. |
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Minnesota |
Other |
Transparency, Drug Pricing |
SF 1098: Prescription Transparency Drug Pricing Act |
Requires drug manufacturers to submit specified pricing information to the commissioner of health for certain new drugs and for existing drugs with price increases above a defined threshold. The commissioner is directed to post on its website (subject to certain confidentiality restrictions) the reported pricing information. Failure to comply with the reporting requirements may subject a manufacturer to civil penalties not to exceed $10,000 per day of violation. |
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Minnesota |
PBMs |
Licensing, Substitutions |
SF 278: An Act relating to Health Care |
Requires PBMs to be licensed to operate in the State, to report information regarding aggregate pharmaceutical manufacturer rebates, retained rebates, spread pricing and other information to the Commissioner of Commerce, and to provide pharmacies certain information regarding the development of maximum allowable cost lists. This bill also permits pharmacists, with respect to a prescription not covered by the consumer’s prescription drug plan, to dispense a therapeutically equivalent and interchangeable prescribed drug that is covered, pursuant to certain conditions and requirements. |
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Minnesota |
Insurers |
Drug Price |
SB 12: Omnibus Health and Human Services Appropriation Bill |
Appropriations bill with a number of detailed limitations, such as limiting cost sharing on insulin and regulating the sale of medical cannabis. |
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Minnesota |
Pharmaceutical Manufacturers |
Drug Price |
HF3100: Alec Smith Insulin Affordability Act |
Obligates pharmaceutical manufacturers to make insulin available to eligible individuals who urgently need insulin or require access to an affordable insulin supply. |
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Mississippi |
No Recently Enacted Legislation Applicable |
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Missouri |
No Recently Enacted Legislation Applicable |
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Montana |
PBMs |
Transparency, Drug Price |
SB 395: Montana Pharmacy Benefit Manager Oversight Act |
Establishes the standards and criteria for licensure and regulation of PBMs. The bill also (1) prohibits PBMs from including clauses in contracts with pharmacies that prevent the disclosure of the process that is used to authorize or deny drug coverage or benefits; (2) requires PBMs to disclose to health plans certain cost information, including wholesale acquisition costs from a manufacturer and aggregate rebate amounts from manufacturers; and (3) prevents PBMs from excluding 340B entities or their contract pharmacies from networks or reimbursing them differently than similarly situated pharmacies. |
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Montana |
PBMs, Insurers |
Transparency, Drug Price |
SB 270: An Act revising Conditions for a Network Pharmacy or Pharmacist |
Imposes a prospective requirement that regulated entities (e.g., PBMs) provide pharmacies with their maximum allowable price list at the time of contracting and prohibits regulated entities from penalizing pharmacies for sharing reimbursement information with patients. |
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Nebraska |
PBMs, Insurers |
Drug Price, Transparency |
LB 316: A Bill for an Act relating to Pharmacy; to adopt the Pharmacy Benefit Fairness Act |
Prohibits regulated entities (e.g., Insurers) from requiring a point-of-sale payment in excess of either the non-insured cash cost or the patient's contractual payment, whichever is less. Further prohibits penalizing pharmacies for disclosing cost related information to patients. |
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Nevada |
PBMs |
Drug Price, Transparency |
AB 141: An Act relating to Pharmacy Benefit Managers |
Prohibits a PBM from preventing a pharmacy from disclosing less expensive options to patients and from penalizing a pharmacy for selling a less expensive generic drug to patients. |
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Nevada |
Pharmaceutical Manufacturers |
Drug Price, Transparency |
SB 262: An Act relating to Prescription Drugs |
Extends certain reporting requirements for the sale of diabetes treating drugs to treatments for asthma. |
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Nevada |
PBMs |
Transparency, Drug Price |
SB 378: An Act relating to Prescription Drugs |
This law alters a number of existing provisions related to PBMs, including altering the standard governing a PBM's contractual relationship from a fiduciary standard to a good-faith standard. It further alters how the state operates its Medicaid program by allowing the Department of Health and Human Services to contract with a PBM for the administration of the State Plan for Medicaid and the Children’s Health Insurance Program. |
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Nevada |
PBMs, Pharmaceutical Manufacturers |
Transparency |
SB 380: Revises provisions governing the reporting of data concerning the prices of prescription drugs. |
Revises the Department of Health and Human Services’ responsibility for reporting information on drug prices by adding drugs with a WAC exceeding $40 for a course of therapy that have been subject to an increase in WAC of 10 percent or greater during the immediately preceding calendar year or 20 percent or greater during the immediately preceding two calendar years and removing asthma drugs. Manufacturer reporting responsibilities are expanded to cover this new category of drugs. The bill also updates the reporting requirements for PBMs and adds a new reporting requirement for wholesalers that sell prescription drugs included on either or both of the lists compiled by the state. |
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Nevada |
Pharmacists, PBMs, Pharmaceutical Manufacturers |
Drug Price, Transparency |
SB 539: An Act relating to Prescription Drugs |
Creates a number of new reporting requirements related to the sale of drugs treating diabetes. |
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New Hampshire |
Pharmaceutical Manufacturers |
Transparency |
HB 703: Relative to providing notice of the introduction of new high-cost prescription drugs. |
Creates a notice requirement for a new prescription drug introduced at a wholesale acquisition cost that exceeds the threshold set for a specialty drug under the Medicare Part D program. For such drugs, the manufacturer must provide notice to the Insurance Department and certain disclosures, including a description of the marketing and pricing plan for the drug in the US and internationally, the estimate volume of potential patients, whether the drug was granted breakthrough designation or priority review by FDA, and the date and price of acquisition if the drug was not developed by the manufacturer. Failure to provide the required disclosures may result in a civil penalty of not more than $1,000 per day, injunctive relief, and payment of attorneys’ fees. |
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New Hampshire |
Pharmaceutical Manufacturers |
Drug Price |
HB 1280: Relative to copayments for insulin, establishing a wholesale prescription drug importation program, establishing a New Hampshire prescription drug affordability board, establishing the prescription drug competitive marketplace, relative to the pricing of generic prescription drugs, relative to prior authorization for prescription drug coverage, and requiring insurance coverage for epinephrine auto-injectors |
The bill covers a number of topics, including: (1) requiring health plans to cap insulin out-of-pocket cost at no more than $30 for a 30-day supply; (2) establishing a wholesale importation program for prescription drugs from Canada by or on behalf of the state; (3) establishing a prescription drug affordability board to determine annual public payer spending targets for prescription drugs, develop and implement policies and procedures for the collection of prescription drug price data, implement a register of drug manufacturers for drug pricing data and establish funding for the board by reasonable user fees and assessments; (4) revising the consumer protection law to include as an unfair method of competition or unfair and deceptive act or practice the pricing of generic prescription drugs in a manner that tends to create or maintain a monopoly or otherwise harm competition; (5) revising the managed care law to regulate the procedure for the prior authorization of drugs on a health plan formulary; (6) requiring insurance coverage for epinephrine autoinjectors; and (7) adopting a reverse auction process for state health plan selection of PBMs. |
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New Hampshire |
PBMs |
Drug Price |
SB 226: An Act relative to Registration of PBMs, and reestablishing the Commission to study greater Transparency in Pharmaceutical Costs and Drug Rebate Programs |
Creates a number of requirements for PBMs, including that PBMs must register to operate within the state and provide a process for pharmacies to appeal disputes regarding maximum allowable cost pricing. |
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New Jersey |
Other |
Drug Pricing |
S887: Requires DHS to contract with third party entity to apply risk reduction model to Medicaid prescription drug services. |
Requires the Department Human Services to transition Medicaid prescription drug services from a managed care delivery system to a fee-for-service delivery system and to conduct a reverse auction to contract with a PBM to administer the fee-for-service system. |
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New Jersey |
Pharmaceutical Manufacturers |
Transparency |
S 2389: An Act concerning the Disclosure of Prescription Drug Price Information |
Requires the Board of Pharmacy to establish a prescription drug pricing disclosure website and requires pharmaceutical manufacturers in the state to provide the current wholesale acquisition price for drugs or biologics marketed in the state. |
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New Jersey |
PBMs, Insurers |
Drug Price |
SB 2690: An Act concerning Pharmacy Benefits Managers |
Prohibits regulated entities (e.g., PBMs) from requiring a point-of-sale payment in excess of either the non-insured cash cost or the patient's contractual payment, whichever is less, and prohibits penalizing pharmacies for disclosing cost-related information to patients. |
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New Mexico |
Canadian Drug Importation |
Drug Price |
SB1: An Act relating to Health; enacting the Wholesale Prescription Drug Importation Act; providing Power and Duties; creating a Program; creating a Committee; requiring Federal Certification; creating a Fund; declaring an Emergency |
This measure requires the Department of Health to design a wholesale prescription drug importation program that complies with federal requirements. |
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New Mexico |
Pharmaceutical Manufacturers, PBMs, Pharmacists |
Drug Price |
SB 131: An Act relating to Procurement |
This law established the "Interagency Pharmaceuticals Purchasing Council" to study, review and coordinate ways to manage drug costs through group purchasing and other means. |
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New Mexico |
PBMs |
Drug Price, Transparency, Volume Purchasing |
SB 415: An Act relating to Health Care |
Creates a number of requirements for PBMs, including that PBMs must be licensed to operate within the state and provide a process for pharmacies to appeal disputes regarding maximum allowable cost pricing. |
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New Mexico |
Insurers |
Drug Price |
HB 292: Prescription Drug Cost Sharing |
Requires insurers to cap the total amount an insured individual is required to pay for prescription insulin drugs at $25 per 30-day supply, regardless of the amount or the number of prescription drugs or types of insulin prescribed. It also requires the superintendent of insurance to study the cost of prescription drugs for New Mexico consumers and make recommendations on increasing accessibility of prescription drugs in a report to be issued no later than October 1, 2020. |
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New York |
N/A |
Transparency |
SB 7506B: A Budget Bill |
Directs the Department of Health to remove Medicaid pharmacy benefits from the managed care benefit package and provide those pharmacy benefits under the fee for service program to ensure transparency and efficiency of services. It also empowers the Superintendent of Insurance to investigate certain prescription drug price increases of more than 50 percent over a 12-month period and provide such information to the newly created drug accountability board, which is authorized in certain instances to evaluate and report to the Superintendent on (among other things) a drug’s impact on premium costs, affordability, and price compared to therapeutic benefit. It also caps cost sharing for prescription insulin at $100 for a 30-day supply regardless of the amount of insulin needed to fill the prescription. |
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New York |
PBMs
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Drug Price, Transparency |
SB 1507: An Act to amend the Public Health Law, in relation to extending and enhancing the Medicaid Drug Cap and to reduce unnecessary Pharmacy Benefit Manager Costs to the Medicare Program |
Prohibits PBMs in the Medicaid program from retaining any portion of spread pricing and requires the registration of PBMs. |
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North Carolina |
Pharmacists, PBMs |
Drug Price, Transparency |
HB 466: An Act relating to the Regulation of Pharmaceutical Benefit Managers |
Imposes new requirements on the interactions between PBMs and pharmacists, including that (1) PBMs cannot prohibit pharmacists from providing cost share information to the patient or penalize a pharmacist for selling lower-priced drug to the patient if available, and (2) PBMs may not charge a co-payment greater than the total charge submitted by the pharmacy for the drug. |
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North Dakota |
PBMs |
Transparency, Other |
HB 1492: Permitting pharmacists to administer SARS-CoV-2 tests; to provide a penalty; and to declare an emergency |
Prohibits health plans or their PBMs from disadvantaging 340B covered entities or their contract pharmacies. |
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Ohio |
PBMs |
Drug Price (Reimbursements) |
SB 263: Prohibit pharmacy benefit managers acting on certain reimbursals
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Prohibits health plans or their PBMs from disadvantaging 340B covered entities or their contract pharmacies in reimbursement rates or dispensing fees or through the imposition of other fees. |
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Oklahoma |
PBMs |
Drug Cost, Transparency |
HB 2632: Patient's Right to Pharmacy Choice Act |
Prohibits restrictions on a patient’s right to choose a pharmacy provider without paying a penalty and creates an advisory committee to review complaints and administer fines. |
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Oregon |
Pharmaceutical Manufacturers, Insurers |
Drug Price, Transparency |
HB 4005: An Act relating to the Price of Prescription Drugs |
Imposes a number of new reporting requirements on pharmaceutical manufacturers, including annual reports on certain factors regarding the manufacturer’s price increases for drugs that cost $100 or more for a one-month supply and that increase in price by more than 10 percent. The law further requires that Insurers report information regarding their 25 most costly drugs. |
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Oregon |
Pharmaceutical Manufacturers |
Drug Price, Transparency |
HB 2658: An Act relating to Prescription Drug Costs |
Effective January 1, 2020, pharmaceutical manufacturers must report certain intended material price increases to Oregon’s Department of Consumer and Business Services, including (1) the date of the increase, (2) the current price, (3) the amount of the increase, (4) an explanation of why the increase is necessary, and (5) the year the drug became available in the United States. |
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Oregon |
Pharmacy Benefits Managers |
Drug Price, Transparency |
HB 2185: An Act relating to PBMs; Creating New Provisions; and Amending ORS 735.530 and 735.534 |
Prohibits PBMs from requiring a prescription to be filled by a mail-order pharmacy as a condition for reimbursing the cost of the drug. The law does, however, allow a PBM to require a prescription for a specialty drug to be filled at a specialty pharmacy as a condition for reimbursement of the cost of the drug. It further prohibits PBMs from restricting or penalizing network pharmacies for disclosing the difference between the out-of-pocket cost for the drug and the pharmacy's retail price for the drug. |
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Pennsylvania |
PBMs |
Pharmacy Services and Study |
HB 941: In public assistance, further providing for medical assistance pharmacy services and providing for prescription drug pricing study. |
Amends regulation of the State’s public assistance programs to prohibit an MCO or PBM from requiring an enrollee to use a specific pharmacy and a PBM from retaining a pharmacy spread, and instructs the Legislative Budget and Finance Committee to study prescription drug pricing under the medical assistance managed care program. |
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Pennsylvania |
PBMs and Pharmacists |
Transparency |
HB 943: Consumer Prescription Drug Pricing and Freedom Disclosure Act |
Grants pharmacies the freedom to provide consumers drug cost and consumer cost sharing information and prevents PBMs from prohibiting such disclosure or prohibiting pharmacies from disclosing the availability of therapeutically equivalent alternative drugs or selling more affordable alternatives to consumers. |
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Rhode Island |
PBMs and Pharmacists |
Transparency |
S 497: Prescription Drug Benefits |
Plan sponsors, health insurers and PBMs cannot block pharmacists from providing cost sharing information to insured consumers and cannot penalize pharmacists for selling a lower-priced drug to an insured consumer. |
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South Carolina |
PBMs |
Licensing, Transparency |
S 359: An Act to amend the Code of Laws of South Carolina, 1976 |
Establishes a State licensing requirement for PBMs and imposes a number of limitations on PBM operations. The law prevents PBMs from limiting the health care information pharmacists can provide to patients (i.e., information the pharmacists deem appropriate and within the scope of practice), prohibiting pharmacist from discussing certain cost information regarding drugs or collecting a copay that exceeds the total contracted price, or the amount an individual would pay if that individual was paying cash, for the drugs, among other things. |
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South Dakota |
PBMs |
Drug Price |
HB 1137: An Act to revise certain Provisions regarding Pharmacy Benefit Managers |
Limits a PBM's ability to contract for certain terms, such as to charge a patient an amount that exceeds the amount retained by the pharmacist. |
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Tennessee |
PBMs |
Drug Price |
HB 786: An Act to amend Tennessee Code Annotated, Title 56, Chapter 7, Part 31, relative to pharmacy benefits managers |
Limits a PBM's ability to contract for certain terms, such as terms that would require a pharmacist to dispense a product contrary to the pharmacist's professional judgment, and prohibits PBMs from reimbursing pharmacies less than the amount reimbursed to the PBM's affiliate entities. |
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Tennessee |
PBMs |
Drug Price and Transparency |
SB 1617 / HB 1398: AN ACT to amend Tennessee Code Annotated, Title 4; Title 56 and Title 71, relative to pharmacy benefits |
Prohibits health plans and PBMs from taking certain steps, including the use of lower reimbursement rates, to discriminate against 340B covered entities or their contract pharmacies. |
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Texas |
Pharmaceutical Manufacturers, PBMs |
Drug Price, Transparency |
HB 2536: An Act relating to Transparency related to Drug Costs |
Requires pharmaceutical manufacturers to provide reports of certain price increases for drugs which have a cost of at least $100 for a 30-day supply. Where the increase in price is greater than 40 percent or more over the previous three years or greater than 15 percent over the last year, the manufacturer must provide a report within 30 days of the price change. |
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Utah |
PBMs, Insurers, Pharmacists |
Transparency |
HB 370: Pharmacy Benefit Manager Amendments |
Imposes a licensing and reporting requirement on PBMs and provides certain restrictions on claims reimbursements, as well as a prohibition on PBMs charging insured consumers costs sharing that exceeds the allowed claim amount, the total pharmacy reimbursement for the drug or the retail price for the drug, if not insured. |
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Utah |
Insurers |
Coupons, Cost Sharing |
HB 207: Insulin Access Amendments |
With some exceptions, requires health benefit plans to cap the total amount that an insured is required to pay for insulin at an amount not to exceed $30 per 30-day supply, regardless of the amount of insulin needed and whether the insured has met her deductible. |
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Utah |
PBMs |
Transparency, Cost Sharing |
HB 272: Pharmacy Benefit Amendments |
Amendments to the Pharmacy Benefit Act prevent PBMs from retroactively denying or reducing a pharmacy’s claim and contracting with a health insurer in certain instances unless the pharmacy benefit manager agrees to regularly report to the insurer detailed, claim-level information regarding pharmaceutical manufacturer rebates received by the PBM in connection with the contract.
The Prescription Drug Price Transparency Act, among other things, requires manufactures to report certain information if the wholesale acquisition cost for a drug increases by 10 percent in one calendar year or 16 percent across two calendar years, including information regarding the factors that lead to the increase, recent FDA approvals, recent patent expirations and certain R&D cost information. It also direct insurers to report certain information their 25 highest spend drugs. |
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Utah |
PBMs |
Drug Price |
SB 138: Pharmacy Benefit Revisions |
Among other provisions, this measure prohibits PBMs from charging an enrollee, who uses an in-network retail pharmacy that offers delivery or mail order services, a fee or copayment that is higher than the fee or copayment the enrollee would pay if the enrollee used an in-network retail pharmacy that does not offer delivery or mail-order services. |
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Utah |
Manufacturers and Insurers |
Transparency |
HB 6011: Pharmaceutical Reporting Amendments |
Defers implementation of manufacturer price reporting requirements to Jan. 1, 2022, and defers implementation of insurer reporting on prescription drug spending to Aug. 1, 2021. |
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Vermont |
Pharmaceutical Manufacturers |
Drug Price, Transparency |
SB 216: An act relating to Prescription Drugs |
Authorizes the Vermont Attorney General to require manufacturers to provide justifications for price increases where the State spent “significant health care dollars” and where the wholesale acquisition cost of a drug has increased by a certain amount (by 50 percent over the last five years or by 15 percent over the last 12 months). |
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Vermont |
Pharmaceutical Manufacturers, Pharmacists, Insurers |
Drug Price, Transparency, Substitutions |
S 92: An Act relating to prescription Drug Price; Transparency and cost containment |
Imposes a number of requirements on different entities within the healthcare sector, including requiring pharmacists to select the lowest priced interchangeable biological product unless otherwise instructed by the prescriber (or the purchaser, if they agree to pay the extra cost). It further requires insurers to provide a report on the costs associated with covering prescription drugs and the year-over-year increases in drug prices. The law places varying reporting requirements on Insurers based upon the number of individuals they insure. |
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Vermont |
Pharmaceutical Manufacturers |
Importation |
S 175: An Act relating to the Wholesale Importation of Prescription Drugs |
Directs the Agency of Human Services to design a program for wholesale importation of prescription drugs from Canada in compliance with all applicable federal standards. |
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Vermont |
Pharmaceutical Company (Wholesalers) |
Drug Price |
H 542: An Act relating to making Appropriations for the Support of Government. |
Directs the Agency of Human Services to extend the deadline by which the Agency of Human Services must implement a wholesale drug importation program. |
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Virginia |
Insurers (third-party administrators) |
Drug Price, Transparency |
HB 29: A Budget Bill |
Requires the Department of Human Resource Management to include language in all contracts with third-party administrators to maintain policies and procedures for transparency in pharmacy benefit administration programs. |
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Virginia |
Insurers |
Drug Price |
HB 66: An Act relating to Health Insurance; Pharmacy Benefits; Cost-Sharing Payments for Prescription Insulin Drugs |
Caps cost-sharing payments for prescription insulin drugs at $50 for a 30-day supply of insulin. |
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Virginia |
PBMs |
Transparency and Drug Price |
HB 1290: Pharmacy benefits managers; licensure and regulation. (Incorporates HB 1292, HB 1459, HB 1479, HB 1659) |
Requires PBMs to obtain a license from the State Corporation Commission and creates recordkeeping and reporting requirements for PBMs. The bill also prohibits PBMs from engaging in spread pricing, charging a pharmacist a fee related to the adjudication of a claim other than a reasonable fee for an initial claim submission, or reimbursing a pharmacy an amount less than the amount that the PBM reimburses an affiliate for providing the same services. |
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Virginia |
PBMs |
Drug Price |
HB 1291 / SB 568: Medical assistance services; managed care organization contracts with pharmacy benefits managers. |
This measure prohibits PBMs that contract with Medicaid managed care organizations from using spread pricing. The bill applies to agreements entered into, amended, extended, or renewed on or after July 1, 2020. |
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Virginia |
PBMs |
Transparency |
SB 251: Pharmacy benefits managers; licensure and regulation. (Incorporates SB 252 and SB 862) |
Requires PBMs to obtain a license before operating in the state and prohibits PBMs from using false advertisement and from including any mail-order pharmacy or PBM affiliate in calculating or determining network adequacy. The bill also requires PBMs to submit quarterly reports detailing manufacturer rebate information and prohibits PBMs from engaging in spread pricing. |
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Virginia |
PBMs |
Drug Price, Cost Sharing |
SB 568: An Act relating to Medical Assistance Services; Managed Care Organization Contracts with Pharmacy Benefit Managers; Spread Pricing |
Prohibits PBMs that contract with Medicaid managed care organizations from using spread pricing. |
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Virginia |
Insurers |
Coupons, Drug Price |
S 1596: An Act to amend and reenact §§ 38.2-4214 and 38.2-4319 of the Code of Virginia |
Requires any insurance carrier in Virginia to count any payments made by another person on the enrollee's behalf, including payments through prescription drug coupons, toward a patient's out-of-pocket maximum cost sharing requirement for plans created or extended after January 1, 2020. |
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Virginia |
PBMs |
Study and Drug Price |
HJ 52: Requesting the Secretary of Health and Human Resources to study the establishment of a Prescription Drug Affordability Board. Report. |
This measure urges the House of Delegates, the Senate and the Secretary of Health and Human Resources to study the pharmaceutical distribution payment system in the state and innovative solutions to address the cost of prescription drugs to Virginians at the point of sale. The study must include a review of transparency for pharmaceutical manufacturers, PBMs and health insurance carriers and develop and recommend a plan for the establishment of a Prescription Drug Affordability Board with the authority to review and regulate the cost of prescription drugs to be submitted to the legislature by September 14, 2021. |
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Washington |
Pharmaceutical Manufacturers, PBMs, Insurers |
Drug Price, Transparency |
HB 1224: An Act relating to Prescription Drug Cost Transparency |
Imposes a number of new reporting requirements on pharmaceutical manufacturers, PBMs and Insurers related to price increases, prescription frequency, and reimbursement amounts. |
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Washington |
PBMs |
Drug Price, Transparency |
SB 5601: An Act relating to Pharmacy Benefit Managers |
Requires PBMs to obtain a license and prohibits PBMs from reimbursing a pharmacy or pharmacist in the state an amount less than the amount the PBM reimburses an affiliate for providing the same services. |
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Washington |
Pharmaceutical Companies, Insurers |
Drug Price |
HB 2662: An Act reducing the Total Cost of Insulin |
Creates the Total Cost of Insulin work group, which must submit a report to the governor and legislature detailing strategies to reduce the cost of and total expenditures on insulin for patients, carriers, and the state. This measure also requires health plans to cap cost-sharing for insulin at $100 per 30-day supply. |
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Washington |
Insurers |
Drug Price |
HB 6087: An Act relating to Cost-Sharing Requirements for Coverage of Insulin Products |
Caps the total amount that an insured individual is required to pay for insulin at $100 per 30-day supply and allows health plans to raise the cost-sharing amount for a 30-day supply by $5 for every $100 increase in the cost of an insulin product to the health plan. |
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West Virginia |
PBMs, Insurers |
Drug Price |
HB 2770: A BILL to amend the Code of West Virginia, 1931 |
Effective January 1, 2020: when an insured’s contributions to an applicable cost-sharing requirement are calculated (e.g., an out of pocket maximum), the Insurer and PBM must include the cost-sharing amounts paid by the insured or on behalf of the insured by another person. |
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West Virginia |
Pharmaceutical Manufacturers, Insurers |
Transparency |
SB 689: An Act relating to enacting the Requiring Accountable Pharmaceutical Transparency, Oversight, and Reporting Act |
Requires drug manufacturers to submit an annual report to the auditor with regard to brand and specialty drugs with a wholesale acquisition cost of at least $100 and an increase of 40 percent or more over the preceding three years or 15 percent of more in the previous year, including information regarding the factors that lead to the increases, recent patent expirations and certain R&D cost information. It also directs insurers to report certain information for their 25 most frequently prescribed drugs. |
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West Virginia |
PBMs |
Transparency |
SB 489: An act amending the Pharmacy Audit Integrity Act |
Requires licensure of PBMs. |
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West Virginia |
PBMs, Insurers, Pharmaceutical Manufacturer |
Drug Price |
HB 4543: An Act relating to Insurance Coverage for Diabetics |
Caps the total amount that a carrier can required a covered patient with diabetes to pay for a 30-day supply of insulin at $100, regardless of the quantity or type of insulin needed to fill the person's needs. Also prohibits a manufacturer, wholesaler or PBM from passing through the costs of the prescribed insulin to the pharmacist or pharmacy. |
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West Virginia |
PBMs |
Drug Price and Transparency |
HB 2263: Update the regulation of pharmacy benefit managers. |
This bill (1) prohibits PBMs from collecting from a pharmacy a cost share charged to an enrollee that exceeds the total submitted charges by the pharmacist to the PBM; (2) prohibits PBMs from reimbursing a pharmacy or pharmacist an amount less than the national average drug acquisition cost (NADAC) at the time the drug is administered or dispensed, plus a dispensing fee; (3) requires PBMs to use NADAC as a point of reference for the ingredient drug product component of a pharmacy's reimbursement for drugs appearing on the NADAC list and to report on drugs reimbursed 10 percent below and above the NADAC; (4) requires PBMs to offer a health plan the option of charging the plan the same price for a prescription drug as it pays a pharmacy for the drug; (5) directs PBMs to report to the health plan the difference between the amount the PBM reimbursed a pharmacy and the amount the PBM charged the health plan; and (6) mandates that an enrollee's cost sharing for each drug will be calculated at the point of sale based on a price that is reduced by an amount equal to at least 100 percent of all rebates received. Any rebate over and above the defined cost sharing will be passed on to the health plan to reduce premiums. |
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West Virginia |
Pharmaceutical Manufacturers |
Transparency |
SB 689: Requiring Accountable Pharmaceutical Transparency, Oversight, and Reporting Act. |
This measure requires drug manufacturers and health plans to submit annual reports to the State Auditor. Manufacturer reports must cover generic, brand and specialty drugs that meet specified cost and price increase parameters, and include (among other things) information regarding WAC changes, aggregate company R&D costs, US revenues for drugs that lost patent exclusivity in the calendar year and a statement regarding the factors that caused any WAC increase. Health benefit plan annual reports must cover certain aspects of prescription drug spending and their impact on premium. The bill requires the State Auditor to create a searchable pharmaceutical transparency website containing the information disclosed in the manufacturer and health plan annual reports. |
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Wisconsin |
PBMs and Pharmacists |
Transparency |
SB 3: Pharmacy benefit managers, prescription drug benefits, and granting rule-making authority. |
Revises licensing and reporting requirements for PBMs and imposes certain limitation on activities of health plans and PBMs, including (1) limiting the situations in which pharmacy claims may denied retroactively; (2) prohibiting PBMs/plans from penalizing pharmacies for informing an enrollee of any differential between the out-of- pocket cost of a drug and the cost an individual would pay for the drug without using insurance; (3) prohibiting PBMs/plans from requiring an enrollee to pay more for a covered drug than either the enrollee’s cost-sharing amount or the amount the enrollee would pay for the drug without using insurance, whichever amount is lower.
Requires pharmacies to post a sign describing the pharmacy’s ability to substitute a less expensive drug product equivalent or interchangeable biological product for the prescribed drug or biological product. Each pharmacy also must have available for the public (1) a listing of the retail price, updated monthly or more often, of the 100 most commonly prescribed prescription drugs available for purchase at the pharmacy and (2) information describing how to access a list, created by the Pharmacy Examining Board, of the 100 most commonly prescribed generic drugs with the corresponding brand-name, and the list of currently approved interchangeable biological products. |
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Wyoming |
PBMs |
Transparency |
HB 63: An Act relating to Regulation of PBMs under the Insurance Code |
Precludes PBMs from prohibiting or penalizing a pharmacy or pharmacist for informing a covered person about alternatives that may cost less than paying for a prescription drug using the person's prescription drug insurance. |
1 Satewide Prescription Drug Database: 2015-Present, National Conference of State Legislatures (July 14, 2021).
2 An act relative to copayments for insulin, establishing a wholesale prescription drug importation program, establishing a New Hampshire prescription drug affordability board, establishing the prescription drug competitive marketplace, relative to the pricing of generic prescription drugs, relative to prior authorization for prescription drug coverage, and requiring insurance coverage for epinephrine auto-injectors, H.B. 1280-FN, 2020 Reg. Sess. (2020)
3 Expand Canadian Prescription Drug Import Program, S.B. 20-119, 73rd Colo. Gen. Assemb. 2020 Reg. Sess. (2020)
4 Governor Ron DeSantis Announces Florida's Submittal of Drug Importation Proposal to Federal Government, Ron DeSantis News Releases (Nov. 23, 2020)
5 Renzo Downey, Gov. DeSantis re-ups call for Biden administration to approve Florida's drug import plan, FLORIDA POLITICS (July 9, 2021)
6 HHS moved to dismiss the case on May 28, 2021, citing lack of subject matter jurisdiction and failure to state a claim upon which relief can be granted. HHS argued that the lawsuit was premature because the federal government had not adopted a drug importation program. In response, PhRMA filed an amended complaint on July 2, 2021. HHS has until August 27, 2021 to respond. Florida is still waiting for HHS to approve its drug importation program. The case is Pharmaceutical Research and Manufacturers of America et al. v. U.S. Department of Health and Human Services et al., case number 1:20-cv-03402, in the U.S. District Court for the District of Columbia.
7 Katheryn Houghton, Bringing down drug prices: States target PBMs, BENEFITS PRO (July 1, 201)
8 Montana Pharmacy Benefit Manager Oversight Act, S.B. 395, 67th Legis. (2021)
9 See, e.g., An Act Relating to Healthcare, Ala. S.B. 227 (2021); Ga. SB 313 (2020); Ominbus health and human services finance bill, Minn. HF 2128 (2021)
10 President Biden, Remarks by President Biden on How His Build Back Better Agenda Will Lower Prescription Drug Prices, THE WHITE HOUSE, (Aug. 12, 2021)
11 Letter from Amy Klobuchar et al. to Xavier Becerra, (July 26, 2021).
12 Preserve Access to Affordable Generics and Biosimilars Act, S. 1428, 117th Cong. (2021), Affordable Prescriptions for Patients Act of 2021, S. 1435, 117th Cong. (2021); Prescription Pricing for the People Act of 2021,S. 1388, 117th Cong. (2021); Stop STALLING Act, S. 1425, 117th Cong. (2021), Michael Gallagher et al., Federal Lawmakers Turn Their Sights to Drug Pricing, Introducing a Package of Bills Seeking Changes to Antitrust and Patent Law, WHITE & CASE (May 25, 2021).
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