State News

Maryland has passed a law authorizing the state Prescription Drug Affordability Board (PDAB) to set upper payment limits, according to Arnold Ventures. Upper payment limits determine how much state and local governments will pay for high-cost drugs. SB 202 / HB 279 will empower the Maryland PDAB to make these prescriptions more affordable for governments, and later make recommendations to the General Assembly on how to make drugs more affordable for all state residents.

New Mexico has passed a law to reduce consumer prescription drug costs, according to the Los Alamos Daily Post. Senate Bill 51 stipulates that insurers must apply any discounts enrollees
receive to their cost-sharing obligation for prescription drugs, ensuring that pharmacies pass on discounts to consumers.

A health equity analysis of data from Colorado’s APCD found that social factors such as income, housing, race, and education are strongly associated with potentially preventable visits to the emergency department, according to the Center for Improving Value in Health Care. In urban areas, all five social factors evaluated (income, education, employment, housing/transportation, and race/ethnicity/language) were all strongly correlated to greater preventable emergency department visits and adults not receiving preventive care. However, in rural areas, only income and education levels impacted potentially preventable emergency visits and only income levels influenced adults not getting preventive care. Statewide, the social factors analyzed did not show an impact on children and adolescents receiving preventive health care.

South Carolina policymakers passed legislation exempting feminine hygiene products from sales tax, reports The Hill. Approximately 200,000 women in South Carolina are impacted by period poverty, and the repeal of the tax aims to improve health care affordability and access for women across the state by reducing the financial burden of menstrual products.

Health care spending in Connecticut has eclipsed economic growth in recent years, according to Connecticut Public Radio. Spending increased 6 percent between 2020 and 2021, which exceeded the state benchmark target of 3.4 percent, and was driven primarily by increases in commercial health insurance spending.

The basic health program (BHP) in New York and Minnesota succeeded in helping low-income consumers access affordable care and reducing administrative complexity, but those results may not be replicable in other states, based on state-specific factors such as regulation and provider reimbursement, according to a report from the Urban Institute. While only two states implemented a BHP after the ACA was enacted, several states have recently begun considering their own programs: Oregon, Kentucky, Illinois, and West Virginia. However, the fiscal impact of a BHP can vary based on the coverage provided, Marketplace premiums, and provider reimbursement rates. One factor in New York’s success has been the state’s ban on age rating in the individual market. New York and Minnesota both reported stable markets with many insurers participating in their BHP, but it is difficult to predict how insurers in other states will react.

Oregon established Medicare reference-based pricing for hospitals for its state employee health plans in 2017, and a 2021 audit found over $112 million in savings, reports NASHP. Payments for in-network and out-of-network services are not to exceed 200 and 185 percent of Medicare reimbursements, respectively; average reimbursements went from 215 percent of Medicare reimbursement amounts prior to the legislation’s enactment in 2017, to 163 percent in 2021.

North Carolina has become the 40th state to expand Medicaid under the Affordable Care Act, according to The New York Times. This expansion will allow low-income residents to access free health insurance through the state’s Medicaid program, estimated to cover 600,000 people. The expansion will take effect once the state adopts a budget, which is expected by June.

A prescription drug transparency bill has been signed into law, requiring drug manufactures to disclose list prices of their medications in Wyoming, reports Wyoming News Now. The governor vetoed line items in the bill that would have required manufacturers to disclose the reasons for price increases and information on financial assistance for patients, citing too great a burden on small business pharmacies. Critics argue that this weakened version of the bill does not address the root causes of high drug prices and will not provide meaningful relief to consumers.