“The Year That Could Have Been” might be an apt title for any retrospective piece about 2020, but especially so regarding legislative affairs. Typically, years of work go into laying the foundation for policy change. Despite the focus on final votes, much of the work is done far in advance of those headline-grabbing roll calls. Days and nights spent away from families to build coalitions; in untold numbers of meetings with partners, legislators and the opposition; and on phone calls—these countless hours of behind-the-scenes work are needed to move toward the single inflection point of pass or fail. That slow build is what makes 2020 so frustrating from a legislative perspective.
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Interrupted Sessions & Shifting Agendas
Going into the year, we were anticipating movement in states on many key issues, such as utilization management reform and pharmacy benefit manager (PBM) regulations. One hundred fifty-eight bills relating to PBM regulations, 61 on drug supply chain pricing transparency and 69 relating to coupons and cost sharing had been filed. The groundwork had been laid for 2020 to be a very important year for state legislative activity.
However, those expectations were dashed as legislators shifted their focus to gaping budget holes, policy problems surrounding COVID-19, emergency licensing for healthcare providers and myriad other emergency items that no one anticipated late last year. Almost no area of life has been left untouched by COVID-19, and state legislative sessions were no exception.
Forty-two states experienced an interruption or delay in the legislative session stemming from concerns over the virus, and agendas shifted dramatically. Of the 69 coupon and cost sharing bills introduced, eight have been signed into law. Five of those only apply to insulin prescriptions. Of the 158 bills seeking new regulations on PBMs, only 19 have passed, with Georgia being the only state to pass something resembling the sweeping reform that was not uncommon only a year ago. And of the 61 transparency bills, only two have crossed the legislative finish line.
There has been one bright spot of legislative activity. We were expecting to see as many as five states pass utilization management reform; to date three—Louisiana, North Carolina and South Dakota—have passed significant step therapy reform bills. We are still working to get step therapy reform passed in Massachusetts. We remain hopeful, although a victory is far from certain.
Outside step therapy, the remaining statistics reflect part of the extensive toll of COVID-19. The work, the energy and momentum to move pieces of legislation vanished in light of the health emergency, seemingly in an instant. Like many healthcare facilities, our legislatures were overwhelmed and consumed by the response to the pandemic.