With 2023 state legislative sessions underway, some early prevailing themes are emerging. Usually, these early themes can forecast issue areas where we will see the most wins in a legislative year. Such trends are typically good predictors, but they are not always accurate. In 2022, we expected a big year for copay accumulator legislation that did not materialize, although we did have some significant wins on that issue. Will 2023 be the year of mandatory white bagging bans or copay accumulator bans? Only time will tell, but here is a brief look at some of the early legislation and trends we are spotting in state houses across the U.S.
Utilization Management
An early trend in utilization management legislation is cleanup bills that adjust details in bills that have passed with less-than-ideal language, such as approval timelines that are longer than desired. For example, legislation introduced in Maryland (HB 305/SB 308) would change the approval timeline from business days to calendar days. Such changes may seem small, but they can make tremendous differences in wait times for patients and lead to more timely access to care.
Prior authorization gold card legislation, which establishes a continuous prior authorization exemption for physicians who earn a 90% approval rate on requests for a given service over a period of six months, continues to be discussed in various state capitols around the nation. Notably, Kentucky has reintroduced gold card legislation that it considered last year. We will continue to work with our partners at the Kentucky Medical Association and the Kentuckiana Rheumatology Alliance to support the legislation.
We expect similar legislation to be filed in other states, but momentum behind these efforts has stalled, in large part because of the complexity of the implementation process in Texas, which passed a gold card bill in 2021. Operational challenges have emerged during the regulatory process there, especially related to pharmaceuticals. The Texas bill was the first of its kind, and a smooth path to implementation rarely exists for novel policy innovations. The ACR remains committed to working with our partners to come up with solutions to the difficulties that arose in Texas and to work toward rolling out these policies across the nation.
Copay Accumulator Bans
Copay accumulator legislation will once again be a hot topic in 2023. At the end of 2022, the rheumatology community scored two big wins with the approval of copay accumulator bans in Delaware and New York. A total of 16 states and Puerto Rico have enacted accumulator bans. These bills, which prevent restrictions on the application of patient assistance funds toward patient cost-sharing requirements, are critical to patients’ ability to afford the medications they need.
