At least six states are currently considering accumulator legislation this session, including Florida, Texas and Washington. At least two additional states are in the drafting process, and more accumulator bills will undoubtedly be added as the calendar moves forward. The ACR is actively supporting copay accumulator legislation across the country and is planning media campaigns in specific states to support bills that have yet to be introduced.
Mandatory White Bagging Bans
Mandatory white bagging continues to be an issue of growing concern, particularly for rheumatologists in private practice. These policies require physicians to acquire provider-administered drugs through a preferred specialty pharmacy designated by a payer or pharmacy benefit manager (PBM).
White bagging bills have been filed in several states. Most of these efforts are being led by state hospital associations. The ACR is working with our partners to ensure that private practice physicians are included in the language of the legislation. The nation’s first white bagging ban, in Louisiana, largely excluded private practice physicians. Despite the ban being celebrated in the rheumatology community, it actually had very little impact on those in private practice who are most vulnerable to mandatory white bagging. We hope to avoid the same outcome in future legislation.
Despite the early flurry of bills banning white bagging, it is difficult to predict the odds for success. There was a similar level of activity last session, but the year ended with no significant wins on the issue. Our primary focus this year will be continuing to work to ensure the language includes providers. This is particularly important for this issue because it will be much more difficult to go back and correct language in these bills than in some other legislation.
Pharmacy Benefit Manager Reform
A trend from previous years that is continuing so far in 2023 is PBM legislation. We are continuing to see states address PBMs on an issue-by-issue basis, rather than taking up larger PBM reform packages. One issue on which we have seen a flurry of early activity is rebate pass-through legislation.
Rebate pass-through legislation requires a certain percentage of rebates collected by PBMs to be passed back to the consumer or health plan. The current bills that we are tracking are consumer-focused and require the consumer’s cost-sharing to be reduced at the pharmacy counter. The current trend is for that reduction to be 80% of rebates that a PBM is expecting to receive. A few notable examples of early rebate pass-through legislation are HB 343 in Georgia and SB 1425 in Virginia.
