2024 State Legislative Preview

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Across the country, state legislative sessions have begun. The ACR is already hard at work with our partners, ensuring  the voice of the rheumatology community is heard as legislators are considering healthcare legislation. Here is a look at some of the bills we are already monitoring and the trends we expect to play out over the 2024 legislative calendar.

Copay Accumulator Bans

State copay accumulator legislation will continue to be a key component of our state legislative priorities in 2024, and we expect to see a flurry of activity around this issue. These laws prevent payers and pharmacy benefit managers (PBMs) from excluding manufacturer copay assistance from counting towards patients’ annual deductibles or out-of-pocket maximums. Without this legislation, patients may face unexpected financial burdens, hindering their ability to afford essential medications.

We expect accumulator ban legislation to be considered in at least 16 states this year. So far, 20 states and Puerto Rico have enacted bans. Most of the legislative activity will be in states that have previously considered bans but have not enacted them for a variety of reasons. These states include Wisconsin, Missouri, Ohio, Michigan and Florida. If history serves as a guide, we can expect to see wins in a couple of states by the end of the legislative session. However, that is not guaranteed, and the rate of adoption is  slower than we would like to see on this issue.

PBM Reform

In 2024, we are noting the continuation of a recent trend: More states are addressing PBMs on an issue-by-issue basis, rather than taking up larger PBM reform packages. Some of this is because a lot of progress has been made at the state level on PBM reforms already. The prevailing trend we see early on is that there again seems to be a lot of 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 the 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. Most require 80% of rebates that a PBM is expecting to receive to be passed through to the patient at the pharmacy counter, but the amount will vary from state to state. In Georgia, for example, HB 343 only requires 50% of the rebate to be passed through to the patient at the pharmacy counter. The ACR will continue to work with our partners to support rebate pass-through legislation across the country so that patients can more easily afford and access the medications they need.