The states that received the lowest scores were Idaho (42/150), Mississippi (39/150), South Carolina and Nevada (both 38/150) and Wyoming (37/150). All five earned an overall letter grade of D.
South Carolina, Wyoming and Mississippi were among the lowest in the 2018 report card, along with Alabama and Oklahoma.
This year’s report card recognizes Oklahoma as the most improved state, moving to an overall C grade vs. D in 2018. Its score went up by 31 points, and it moved from the lowest scoring state to a ranking of 20th place in 2022. Oklahoma is one of only 13 states that have passed laws to ban state-regulated insurance plans from using copay accumulators. These accumulators are used by insurers and PBMs to prevent drug manufacturer copay assistance coupons from counting toward a patient’s deductible and maximum out-of-pocket spending.
Oklahoma and Louisiana were the only two states to see an increase in their grades.
This year’s lowest ranking state, Wyoming, had an F for both access and affordability, and a C for activity. The state can improve these areas by passing legislation that promotes PBM transparency and preventing insurers from implementing step therapy, prior authorization, copay accumulators and specialty tiers, Ms. Givens says.
Access, Affordability, Activity
Looking further at grades given by category, states are a mixed bag in terms of access. While New York received an A, most other states earned a B, C, or D. South Carolina, Nevada, Utah and Wyoming all earned an F for access.
The report card points out the stark difference in some states regarding the number of rheumatologists working there. In Massachusetts, there is one rheumatologist for every 19,000 people; in Wyoming, it’s one rheumatologist per 156,611 people. The overall average is one rheumatologist per 40,000 people, according to the report. A lack of health insurance also remains a problem for many with rheumatic diseases.
This year’s lowest ranking state, Wyoming, had an F for both access & affordability, & a C for activity.
Under affordability, many states received a D or F—in fact, 20 states received an F. This is often due to “exorbitantly expensive” prescribed treatment costs. Although some states have made changes to reform PBM practices since 2018, fewer than half have put limits on insurers’ use of specialty tiers or prohibited the use of copay accumulator programs that leave patients with higher out-of-pocket costs. Louisiana received the only A for affordability. A handful of other states received a B.
