Florida passed a sweeping drug-pricing reform package. It is the most ambitious state level PBM reform package in recent years. The Florida legislation also included a 100% rebate pass-through provision and banned pharmacy claw backs, pharmacy steering, payer-mandated online pharmacy ordering and spread pricing. What makes the Florida legislation so unique is its regulation of manufacturers. Under the new requirements, pharmaceutical manufacturers will be required to submit reports to the state if the wholesale acquisition cost increases by 15% over the previous 12 months, or by 30% over the previous three years. Reports will have to include some justification for the price increases, and the information will be shared publicly.
The Florida legislation could mark a shift in the drug-pricing conversation. PBMs are and will likely remain a target of state and federal legislators for the foreseeable future. However, this could signal the beginning of a more holistic evaluation of the drug supply chain. Although that is yet to be determined, we can be sure that states will continue to seek innovative approaches to address the drug-pricing problem, especially if reform efforts in Washington, D.C., continue to stall.
Copay Accumulators
The issue of copay accumulators is a confounding one. It is an issue that seems primed to move, especially because it can immediately improve patients’ ability to afford their medicines. We have tracked 16 bills being considered in 13 states. So far, only Colorado (SB 195) and New Mexico (SB 51) have passed legislation, and the Colorado legislation has not yet been signed by the governor. Pending a signature on the Colorado bill, that will bring us to 16 states and Puerto Rico with accumulator legislation.
Although there are some potential wins on this issue that could still come later in the year, the progress on copay accumulator ban legislation remains surprisingly slow. There are a lot of reasons for this slow rate of progress. The most likely is that payers, and in some cases plan sponsors, have gotten better at defending the programs. Also, the uncertain fiscal environment makes legislators less inclined to approve legislation that might impact the bottom line of companies operating in their state.
Despite the slow rate of progress, the ACR remains committed to the issue at a federal and state level. The legislative process is typically a long slog, not a quick sprint, even on issues that seem like they should move fast. Even experienced advocates forget this from time to time. The process can take years, and sometimes we get excited for what could be quick and easy wins on important issues. We must remind ourselves that rarely happens and settle back into our marathon mentality. The wins will continue to come, but like many of our other issues, they will take time and persistence.
