The 2024 legislative session is progressing, with numerous bills of interest advancing in state houses across the country. The ACR is actively monitoring more than 60 pieces of legislation, focusing on such key issues as copay accumulators, utilization management reform, gold card programs and other emerging concerns. Despite this activity, significant legislative victories have been limited, with only two notable successes thus far this year.
Significant Advances on Utilization Management Reform
In New Mexico, significant progress was made with the passage of step therapy reform legislation (SB 135), signed into law by the governor. This legislation mandates a 24-hour response requirement for emergency step therapy exemption requests and a 72-hour response requirement for non-emergency requests. Although it incorporates most standard exceptions typical of state step therapy legislation, this bill lacks an exception for patients currently stable on medication. Nonetheless, this legislation marks a substantial advancement for patients and providers in New Mexico.
Another victory was in Wyoming (HB 14), where a comprehensive approach to utilization management reform was taken. The Wyoming bill enforces a 72-hour response requirement for prior authorization requests and introduces a gold card component. However, prescription drugs are exempt from the gold card provisions. Providers with a prior authorization approval rate of 90% or higher for a healthcare service over the previous year will receive a one-year exemption from prior authorizations for that service. The ACR has consistently supported prior authorization gold card initiatives and continues to explore ways to implement them effectively for prescriptions.
Gold Card Legislation
We are currently monitoring gold card legislation in five other states, with Alaska being particularly noteworthy due to companion bills in both the House and Senate. These bills include prescriptions in their gold card provisions, offering an opportunity to evaluate the feasibility of gold carding for prescriptions in smaller populations.
Copay Accumulator Bans
One anticipated trend at the start of the legislative session was the prevalence of copay accumulator legislation. Currently, we are tracking accumulator bans in 17 states, although none have been enacted yet. We remain optimistic about the potential progress in this area as the session continues.
Prescription Drug Affordability Boards
An emerging issue receiving significant attention this year is prescription drug affordability boards (PDABs), which conduct affordability reviews of expensive drugs within their state. Each PDAB selects around five drugs for review, but the rules governing their operations vary. Following review, PDABs can designate a drug as “unaffordable” and impose price caps on that drug. Even though the ACR has maintained a neutral stance on this legislation, it has cautioned against the potential negative implications of hastily implemented price caps. Although the ACR lacks specific policies on PDABs or price caps, it will continue to monitor these boards and develop necessary policies to safeguard patients and providers should they impact the rheumatology space adversely.
