Too frequently, we gauge the rate of political progress solely based on what happens in Washington, D.C. Although what happens—or more frequently, doesn’t happen—in the nation’s capitol is an important barometer of the political environment, it doesn’t paint a complete picture. With gridlock only seeming to worsen on Capitol Hill, states are increasingly taking the lead on issues critical to our members and the field of rheumatology.
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In 2021, we made significant strides for ACR members at the state level. Seven states passed copay accumulator legislation, meaning 11 states now have accumulator bans. Five states passed step therapy reform, bringing the total to 30. Georgia and Oregon passed prior authorization reform. Additionally, Texas passed first-of-its-kind prior authorization gold card legislation, exempting providers with a 90% or higher approval rate from prior authorization requirements. In another first, Louisiana passed a ban on white bagging, an arrangement in which medications are sent from a payer-contracted pharmacy to the site of care for patient administration. Finally, Gov. Kathy Hochul signed New York’s non-medical switching legislation into law.
These are significant wins that mark sustained efforts to increase access for patients and decrease provider burden.
State legislation in the coming year will primarily focus on copay accumulator bans and white bagging restrictions. There are likely to be at least 15 states considering bans on copay accumulator policies in the coming year. Many of these will be bills carried over from the 2021 sessions. There is momentum behind this legislation, particularly because this is an election year.
As mentioned previously, Louisiana was the first state to pass a white bagging ban last session. The success there has generated interest in the legislation from state hospital associations and medical societies. More than 10 states are considering white bagging bans this year, including Ohio, Wisconsin, Minnesota, California and Kentucky. This degree of activity demonstrates the significant issues that white bagging policies cause patients and practices.
Another big development in the coming year will be the emergence of prior authorization gold card legislation in more states. We have been working with some state medical societies on these efforts and look forward to providing more detail on those efforts later in the year. There is considerable interest and momentum behind the gold card concept after the success of the Texas legislation last year. Additionally, the National Council of Insurance Legislators has had open discussions about this issue, and it was generally well received. We do expect robust opposition from the insurance lobby to emerging bills, so member engagement with your legislators will be especially important to help support this legislation.
Finally, pharmacy benefit managers (PBMs) and drug pricing will continue to be areas of focus for state legislatures this year. These once again appear to be mostly pared down, piecemeal bills. However, state efforts will be buoyed by recent wins in the Supreme Court (Rutledge v. PCMA) and the 8th Circuit Court of Appeals (PCMA v. Wehbi) that expanded the ability of states to regulate PBMs. The ACR filed amicus briefs with the Alliance for Transparent and Affordable Prescriptions (ATAP) that supported state regulations in both cases. Only time will tell how these legal wins will change how state legislatures choose to regulate PBMs, but as states gain more legislative and regulatory tools, the ACR’s work with ATAP and other partners will be important to help shape and monitor emerging state legislation.
Making a Better 2022
This year, it is more important than ever for you to engage with your legislators at the state and federal levels. At a time when everyone thinks they are a medical expert, legislators need to hear from the people who actually are. You can use our Legislative Action Center to let your voice be heard on the issues that matter most to you and your patients. If we can be of any assistance, email us at [email protected] and the relevant advocacy team member will respond to your inquiry. We are happy to help you engage on any issue confronting your rheumatology practice or your patients. On behalf of the entire ACR advocacy team, we hope you have a healthy, happy and successful 2022.
Joseph Cantrell, JD, is the senior manager of state affairs for the ACR.