State lawmakers will continue to focus on the cost of prescription drugs as the 2020 legislative season gets underway, potentially advancing measures to require the disclosure of manufacturer drug pricing information and bills to limit or eliminate the role PBMs play in state Medicaid programs.
However, the abbreviated length of the election-year legislative sessions, plus some unexpected hiccups in states that already have passed bills on those issues, could limit how much actually gets done at the state level in 2020, legislative observers say.
“We expect considerable action this year, but it is a short session in most states, which limits the number of bills that will be considered,” says Trish Riley, executive director of the National Academy for State Health Policy. “We expect to see bills that address prices, address price gouging [and] allow importation. Several states may advance bills to allow a buy-in to public programs and the ability to bulk purchase drugs.”
In recent years, state lawmakers have been looking into managed care programs and their drug spend, turning to their PBM contracts as a source of potential savings, says Matt Magner, director of state government affairs for the National Community Pharmacists Association. West Virginia, for example, decided in 2017 to carve out its pharmacy benefits from its Medicaid program, Magner says, noting, “they saved $54 million in the first year they did that.”
Still, the pace of state legislative action regarding PBMs may not be as brisk in 2020 as it was in 2019. Riley says that PBMs already have been the subject of considerable state action, so it’s not clear how many more states will consider bills on PBM issues in 2020. “We may see several more states eliminate or deeply regulate PBMs in Medicaid and develop more enforceable contracts to ensure discounts are passed through,” she says.
Drug pricing likely will stay in the news, says Jeff Myers, founder of OptDis, but he anticipates a slowdown in drug price transparency legislation, in part because states that have approved such legislation are running into roadblocks in implementation.