PHARMACEUTICALS: Overview and NCSL Resources
Updated: June 25, 2008
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AT A GLANCE: Prescription drugs continue as one of the most active health policy issues for 2008. NCSL has followed the state aspects of these issues for a number of years.
Prescription drug spending is projected to reach $497.5 billion by 2016, more than double the expected drug spending level for 2006. CMS researchers predicted that prescription drug spending will grow at an average annual rate of 8.6 percent until 2016, as increases in the generic drug dispensing rate levels off, new drugs to treat cancer and other diseases are approved, and drugs already on the market gain approval for new versions or treatments. Drug spending in 2006 was expected to grow 6.5 percent. Implementation of Part D has increased prescription drug use among beneficiaries who previously had limited or no drug coverage. However, the expected increase as a result of Part D is anticipated to be offset by a deceleration in drug price growth. (CMS Office of the Actuary, release 2/21/2007). |
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In 2006, 63 percent of all prescription drugs dispensed in the United States were generics -- a 13 percent increase from 2005. That is due in part to patent expirations for several brand-name drugs. (Center for Medicine in the Public Interest, October 2007)
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Spending on anti-depressants, anti-psychotic drugs, drugs to reduce cardiovascular risk, treat pain and insomnia was $127 billion in 2005 and was nearly two-thirds of the total $199 billion spent on all outpatient prescription medicines (Agency for Healthcare Research and Quality, February 2008)
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$36 billion for prescription drugs to lower blood sugar, reduce cholesterol, or treat other metabolic problems.
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$33 billion for drugs to reduce high blood pressure and treat heart conditions.
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$26 billion for central nervous system drugs, including pain killers, sleep aids and attention-deficit disorder drugs.
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Anti-depressants and anti-psychotic drugs cost $17 billion,
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gastrointestinal drugs, including antacids and laxatives, cost consumers $15 billion.
As of Spring 2008, at least 38 states had passed some type of state pharmaceutical assistance law and four others had executive agency initiatives, for a total of 42 states with assistance programs enacted or authorized. 2 Most use state funds to help pay for a portion of the cost of pharmaceuticals for eligible residents who meet age and income criteria. Some states also have established cost-sharing features including co-payments, annual enrollment fees, or monthly limits.
Other states are operating or authorizing broader discount programs aimed at assisting people lacking private insurance, or even the general consuming public. In separate actions, all 50 states have adjusted Medicaid pharmaceutical policy in the past six years. NCSL now has more than 70 reports and presentations on pharmaceuticals, most of which are online and listed below.
RECENT MATERIALS & ACTIVITY:
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Hear about three programs that are up and running in a growing number of states.
- Prescription Drug Monitoring Programs help medical professionals prevent misuse and abusers from obtaining prescriptions fraudulently before the police knock on the door.
> Speaker: Sherry Green, National Alliance for Model State Drug Laws, Alexandria, VA.
- The federal 340B Drug Pricing Program helps over 12,400 qualified health centers, clinics and hospitals provide comprehensive pharmacy services for over 10 million patients.
> Speaker: Lisa Scholz, HRSA Pharmacy Services Support Center, Washington, DC.
- Medication Therapy Management (MTM) programs allow pharmacists to provide in-depth counseling to insure that patients get the full benefit of chronic prescribed drugs.
> NCPA spokesperson.
> Marjorie Powell, Senior Assistant General Counsel, PhRMA, Washington, DC. |
- 2008 Prescription Drug State Legislation - NCSL's latest report on bills and resolutions in 41 of the 44 states in session in 2008; law have been signed in at least 13 states and DC. Updated June '08
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"E-PRESCRIBING: MISSIVES FROM THE FRONT" - New Hampshire, Mississippi and Florida are just three of the states that are seeking to prevent medical errors by expanding the use of e-prescribing. 1/08. |
These web documents include information on laws and initiatives to provide state subsidies, as well as discounts, bulk purchasing, price regulation and other regulatory and funding policies, including state Medicaid and Medicare activities:
- PRESCRIPTION DRUG STATE LEGISLATION - Each year since 1999 NCSL has compiled and published the most comprehnsive tracking report of bills and resolutions affecting pharmaceuticals. The reports are updated regularly, including final outcomes at the end of each calendar and session year.
- State Pharmaceutical Assistance Programs, 2008 edition - features tables summarizing all current and recent historical state subsidy and discount programs, for seniors, disabled, uninsured and others. Updated regularly. [22 pages]
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- Generic Drug Pricing and States: $4 drug promotions - NCSL report, updated 6/08.
- Medicare Prescription Drug Coverage: NCSL Tools for State Legislatures - NCSL overview, updated 2/08.
- Medicaid Prescription Drug Laws and Strategies, 2001-2008 - reposted 3/08. [18 pages]
- "State Pharmaceutical Discount Programs for Residents Under Age 65" - NCSL report, updated 12/07.
- Prescription Drug Bulk Purchasing, 2008 edition - material on state initiatives, both multi-state and inter-agency. Updated 2008.
- Prescription Drug/Pharmaceutical related stories from State Health Notes, an NCSL publication, updated regularly 2008.
- States and the 340B Drug Pricing Program - NCSL resource report, updated 2008
- Marketing and Direct-to-Consumer Advertising of Pharmaceuticals, 2001-07 - an NCSL report and chart of state legislation, updated 2007.
- "Medication-Assisted Treatment for Opiate Addiction" (MAT) - published by NCSL's DC staff, for 2008.
- Prescription drug emergency controls, scams and hoarding - This report analyzes retail, wholesale and Internet purchases and potential fraudulent, counterfeit or illegal transactions, with a special flu vaccine update. Updated 2007.
- Pharmaceutical Benefit Management (PBMs): Roles and Regulation by the States - PowerPoint slides by NCSL staff Richard Cauchi, as presented to NCOIL (National Conference of Insurance Legislators), Savannah, GA, 6/29/07.
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Prescription Drug Monitoring Programs - NCSL resources by Criminal Justice Program & Health Program, 2008
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RX at NCSL's Annual Meeting in Boston: Achieving Pharmaceutical Access: The Roles of Disclosure and Privacy August 6, 2007 hosted by the Health Committee. Most Americans rely on the private market for their medicines. This session will examine two hotly-debated prescription drug policies facing states and pharmacists. First, should precription records identifying doctors or patients be available for marketing purposes by industry professionals? Second, should states set standards for Pharmacy Benefit Managers (PBMs), the middlemen that negotiate prices and transactions for 200 million Americans
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Welcome/Introduction: Senator Leticia Van de Putte, Texas Senate; NCSL President
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Presiding: Senator Durell Peaden, Florida; Vice-Chair, NCSL Health Committee
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Donna Boswell, Hogan & Hartson, Washington DC | PowerPoint 
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Representative Cindy Rosenwald, New Hampshire; Chair, NH Health and Human Services Committee | PowerPoint
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Barbara Levy, Pharmaceutical Care Management Association (PCMA) | PowerPoint
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Mark Riley, Vice President, National Community Pharmacists Association (NCPA), Arkansas | PowerPoint
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"POINT-COUNTER POINT: SHOULD STATES REGULATE DATA MINING?" - a transcript excerpt from the session, published in State Health Notes - 9/4/07.
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Update on State Actions Related to Medicare Part D Prescription Drug Coverage, Rx Sessions at NCSL Fall Forum in San Antonio, Texas - December 7, 2006.
On January 1, 2007, the second year of Medicare pharmaceutical benefits begins. Many states continue to play a significant role for seniors and persons with disabilities needing medicines - by providing "wrap around" subsidies for premiums and coverage gaps, by problem-solving and by sponsoring programs for those not eligible for Medicare. New commercial plan designs, questions about state "clawback" payments, Medicaid program responses and possible actions in Congress all loom as legislators prepare to tackle state pharmaceutical budgets and policy. Hear four experts share the latest news and trends.
- Steven McAdoo, Deputy Regional Administrator, Centers for Medicare and Medicaid Services (CMS Region 6), Dallas, Texas | PowerPoint [3.8 Mb]
- Joy Johnson Wilson, Health Policy Director, NCSL staff, Washington, DC
- Richard Cauchi, Health Program Director, NCSL Staff, Colorado | PowerPoint PDF
> "Are our Drugs Safe Enough? A look at Counterfeits, Unapproved Products and Prescribing without Mistakes
International and domestic prescription drug counterfeiting has become a visible policy issue, as suspect copies of drug products have been increasingly confiscated by the FDA. At the same time, consumers read that "hundreds of unapproved drugs made in the US are sold by prescription." Learn what some states are doing, from requiring wholesale product "pedigrees" to demanding legible records, to assure that pharmaceuticals are both safe and accessible.
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Annual Meeting Rx Sessions - held August 16, 2006 in Nashville, TN.
- "Medicare Prescription Drug Coverage and the States" - Even with the Medicare Part D Program well underway, states continue to play important roles in prescription drug coverage for millions of low-income people. In addition to supplementing the new federal coverage, many states are modifying their State Pharmaceutical Assistance Programs and making adjustments to Medicaid and other Rx programs.
* Vernon Smith, Principal, Health Management Associates, Lansing, Michigan PowerPoint Online | html
* Assemblymember Richard Gottfried, Chair, Assembly Health Committee, New York State * Gloria Parker, Associate Regional Administrator, Centers for Medicare and Medicaid Services, Region Four, Atlanta, Georgia PowerPoint * Edward Belkin, VP for Communications and Public Affairs, Pharmaceutical Research and Manufacturers of America, D.C. PowerPoint * Moderator: Senator Judy Lee, North Dakota - "Prescription Drug Discounts: from 340B to Consumer Cards." - For the 40+ million Americans not on Medicare or comprehensive private insurance, access to prescription drugs remains a visible concern. The federal 340B drug discount program provides one significant option - including a fast-expanding network of clinics and pharmacies in every state. In addition, user-friendly industry-sponsored assistance cards and new state discount laws keep pharmaceuticals near the top of policymakers' priority lists.
* Harry Hagel, Senior Director, HRSA Pharmacy Services Support Center, Washington, DC PowerPoint
* Roba Whiteley, Executive Director, Together Rx Access, Alexandria, Virginia PowerPoint | html
* Moderator: Senator Renee Unterman, Georgia
- Discount Card Programs, Public and Private - NCSL summary of programs and links.
Prescription Drug Laws in Maine - Health Program.
MMA- MEDICARE MODERNIZATION ACT:
- "Part D Decisions" for State Retiree Health Programs - State Legislatures magazine, published September 2006 [NCSL member password required]
- "States' Rx for Medicare Gaps" pdf / html - State Legislatures magazine, March 2006
Some states have made long-term commitments to help low-income citizens pay for their out-of-pocket costs for Medicare Part D.
- Medicare Prescription Drug Coverage: NCSL Tools for State Legislatures Resources and information for legislators from CMS and NCSL on Medicare Part D. Updated 2006.
- CMS 2006 Fact Sheets- Update for State and Local Government Officials Medicare Part D Implementation updated regularly
- State Transitional and Emergency Coverage for Medicare Part D updated 3/06.
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NCSL'sWeb-Assisted Audioconference on “Legislators and Medicare Prescription Benefit” November 17, 2005
CMS slides by Leslie Norwalk, Deputy Administrator, CMS- http://www.ncsl.org/slides/health/norwalkslides_jpg_files/frame.htm
Rep. Boyd/NCSL slides- http://www.ncsl.org/slides/health/boydslides_jpg_files/frame.htm
- NCSL Legislative Tools for Medicare Prescription Drugs - Resources and information for legislators from CMS and NCSL on Medicare Part D.
- Medicare Part D: Latest State Updates NCSL SPRING FORUM- RX Session: held Friday, April 7, 2006 in Washington DC. As part of their ongoing efforts to help Medicare beneficiaries understand Part D, states often are reshaping or creating State Pharmaceutical Assistance Programs to provide additional wrap-around support for Part D enrollees. States are looking at Part D's impact on Medicaid prescription drug programs, including preferred drug lists and rebates. Learn about current state legislative activity on prescription drugs related to Part D and hear from the federal government about key implementation issues affecting states. Speakers:
* Joseph Fine and Cora Tracy, [PowerPoint / slides] - Centers for Medicare and Medicaid Services, Baltimore, MD.
* Richard Cauchi and Donna Folkemer, [PowerPoint / slides] -NCSL staff Directors, Denver and Washington, DC.
More NCSL Reports 2003-2005
- Frequently Asked Questions: Prescription Drugs - Published by the NCSL Forum for State Health Policy Leadership, spring 2005.
- States and the Medicare Pharmaceutical Law: Resources for State Policymakers. A quick compendium of NCSL-related resources including PowerPoint presentations, audio transcripts and related reports. Updated regularly.
- NCSL Federal Affairs Resources regarding the MMA prepared by NCSL and CMS, updated regularly.
- NCSL Summary of MMA, updated 12/04 -prepared by NCSL Federal Affairs Counsel. see Federal Register 1/28/05.
- MMA: Part D and SPAPs. PowerPoint slides by CMS staff member Marge Watchorn, Pharmacy Division, for NCSL audio-conference, 2/14/05.
- 2004 State Pharmaceuticals: Medicare State Adjustment Legislation- by NCSL, 1/05.
- Medicare Pharmaceuticals: Three Weeks to D-Day NCSL's FALL FORUM, CHICAGO IL - December 8, 2005
With Medicare Part D benefits and requirements about to affect tens of millions of Medicare beneficiaries, learn about the latest plans and implementation steps from hands-on experts. The session covered updates on resources and policies from CMS, and examples of state responses and activities.
- Presenters: Peter Leonis, Intergovernmental Affairs Specialist Centers for Medicare and Medicaid Services (CMS) Chicago Region V Office
- Scott McKibbin, State of Illinois Special Advisor for Prescription Drugs
- Senator Judy Lee, North Dakota Senate [PowerPoint]
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Rx presentations at NCSL 2005 Annual Meeting in Seattle, Washington, August 18:
- Achieving Access to Prescription Drugs: Changing Roles for the States,
- Carol Crimi, MMA, Centers for Medicare and Medicaid Services [PowerPoint]
- Thomas Snedden, Executive Director, PACE Program, [PowerPoint]
- Senator Jon Tester, Senate President, Montana [Handout on MT SB 324]
- Chiquita White, Manager, Medicaid Practice, Avalere Health [PowerPoint]
- Science and Money: Biomedical Research and Economic Development,
- Patrick Kelly, VP, Biotechnology Industry Organization (BIO) [PowerPoint]
New State Laws on Rx Promotional Spending Limits and Price Disclosures. PowerPoint slides by Karmen Hanson, NCSL staff, 1/26/05.
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Prescription Drugs: Issues for the States in 2005 - PowerPoint slides by Donna Folkemer, NCSL staff for Governing Magazine, 2/2/05.
- NCSL Health Conference features Medicare Rx law updates (December 8, 2004):
> Medicare Part D and Implications for Medicaid - opening plenary by Donna Boswell.
> Impact of Medicare law on States as Employers and Plan Sponsors - by Derek Guyton & Jean Schumacher - Mercer Human Resources Consulting. [pdf format]
> NCSL Resolution Adopted by the Task Force on Medicaid from the Fall Forum of the NCSL Standing Committees, December 10 2004, Savannah, Georgia. Includes NCSL action comments on dual-eligibles and the "clawback" payments within the Medicare Modernization Act.
> Medicare, Medicaid and the Role of the States (part 1) by Donna Folkemer.
> Medicare, Medicaid and the Role of the States (part 2) by Richard Cauchi. PowerPoint from NCSL Health Chairs 12/7/04. [pdf format]
What's the Benefit?" - States and the Medicare Law. Article in State Legislatures Magazine July/August 2004. (NCSL Members-Requires password)
- Medicaid:
- "Pharmacy Plus" Medicaid Waivers: A growing number of states are able to combine state and federal funds to subsidize prescription drugs for seniors not eligible for traditional Medicaid.
- "Pharmacy Plus: The Perfect Cure?" State Legislatures magazine article, Feb. 03 [members only, password required].
- "Medicaid Pharmaceutical Copays" Completed for the National Conference of State Legislatures and the Kaiser Commission on Medicaid and the Uninsured, by Health Management Associates. 2004.
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- "Coming to the Aid of Veterans by Providing Discounts" article on state laws for repackaging Rx for LTC facilities, 8/05 [State Health Notes password required]
- 50 State Summary of Disease Management Laws laws in 25+ states.
- States Where Pharmacists Have the Authority to Immunize: A 50 State Snapshot showing laws of immunizations and pharmacists, 2004.
- Prescription Drug Abuse, 6/30/05.
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50 State Summary of Emergency Contraception Laws- compiled by NCSL Maternal and Child Health Project, May 2005.
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Non-NCSL Resources:
Prescription Drug Resources for 2007 - A selection of additional reports from government, academic, industry and consumer sources, including 50+ direct web links, updated regularly. Note: NCSL provides links to other Web sites for information purposes only. Providing these links does not indicate NCSL's support or endorsement of the site.
NCSL Archive Reports:
(Items three or more years old that may still be of interest)
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NCSL 2004 Annual Meeting Featured 3 Pharmaceutical Sessions:
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Health Care Cost Solutions, 7/20/04
PowerPoint by John Santa of Oregon ~ PowerPoint by William von Oehsen of DC
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Affordable Pharmaceuticals: Medicare and the States, 7/22/04- View full video webcast of speakers, courtesy of KaiserNetworks.org
PowerPoint by Robert Perkins, Executive Director, Together Rx Card
Powerpoint by Vern Smith, Principal, Health Management Associates, Michigan
PowerPoint by Joan Henneberry, Chair, HHS Prescription Assistance Commission
PowerPoint by Paul Reinhart, Medicaid Director, Michigan
- E-Pharmacies: Consumer Protection and Regulatory Challenges slides by Kevin Nicholson, National Association of Chain Drug Stores, Virginia, NCSL Spring Forum, RX Session: April 30, 2004. Sponsors: NCSL Communications, Technology and Interstate Commerce Committee; NCSL Health Committee)
The ability to shop over the Internet provides great benefits as well as challenges. With the proliferation of Net pharmacies, regulators and medical professionals are concerned about proper medical supervision and quality control. [link updated 2006]
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Pharmacotherapy Treatment of Alcoholism and Drug Addiction: Overview and Bibliography, 12/31/04.
- "Prescription Drugs: Latest News, Latest Views" - This session at the NCSL Health Leaders Forum in Washington, D.C. in December 2003 examined pharmaceutical safety, counterfeiting and reimportation. Featured presenters include State Senator Jarrett Barrios (MA) - (PowerPoint), Moira Gibbons (National Association of Boards of Pharmacy- PowerPoint), and John Taylor (PowerPoint) and Peter Pitts (comments in Word) from the Food and Drug Administration (FDA), with Rep. William Devlin (ND) as moderator.
- Challenges and Solutions in Pharmaceutical Spending - session at NCSL Annual Meeting (San Francisco, CA, July 22, 2003): --As states seek to provide access to pharmaceuticals while containing costs, preferred drug lists, pooled purchasing and state-sponsored discounts are receiving attention. This session analyzed the strengths and weaknesses of new approaches to drug coverage.
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- Speakers:
Representative Eileen Cody, Washington House; Chair of Health Care Committee. [PowerPoint]
- Senator Catherine Cook, Deputy Minority Leader, Connecticut Senate. [PowerPoint]
- Representative David Lemoine, Maine; Chair, National Legislative Association on Prescription Drug Prices (NLARx). [PowerPoint]
- Prof. Frank R. Lichtenberg, Graduate School of Business, Columbia University, New York. [PowerPoint]
2001-2002 State Senior Pharmaceutical Subsidy Legislation - tally of bills in the two dozen states that did not have a prescription drug subsidy program.
2001 Prescription Drug Discount, Bulk Purchasing and Price-Related Legislation - an archive tally of bills filed for the 2001 sessions, by the Health Program. Reposted 2006.
1999-2000 Prescription Drug Discount, Rebate, Price Control and Bulk Purchasing Legislation, 1999-2000 - An archive history of 1999-2000 proposals, successful and unsuccessful, in 25 states. Reposted 2006.
It's Everyone's Battle -NCSL news release about the March 2002 State Legislatures cover story.
"Pharmaceutical Discounts: State Program Opportunities under the Federal 340B program" - Annual Meeting session. Suggested resources and handouts:
Jimmy Mitchell, Director, Office of Pharmacy Affairs discussion with NCSL, August 13. 2001 (PowerPoint).
Pharmaceutical Discounts Under Federal Law: State Program Opportunities August 10, 2001 - a comprehensive report by Bill von Oehsen on opportunities and obstacles for state drug assistance programs to utilize federal drug discount programs. The report is a resource tool for anyone drafting or evaluating state legislation to address the needs of consumers, government and institutions for affordable drugs. (48 pages printed)
"The Double Life of OxyContin - Miracle pain killer and dangerous narcotic?" - published 2/02.
State Pharmacy Assistance Programs in 2001-02: Crafting New Approaches and Building on Old Ones; NCSL's fall Health Policy Conference featured this session in Seattle, Washington. The webcast of the session is available here: also you may print out a transcript (24 pp.) and overhead slides, from 11/01.
New England Tackles High Drug Prices - State Legislatures article 5/00.
Internet Pharmacies - A Survey of Legislative Activity - AFI Committee, 2000.
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