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AT A GLANCE: Prescription drugs continue as one of the more active health policy issues in 2016-2018. NCSL has followed the state aspects of these issues for a number of years.
As reported in 2016, the United States spends more than $320 billion dollars on prescription medicines annually. Total spending on drug therapies is about $371 billion dollars, including over-the-counter (OTC) drug remedies, valued at 31 billion.
2018 Prescription Drug Legislation Database - NCSL's state legislation online database tracks major policies affecting prescription drugs and biologic medicines. The features allows policymakers to view more than 3,500 filed bills across all 50 states and D.C., according to specific topics such as pharmaceutical patient access and affordability, specialty pharmaceuticals, compounding pharmacy regulation, Medicaid and health insurance coverage and reimbursement, and the right-to-try investigational drugs for the terminally ill. This first-in-the-nation state resource is available free to all NCSL members, including the full text of any bill. All users, including the public, can search by state, bill status, and any of 10 topics, using simple check boxes.
LATEST NCSL REPORT - February 23, 2018
A new report Prohibiting PBM “Gag Clauses” that Restrict Pharmacists from Disclosing Price Options - Recent State Legislation 2017-2018 is being released this week focusing on consumers being charged higher prices beacuse pharmacists are not allowed to offer options to patients with health insurance. The NCSL report is the basis of a New York Times, article printed and online Sunday 2/25/2018: Why Your Pharmacist Can’t Tell You That $20 Prescription Could Cost Only $8. Connect to the NCSL report.
In the dozen years between 2001 and 2012, at least 38 states had passed some type of state pharmaceutical assistance law.2 However, the number of operating programs is on the decline, due to Medicare Part D benefits and expanded discounts available under the Affordable Care Act, starting in 2011. 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 decade. NCSL now has more than 40 reports and presentations on pharmaceuticals, most of which are online and summarized below.
RECENT NCSL MATERIALS & ACTIVITY:
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BIOTECHNOLOGY AND STATE ROLES - NCSL live session at Summit in Boston - August 8, 2017.
Biotech research is growing fast. In Massachusetts, more than 63,000 biopharma employees are working on more than 1,600 potential new medicines. Learn how new models for pricing and research are hoping to bring down the cost.
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2017 Recent State Pharmaceutical Laws to Watch: An Interim Progress Report, NCSL, June 2017 - PDF *NEW* coming soon!
- 2015-16 Legislation Related to Cost Transparency of Prescription Drugs, by NCSL | Nov. 2016 update - PDF
- "Increases in Drug Spending Slow" - [PDF | HTML] Top trends article in NCSL State Legislatures Magazine, April 2017.
- "Costly Cures:" Hep C Sets the Bar -"Effective but very expensive drugs are forcing state Medicaid directors to make some tough decisions. NCSL State Legislatures Magazine, February 2017.
- Regulating Compounding Pharmacies - NCSL LegisBrief, Nov. 2016 - (Member password or payment may be required)
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"Prescription Drugs and Costs" Aug. 9, 2016. - Live session at Legislative Summit, Chicago
Summary: Break-through products such as biologics and specialty drugs promise extended lives or first-ever cures for individuals. Yet some price tags in this $310 billion U.S. market have shocked those who foot the bill – including state governments, Medicaid, employers, health insurers and patients themselves. States are considering a variety of legislation to rein in costs, assist consumers or shift the burden. Terms such as "medically necessary," "medication adherence," "fail first," "preferred drug lists," "value-based purchasing" and "interchangeable biosimilar substitution" make state capitals sound like pharmacies. Hear state and medical experts sort out the headlines, the noise and the results so far. Download speaker and session resources:
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State Laws and Legislation Related to Biologic Medications and Substitution of Biosimilars. At least 35 states have established new standards for substituting interchangeable biologics. Updated for summer 2017.
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Medicaid Prescription Drug Laws and Strategies. NCSL overview and state examples. Updated for 2016 - A top-10 popular health resource-
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States and Specialty Pharmaceuticals: 2015-2016 - NCSL Overview online. A Pew Charitable Trusts funded project.
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State Laws and Legislation to allow "Right to Try" unapproved medications for terminally ill patients. - A summary review, updated 2017
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State Medical Marijuana Laws - Find out the latest state legislative activity in regards to medical and adult-use marijuana. Updated 2017.
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State Prescription Drug Return, Reuse and Recycling - Operational laws aiding patients in a dozen states; enacted measures in 30 others Updated March 2017.
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States and Compounding Pharmacies - NCSL Overview online. A Pew Charitable Trusts 2015-7 funded project.
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Medication Adherence: Taking Pills Safely as Ordered. NCSL online resource, updated Match 2016
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Medication Therapy Management - combining Health, Safety and Savings. - NCSL Overview and state examples, updated September 2016
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State Pharmaceutical Assistance Programs - features tables summarizing all current and recent historical state subsidy (SPAP) and discount programs, for seniors, disabled, uninsured and others. Updated periodically; 2015. [22 pages].
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Health Care Reform: A Pharmaceutical Perspective on State Responses - Slide presentation by NCSL, February 2013.
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Medicaid Preferred Drug Lists (PDLs) for Mental Health and Substance Abuse - 50-state research summary by NCSL, posted April 2012.
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Medicare Prescription Drug Coverage: NCSL Tools for State Legislatures - NCSL overview, updated 2016.
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Resources for Prescription Drugs and Cost Containment. Part of the NCSL's Health Cost Containment and Efficiencies series, updated 2017.
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Use of Generic Prescription Drugs and Brand-Name Discounts - PDF File - Initially published by NCSL, June 2010
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Prescription Drug Agreements and Volume Purchasing (Preferred Drug Lists, Rebates, Multi-state Purchasing and Effectiveness Review of Medicine) - PDF File - Published by NCSL, June 2010.
NCSL In the News:
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Absent federal action, states take lead on curbing drug costs. As Congress stalls on what many voters say is a top health concern — high pharmaceutical costs — a growing number of states are trying to tackle the issue themselves. Despite often-fierce industry opposition, Maryland, California, Nevada, New York and Vermont have passed legislation meant to undercut skyrocketing prices. “There is a noticeable uptick among state legislatures and state governments in terms of what kind of role states can play in addressing the cost of prescription drugs and access,” said Richard Cauchi, health program director at the [NCSL]. Washington Post, Oct. 2, 2017
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Drug Price Transparency Laws-may-not-drive-down-spiraling-costs-for-consumers. NCSL cited, "Proposals in other states have included requiring pharmaceutical companies to report closely held research and development costs to government agencies, creating pharmaceutical review commissions and allowing government health programs not to cover certain high-priced drugs. Most of the measures have stalled this year, except in California, New Jersey and Pennsylvania, according to [NCSL]. Supporters of such legislation attribute their failure to proceed in most states to strong pressure from the pharmaceutical industry." KQED media.
- "Angry Over Drug Prices, More States Push Bills for Pharma to Disclose Costs" - NCSL quoted, “While it is too soon to know if this prescription transparency legislation will continue to expand this year,” says Richard Cauchi, the program director for health insurance, financing and pharmaceuticals at the National Conference of State Legislatures, “state legislators often do look at what their colleagues in other states are doing.” Wall Street Journal, April 24, 2015.
MAPPING PRESCRIPTION DRUG POLICIES
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Resources from NCSL and expert speakers:
NCSL Prescription Drug session- November 2015
With pharmaceutical access and costs back in the headlines, NCSL collaborated with Pew Family Trusts to present a session for legislators on Nov. 4., 2015 The materials compiled are available now; they include
Session: "New Medicines: Opportunities and Challenges" - Seattle, August 2015
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STATE RX LEGISLATION ARCHIVE:
PRESCRIPTION DRUG STATE LEGISLATION - Each year between 1999 and 2009 NCSL compiled and published the most comprehensive tracking report of bills and resolutions affecting pharmaceuticals. The reports are updated including final outcomes at the end of each calendar and session year. These annual reports are offline, but are available upon request. Reports for 2010-2014 are not available in published form.
ARCHIVES: NCSL ON-LINE REPORTS & PRESENTATIONS:
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:
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An Introduction to Biologic Medicines - A program for health staff, focused on both science and policy issues related to biologic medicines, and how they fit in the spectrum of medical and pharmaceutical treatments. The program included a welcome from Texas Senator Leticia Van de Putte, a pharmacist for more than 31 years who represents a large portion of San Antonio. Held August 7, 2011.
Speakers: Former Senator Leticia Van de Putte, former President of NCSL (2006-07), San Antonio, Texas
Geoffrey Eich, an executive director at Amgen, California - PowerPoint (PDF file-10 pages)
This program was made possible by Amgen, with funding through NCSL’s Foundation for State Legislatures, facilitated by the NCSL Health Program.
- Generic Drug Pricing and States: $4 drug promotions - NCSL report, updated March 2011.
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Marketing Drugs: Debating the Real Cost - Concern about close ties between doctors and pharmaceutical firms are prompting new financial disclosure laws and education efforts. By Rachel Brand, in State Legislatures Magazine, September 2008.
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Prevention of Prescription Drug/Pharmaceutical Overdose and Abuse - January 2009
- "Part D Decisions" - Like other employers, many states are collecting a new federal subsidy for maintaining retiree drug coverage--but for most, that's not their final answer. - State Legislatures Magazine, 9/06
- Medicaid Prescription Drug Reform Provisions (DRA) - NCSL 's federal policy has urged congress to amend federal Medicaid law to give states greater flexibility in administering their individual state programs. A Department of Health and Human Services (HHS) Office of the Inspector General (OIG) Document: Determining Average Manufacturer Prices for Prescription Drugs Under the Deficit Reduction Act of 2005 (67 page pdf document).
- State Initiatives to Avoid Prescription Drug Errors - NCSL report responds to IOM medication errors report, updated 2008.
- State Prescription Drug Return, Reuse and Recycling Laws" - newly published by NCSL, updated 2012.
- "Condition-specific Drug Substitution Legislation: Epilepsy" - Updated 2/09.
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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.
- States and the 340B Drug Pricing Program - NCSL resource report, updated 2013
- Marketing and Direct-to-Consumer Advertising of Pharmaceuticals, 2001-08 - an NCSL report and chart of state legislation.
- "Medication-Assisted Treatment for Opiate Addiction" (MAT) - published by NCSL's DC staff, for 2008.
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Price Disclosure Laws and Websites for Prescription Drugs - a section of NCSL's Disclosure and Transparency of Health and Hospital Prices - 2012
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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 2010..
- Prescription Drug Monitoring Programs - NCSL resources compiled by the Criminal Justice Program & Health Program, 2008.
ARCHIVE: IDEAS AT WORK FOR PRESCRIPTION DRUGS held Wednesday, July 23, 2008
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. - [ Handout#1 | Handout #2]
> Alan Must, Purdue-Pharma, New Jersey - [ Presentation]
- The federal 340B Drug Pricing Program helps over 13,000 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. - [ Presentation]
- Medication Therapy Management (MTM) programs allow pharmacists to provide in-depth counseling to insure that patients get the full benefit of chronic prescribed drugs.
> Edward Staffa, RPh, Vice President, Mirixa & NCPA spokesperson.
> Marjorie Powell, Senior Assistant General Counsel, PhRMA, Washington, DC.
Non-NCSL Resources:
Prescription Drug Resources for 2015-2017 - A selection of additional reports from government, academic, industry and consumer sources, including 50+ direct web links, updated regularly.
Note on Resources: 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.