Among the tens of thousands of bills that will be filed in the coming weeks as legislatures return to work, close to a thousand are likely to address the cost and availability of prescription drugs.
Why does prescription drug affordability and access continue to be a priority for state legislatures? Medicines save lives, but only if patients can afford them and take them as prescribed. A quarter of adults taking prescription medications say they have a hard time paying for them, according to KFF. Three in 10 adults report not taking their drugs as prescribed due to cost. When people don’t take their medicines as prescribed, it may affect health outcomes, which can impact overall health care costs.
Here are five prescription drug policy trends, listed alphabetically, to watch in 2025.
1. Federal 340B Drug Pricing Program. Lawmakers have been pursuing a host of actions involving the federal 340B program. According to the Health Resources and Services Administration, which administers the program, the intent of 340B is to increase prescription drug access to underserved populations by stretching scarce federal resources.
Growth in the program has risen steadily since 2018, according to the research services provider IQVIA, and several drug manufacturers now restrict access to 340B-priced drugs to contract pharmacies participating in the program to ensure duplicate discounts do not occur. Over 30 states introduced legislation to counteract these restrictions with eight states, including Delaware and Missouri, passing legislation to shape the 340B policy landscape.
2. GLP-1 drugs. As the popularity of these drugs continues to capture the public’s attention, lawmakers are also taking notice. The average annual treatment cost of these medications is $12,000, making them unaffordable for some, according to Milliman.
According to KFF, 13 state Medicaid programs cover certain GLP-1 drugs for obesity treatment, typically with prior authorization requirements; most large employers do not cover them for weight loss. States may opt to increase access to these treatments in state-regulated plans or keep the status quo, among other initiatives.
A recently proposed federal rule may require Medicaid and Medicare to cover these medications when used to treat obesity. The Centers for Medicare & Medicaid Services provides more information on the rule in a recent update, and an NCSL news article covers GLP-1 drugs and state policies.
3. Limiting consumer out-of-pocket costs. Maintaining consumer access to groundbreaking therapies while also keeping premiums and other out-of-pocket costs at the pharmacy counter low has been a perennial bipartisan concern.
More than a dozen states passed legislation in 2024 to limit consumers’ out-of-pocket costs and increase patients’ access to certain treatments. Some lawmakers chose to address utilization management policies by health plans and pharmacy benefit managers, including step-therapy, prior authorization and copay accumulators.
4. Pharmacy benefit managers. These companies that administer prescription drug insurance benefits are still a prominent interest among states with, on average, almost a third of overall prescription drug legislation relating to PBMs. Trends have shifted away from reforms such as requiring state licensure or registration of PBMs (at least 35 states require it) and are moving toward policies to protect independent pharmacies not affiliated with PBMs. These policies include prohibiting PBMs from steering patients to their own or affiliated pharmacies (known as anti-steering); providing equal reimbursement to independent pharmacies and affiliates; and prohibiting increased audits.
5. Prices. Policies that aim to lower prices in the prescription drug market could draw legislative consideration. Nine states have prescription drug affordability boards, according to the National Academy for State Health Policy, and Minnesota will use the prices established in the Inflation Reduction Act as a guide for an upper payment limit, according to KFF. Lawmakers might try this approach or look for other ways to lower prices, such as drug importation. Texas passed legislation in 2023 relating to wholesale importation, and a new bill adds eligible European suppliers.
What Else?
While other high-profile health policy topics—dealing with coverage changes in Medicaid and private plans, addressing workforce shortages, improving behavioral health—may take center stage, escalating health care costs remain a frequent topic of state legislative debate. Prescription drugs are a key piece of those conversations. About 150 bills in 25 states were introduced in the 10 days since states began returning to session, and many of the policies reflect the trends highlighted above.
You can find more information on trends in the Prescription Drug Resource Center, and more on enacted and proposed legislation in the Prescription Drug Legislation Database.
Colleen Becker is a project manager in NCSL’s Health Program.