While their scope and use vary, 23 states have full APCDs, five have partial databases exclusively focused on prescription drug pricing and as many as a dozen state legislatures have authorized studies on APCDs. Kentucky, Nevada, and West Virginia lawmakers are among state legislators reviewing 2021 bills to create APCDs. North Carolina officials tapped the North Carolina Institute of Medicine in January to assess the value of an APCD for the state.
Publicly-accessible price comparison tools
At least nine states use APCD, hospital, and government health department data to maintain “consumer-facing” price comparison websites that allow consumers to ensure accurate price information and induce competition among providers where possible.
As of Jan. 1, the federal government requires all hospitals to provide “clear, accessible pricing information online about the items and services they provide” in “comprehensive, machine-readable” files with all items and services “in a display of ‘shoppable services’ in a consumer-friendly format.”
Among 2021 bills establishing a price-comparison website matriculating through legislatures is Virginia’s HB 2007, which would direct the state’s Department of Health to bulk as a website providing prescription drug prices from every carrier, pharmacy benefits manager, and drug manufacturer in the state.
Right to Shop
New Hampshire, Kentucky, and Utah established “Right to Shop” programs as part of their state employee health plans to curb growing healthcare costs to state budgets. Florida, Maine, Nebraska, Tennessee, Utah, and Virginia have since enacted legislation requiring or encouraging state-regulated private health plans to initiate “Right to Shop” programs for enrollees.
Expanding “Right to Shop” to require private insurers either participate or establish their own programs is among initiatives being proposed in state legislatures. During 2021 sessions, lawmakers in New Jersey, Louisiana, Massachusetts, Illinois, and South Carolina will see revived 2020 “Right to Shop” bills and Oklahoma legislators will deliberate SB 462, the Oklahoma Right to Shop Act.
Among other transparency and price-curbing proposals before state lawmakers nationwide is balanced billing protections — after nearly banning the practice in 2020 — and reducing prior authorization “red tape.”
4. Prescription Drugs
The high cost of pharmaceuticals will remain a priority political discussion on the federal and state levels. As they have the last decade, state lawmakers in 2021 will address prescription drug costs in, literally, thousands of bills. Proposed prescription drug import plans and regulating how Pharmacy Benefit Managers (PBMs) operate will remain among the most common themes.
Prescription Drug Import Plans
Vermont lawmakers were the first to adopt a state program to import prescription drugs from Canada in 2018. Colorado Gov. Jared Polis and Florida Gov. Ron DeSantis in 2019 initiated efforts approved by lawmakers to implement similar wholesale prescription drug import programs in their states.
Although all still await federal — and Canadian — approval, New York, New Hampshire, and New Mexico lawmakers were among state lawmakers who pondered similar programs in 2020. At least 11 2021 bills, including three in North Dakota, propose creating state drug importation programs in at least nine states, including Arizona, Connecticut, Hawaii, Minnesota, New Jersey, New York, Oklahoma, and Rhode Island.
Pharmacy Benefit Managers (PBMs)
As of mid-February, there were 46 bills filed in 22 state legislatures related to PBMs role as the “middleman” between providers and retailers, and practices such as “gag clauses,” “clawbacks” and “spread pricing.” Proposed 2021 bills in Arizona, Hawaii, Kentucky, Maryland, Nebraska, New Jersey, and Wisconsin are among those that amend state laws regulating how PBMs can operate. There are nine New Jersey bills relating to PBMs.
Going into 2020 sessions, at least 33 states had enacted laws prohibiting “gag clauses” in contracts with PBMs that restrict pharmacists from telling customers about a lower-priced generic alternative to brand-name drugs
Lawmakers in Minnesota, Nebraska, and Oklahoma are among legislators deliberating proposed 2021 bills that specifically outlaw the use of “gag orders” by PBMs that prohibit pharmacists from directing customers to lower-cost prescription drugs.
“Spread pricing,” in which PBMs are compensated by retaining the difference, or “spread,” between the amount they charge a plan sponsor and the amount they reimburse a pharmacy is targeted in bills filed in at least 11 state legislatures — Connecticut, Florida, Hawaii, Indiana, Kentucky, Maryland, Missouri, New Mexico, New York, Oklahoma, and Oregon.
5. Telehealth
All 50 states and territories, particularly the District of Columbia, revised telehealth policies in 2020 under emergency orders to increase access to healthcare services that can be delivered remotely and minimize potential exposure to the coronavirus. The discussion in state legislatures in 2021 and beyond is how many of those emergency provisions should be permanently encoded and how they should be paid for under Medicaid and private insurance.