The state legislative session is in full swing, with many states having passed the halfway point. The ACR is currently tracking 114 pieces of state legislation across various issue areas. These include:
- 36 utilization management reform bills;
- 29 copay accumulator bills;
- 13 prescription drug review board bills;
- 12 pharmacy benefit manager reform bills;
- 6 rebate pass-through bills; and
- 6 white bagging bills.
Because most states are in the first year of a two-year session, bills that do not pass this session will carry over to the next session.
Anti-Vaccine Legislation
Over the past few years, vaccines have been under increasing public scrutiny and the subject of intense and, often clashing, debate. We are increasingly seeing this debate emerge in state legislation. In 2024, two states—Idaho and Montana—considered anti-vaccine legislation; this year that number is already at 18 and likely to grow. Here is a breakdown of some of the legislation that we are seeing:
- Wyoming, Oregon, Oklahoma and South Carolina (Florida likely): Proposals to prohibit “hiring discrimination” against unvaccinated individuals.
- Iowa, Montana and Idaho: Bills restricting or banning mRNA vaccines.
- Texas and Kentucky (Florida likely): Measures limiting mRNA vaccine use, with a specific focus on children.
- South Carolina: A proposal requiring providers to inform patients that the long-term safety of vaccines is “unknown.”
- Texas: A bill requiring providers to give patients an information sheet created by an appointed committee on the potential short- and long-term side effects of mRNA vaccines.
- Arizona, Arkansas, Connecticut, Indiana, Minnesota, Mississippi, New Jersey, New York, Oklahoma, Oregon, Texas and Virginia: Efforts to modify vaccine mandates and increase exemptions.
Most of these bills are being pushed under the guise of “freedom of choice,” and some have fines and jail time for non-compliance. The ACR is committed to ensuring that medical decisions remain between the patient and provider. We are working with our partners and the American Medical Association to ensure that all patients living with chronic disease maintain access to FDA-approved vaccinations.
We are also examining the legislation that would prevent employers from requiring vaccination. Settings where employees would frequently be in contact with chronically ill and immunosuppressed patients may need an exemption to protect patients. Hospitals and physician offices need the freedom to implement policies aimed at protecting the patient population they serve.
Also, the Louisiana Department of Health recently banned state-sponsored vaccination events and ordered staff not to promote vaccination. For many uninsured or underinsured individuals, vaccination events are the only way they can receive vaccinations. These kinds of access restrictions create a real danger to the chronically ill and those who care for them, and the ACR will continue to weigh in where it is appropriate and needed.
Prescription Drug Review Boards
There continues to be a lot of interest in prescription drug review boards (PDABs) at the state level. These boards examine the most expensive drugs in a state and then go through a process to determine if they are unaffordable. For those drugs deemed unaffordable, the PDAB can institute upper payment limits, which can regulate a drug’s selling price or reimbursement amount in a state.
Colorado, Maine, Maryland, Massachusetts, Minnesota, New Hampshire, New Jersey, New York, Ohio, Oregon and Washington have all created PDABs. Although the ACR understands the appeal of implementing cost-saving measures, PDABs run the risk of creating access issues and could result in targeted drugs being removed from state formularies. PDABs could also lead to a two-tiered health system, in which those who can afford to pay out-of-pocket for an unaffordable medication can obtain it and those who can’t are out of luck.
It’s important to note that none of the states that have enacted PDAB legislation have completed the review process yet. The PDAB still lacks proof of concept, and the full impacts on patient access are poorly understood. Because of that, the ACR recently submitted a letter to Gov. Glenn Youngkin of Virginia on the PDAB bill currently on his desk (HB 1724) and urged the state to take a wait-and-see approach on PDABs. We are also working with rheumatologists in Colorado on a strategic approach to the next PDAB hearing so the concerns of rheumatologists are heard by policymakers.
Expanding Funding for Fellowships & Loan Forgiveness
Expanding access to loan forgiveness programs and increasing fellowship funding is a key goal of the ACR’s workforce initiatives. The Georgia Senate has passed SB 130, which would accomplish both goals. The bill is sponsored by the majority and is currently in the House. It would make fellows eligible for state service-based loan forgiveness programs. Importantly, it would also make fellowship slots eligible to receive $10,000 per year in state funding payable to the fellow’s designated institution. The ACR is fully supporting this legislation, and we hope to be able to encourage other states to take the same approach.
What’s Next
Many states are entering the final weeks of their legislative session. The pace of legislation will be picking up dramatically and so will our engagement on the issues that are important to our members. It is important to remember that even if a bill doesn’t pass this year, all is not lost. In most states, bills will carry over to next year. We will continue to work with our partners to build broad coalitions to support those pieces of legislation in hopes that we can move them forward in the next year. For other states, sessions are just beginning or will be running through the rest of the year.
Even though the pace of activity is most brisk during the first few months of the calendar year, we remain engaged on state issues year-round. With the changing role of the federal government in health policy, it is more important than ever for the ACR to be engaged at the state level. We will continue to work to ensure that the voice of rheumatology is heard in state policy discussions and that your concerns do not go unanswered.
