By May, many state legislatures have started to wind down their sessions. As those of us engaged in state advocacy enjoy this opportunity to catch our breath and slow down a bit, it is a great time to take stock of the wins and losses so far in the 2021 legislative session.
Utilization management reform continues to be a bright spot this session. Nine states have considered step therapy legislation this year. We have already had wins in Arkansas and Nebraska. Bills in California, Massachusetts, Arizona and Oregon are all still viable. Also, Georgia passed prior authorization reform unanimously in both chambers. The bill is currently with Governor Kemp and awaiting his signature or veto. Even with these state-level gains, and more potentially still on the table, it is important to remember that utilization management reform requires both state and federal solutions because of how insurance is regulated. That is why we continue to work to support the Safe Step Act in Congress.
Another issue where we have seen wins this session is copay accumulator ban legislation. More than 20 states have considered accumulator bans this year. So far, we have seen wins in Kentucky and Oklahoma, with more likely to come in some of the states that are still in session. The progress on this issue has been slower than we had hoped it might be, which has been slightly disappointing. However, it is important to remember that many states are in the first year of a two-year session, so many of these bills will carry over and still be viable next year.
We also had wins in pharmacy benefit manager (PBM) reform in West Virginia and Virginia. The Virginia bill offers some modest improvements over the existing state PBM law. The West Virginia bill is the most robust bill to have passed so far this session but still falls short of the Alliance for Transparent and Affordable Prescriptions (ATAP) and National Council of Insurance Legislators (NCOIL) model language that we prefer. Still, the West Virginia bill is a significant step in the right direction, especially when considered alongside Alabama’s PBM legislation that was thoroughly gutted of significant patient protections.
One of the more disappointing outcomes so far is the continued inability to advance any kind of health reform legislation in Florida. There are many reasons that Florida is a difficult state, such as the strength of the PBM and payer lobby. However, it also highlights the importance of state-level physician advocacy: The only way to overcome these obstacles is for physicians and other stakeholders to be more active in the state legislative process.
