More States Eye Drug Affordability Boards, PBM Regulations

Some states are adding more ‘muscular attributes’ to their Rx boards, such as setting upper limits based on the pending Medicare prices, but federal ERISA legislation still limits the boards’ impact.

50 states of pills
States are still in the early stages of implementing their drug pricing boards. • Source: Shutterstock

PBM and drug pricing regulation will continue to be hot topics at the state level after several years of busy lawmaking, experts predict, even as PBM reforms appear stalled in Congress. They predict that more states than ever will continue to embrace or pursue policies like drug affordability review boards.

Key Takeaways
  • Over 100 drug pricing bills are under consideration in 29 states, much of it based on NASHP model legislation.

  • ERISA limits the impact of state affordability boards in the self-funded commercial market

“I do think the momentum is still strong, because states have the ability to do a lot more,” Kate Sikora, associate principal at Avalere Health, tells AIS Health, a division of MMIT. “Federal bills typically get a little bit watered down by the time they actually pass

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