State agencies and the federal government can take legislative and administrative actions through various programs to curb the rising cost of prescription drugs. This section explores some of these innovative actions.
Implementation of New Laws
A number of states have enacted drug pricing transparency laws requiring manufacturers, pharmacy benefit managers, and other entities to report information explaining high price increases and high-priced new drugs.
State Drug Price Transparency Programs Identify Critical Data on High Cost Drugs, April 2022. This NASHP blog shares key findings from states’ transparency reports.
Drug Price Transparency Laws Position States to Impact Drug Prices, January 2022. This NASHP blog gives an update on state drug transparency laws and their impact.
Transparency Law Comparison Chart, updated December 2023. This NASHP chart compares enacted state drug pricing transparency laws, organized by reporting entity.
What Are We Learning from State Reporting on Drug Pricing?, December 2019. This NASHP report offers a cross-state analysis of drug price transparency findings through August 2019, based on reports from California, Maine, Nevada, Oregon, and Vermont.
California Resources
- California SB 17/Chapter 603, enacted Oct. 9, 2017
- Department of Health Care Access and Information: Prescription Drug Pricing for Purchasers – Regulations, adopted Jan. 1, 2019
- Department of Health Care Access and Information: Cost Transparency Rx website
- New Drug Launch Price Data, updated quarterly
- Prescription Drug Wholesale Acquisition Cost (WAC) Increases Data Set, updated monthly
- California Research Bureau Report: Prescription Drug Pricing and Cost Transparency in California, October 2022
- Department of Managed Health Care: Health Insurer Prescription Drug Cost Transparency Reports (report on the impact of drug costs on health plan premiums):
Connecticut Resources
- Connecticut HB 5384/Public Act 18-41, enacted May 31, 2018
- Office of Health Strategy: Prescription Drug Reporting System
- Office of Health Strategy: Statute-required List of Ten Outpatient Rx Drugs:
- Insurance Department: 2022 Outpatient Prescription Drug Cost Report; March 1, 2022
- Insurance Department: Health Carrier Prescription Drug Rebate Practices Reports:
Insurance Department: Pharmacy Benefit Manager Rebate Reports:
Maine Resources
- 2018 law establishing a study on increased drug pricing transparency, Maine LD 1406/Public Law Chapter 406, enacted May 1, 2018
- Maine Health Data Organization: Prescription Drug Reports website with information on 25 drugs that are the costliest and most frequently prescribed, and have the highest yearly cost increase, updated through June 2022
- 2019 law expanding Maine’s transparency program to include reporting from health plans, manufacturers, PBMs, and wholesale distributors, Maine LD 1162/Public Law Chapter 470, enacted June 24, 2019
- 2021 law to change the structure of Maine’s transparency program, giving MHDO the authority to determine a list of drugs that require reporting, LD 686/Public Law Chapter 305, enacted June 21, 2021
- Maine Health Data Organization: Chapter 570 – Uniform Reporting System for Prescription Drug Price Data Sets, effective Feb. 4, 2020
- Maine Health Data Organization: Annual Prescription Drug Pricing Transparency Report
Minnesota Resources
- Minnesota SF 1098/Chapter 78, enacted May 12, 2020
- Minnesota HF 2128/Chapter 30, enacted May 25, 2021
- Minnesota SF 2995/Chapter 70, enacted May 24, 2023
- Minnesota Department of Health: Prescription Drug Price Transparency Website
- Minnesota Department of Commerce: Public Pharmacy Benefit Manager (PBM) Transparency Report; Dec. 1, 2020
- Department of Health: All-Payer Claims Database Prescription Drug Public Use Files, June 2022
- Department of Health: Prescription Drug Price Transparency Dashboard
- Department of Health: Prescription Drug Price Transparency Report to the Minnesota Legislature, September 2023
Nevada Resources
- 2017 law requiring the Department of Health and Human Services to develop a list of drugs essential to treating diabetes and requiring certain supply chain entities to report on these essential drugs: Nevada SB 539/Chapter 592, enacted June 15, 2017
- Department of Health and Human Services: Drug Transparency Website
- 2019 law expanding Nevada’s transparency program to include drug essential to treating asthma: Nevada SB 262/Chapter 258, enacted May 30, 2019
- 2021 law expanding Nevada’s transparency program to include all prescription drugs: Nevada SB 380/Chapter 547, enacted June 10, 2021
- Department of Health and Human Services: Drug Transparency Reports:
- DHHS 2018 Drug Transparency Reports
- DHHS 2019 Drug Transparency Report, 2019 Essential Diabetes Drugs, May 31, 2019
- DHHS 2020 Drug Transparency Report, 2020 Essential Drugs, June 1, 2020
- DHHS 2021 Drug Transparency Report, 2021 Essential Drugs, June 1, 2021
- DHHS 2022 Drug Transparency Report, June 1, 2022
New Hampshire Resources
- New Hampshire HB 1418/Chapter 350, enacted July 2, 2018
- New Hampshire General Court: Commission to Study Greater Transparency in Pharmaceutical Costs and Drug Rebate Programs Final Report; Nov. 1, 2018
- 2019 law reestablishing the Commission to Study Greater Transparency in Pharmaceutical Costs and Drug Rebate Programs: New Hampshire SB 226/Chapter 320, enacted Aug. 12, 2019
- 2020 law requiring manufacturers to provide notice to the insurance department if they are introducing a new, high-cost drug: New Hampshire HB 703/Chapter 4, enacted Feb. 10, 2020
- New Hampshire Insurance Department: New High Cost Drugs Introduced in New Hampshire, updated annually
New Jersey Resources
- New Jersey S1615, enacted July 10, 2023
North Dakota Resources
- North Dakota HB 1032, enacted April 28, 2021
- North Dakota Insurance Department: Prescription Drug Price Transparency Website
- North Dakota Insurance Department: Filed Disclosure Reports, filed 60 days after receipt of data from reporting entities
Oregon Resources
- Oregon HB 4005/Chapter 7, enacted March 12, 2018
- 2019 law expanding Oregon’s transparency program, requiring manufacturers report high drug price increases at least 60 days in advance: Oregon HB 2658/Chapter 436, enacted June 20, 2019
- Department of Consumer and Business Services: Prescription Drug Price Transparency Program website
- Data Reports from Pharmaceutical Manufacturers and Consumers, updated annually
- Data Reports from Health Insurers, updated annually
- Department of Consumer and Business Services: Annual Prescription Drug Price Transparency Results and Recommendations:
Texas Resources
- Texas HB 2536, enacted June 14, 2019
- Department of Health and Human Services: Drug Transparency Website
- Annual WAC Price Reports, regularly updated
- Price Increase Report Data, regularly updated
Utah Resources
- Utah HB 272, enacted March 28, 2020
- Insurance Department: Prescription Drug Price Transparency Act website
- Pharmacy Drug Manufacturer Transparency Reports by Month, updated monthly
- Health Insurer Premium Impact Reports by Year, last updated December 1, 2021
- Health Insurance Premium Impact Reports
Vermont Resources
- 2016 law requiring Vermont Medicaid to report its top spend drugs: Vermont: S 216/Act 165, enacted June 2, 2016
- 2018 law expanded Vermont’s existing drug transparency program to include health plans with more than 5,000 lives covered and manufacturers: Vermont S 92/Act 193, enacted May 30, 2018
- Green Mountain Care Board: Prescription Drug Transparency – Act 165 & 193 website with top spend drug lists and annual reports on the impact of drug costs on insurance premiums
- Green Mountain Care Board Annual Reports: Impact of Prescription Drug Costs on Health Insurance Premiums per Act 193:
- Vermont Medicaid Top-Spend Drug Lists:
- Department of Vermont Health Access Top-Spend Drug Lists, per Act 193
- 2019 Reports: Top 10 Net Amount Paid, Top 10 Gross Amount Paid, and Pricing Transparency Methodology
- 2023 Report: Top 10 Gross and Net Amount Paid
- 2020 Report: Pricing Transparency Drug Lists and Methodology
- 2021 Report: Pricing Transparency Drug Lists and Methodology
- 2022 Report: Pricing Transparency Drug Lists and Methodology
- 2023 Report: Pricing Transparency Drug Lists and Methodology
- Insurer Top-Spend Drug Lists, largest net price increases:
- Office of the Vermont Attorney General: Prescription Drug Cost Transparency-Manufacturer and Health Insurer Annual Reporting Website per Act 193
- Attorney General’s Reports on Prescription Drug Cost Transparency; December 2016 – December 2022
Virginia Resources
- Virginia HB 2007, enacted March 24, 2021
- Virginia Health Information: Transparency Data Dashboard
- Virginia Department of Health: 12VAC5-219 Prescription Drug Price Transparency Regulations; Jan. 17, 2022
Washington Resources
- Washington HB 1224/Chapter 334, enacted May 9, 2019
- Washington Health Care Authority: Prescription Drug Cost Transparency Website
- Washington Health Care Authority: Reporting Entity Resources
- Carrier Data Submission Guide, effective Oct. 1, 2022
- Pharmacy Services Administrative Organization Data Submission Guide, effective Oct. 1, 2022
- Manufacturer Data Submission Guide, effective March 1, 2022
- Pharmacy Benefit Manager Data Submission Guide, effective March 1, 2022
- Washington Health Care Authority:Prescription Drug Price Transparency program status report for the public, Jan. 1, 2021
- Washington Health Care Authority: Drug Price Transparency Annual Reports
- Washington Health Care Authority: Drug Price Transparency Program Annual Report, Feb. 1, 2022
- Washington Health Care Authority: Drug Price Transparency Program Annual Report, Dec. 30, 2022
West Virginia Resources
- West Virginia SB 689, enacted March 7, 2020
- State Auditor’s Office: Pharmaceutical Manufacturers’ Compliance Manual; Dec. 7, 2020
- State Auditor’s Office: Pharmaceutical Manufacturer/Health Benefit Plan Issuer Transparency Report, most data from 2020
- State Auditor’s Office: Pharmaceutical Manufacturer/Health Benefit Plan Issuer Transparency Dashboard
Since 2018, multiple states have enacted laws advancing wholesale prescription drug importation programs from Canada. As a first step towards implementation, states must design a safe, cost-saving approach to importation and achieve certification from the US Secretary of Health and Human Services. Read NASHP’s recommended changes to the Administration’s notice of proposed rulemaking for importation of certain prescription drugs from Canada.
Colorado Resources
- Colorado SB 5/Chapter 182, enacted May 16, 2019
- Department of Health Care Policy and Financing: Request for Information: Drug Importation Questions for Wholesalers, released Oct. 11, 2019
- Department of Health Care Policy and Financing: Request for Information: Drug Importation Questions for Pharmacies, released Oct. 11, 2019
- Department of Health Care Policy and Financing: Colorado’s Drug Importation Program -Draft Application, released March 9, 2020
- Department of Health Care Policy and Financing: Implementation of a Canadian Prescription Drug Importation Program home page
- Department of Health Care Policy and Financing: Solicitation to Import Prescription Drugs from Canada, Jan. 25, 2021
- Importation Vendor Fact Sheet, December 2022
- Manufacturer Fact Sheet, December 2022
- Colorado Section 804 Importation Program Application, Feb. 27, 2024
- Appendices available on the Colorado Department of Health Care Policy & Financing website
- Department of Health Care Policy and Financing: Annual Prescription Drug Importation Report to the General Assembly:
Florida Resources
- Florida HB 19/Chapter No. 2019-99, enacted June 11, 2019
- Florida Agency for Health Care Administration: Florida’s Canadian Prescription Drug Importation Concept Paper, Aug. 20, 2019
- Florida Preliminary Section 804 Importation Program (SIP) Proposal for the Importation of Prescription Drugs from Canada, November 2020
Maine Resources
- Maine LD 1272/Chapter 472, enacted June 24, 2019
- Department of Health and Human Services: Application to Operate a Section 804 Prescription Drug Importation Program, posted May 1, 2020
- Department of Health and Human Services: Final Adopted Major Substantive Rule: Wholesale Prescription Drug Importation, posted May 15, 2020
New Hampshire Resources
- New Hampshire HB 1280/Chapter 13, enacted July 16, 2020
- Department of Health and Human Services: Application for Section 804 Importation Program, April 21, 2021
New Mexico Resources
- New Mexico SB 1/Chapter 45, enacted March 4, 2020
- New Mexico Section 804 Drug Importation Program Application, December 2020
Texas Resources
- Texas HB 25, enacted June 12, 2023
- Department of Health and Human Services: Wholesale Prescription Drug Importation Program Report, December 1, 2023
Vermont Resources
- Vermont S 175/Act 133, enacted May 16, 2018
- Vermont Agency of Human Services: Report to Vermont Legislature: Wholesale Importation Program for Prescription Drugs Legislative Report, Jan. 3, 2019
- Vermont’s Concept Paper Submitted to the Federal Government, Canadian Wholesale Importation Program for Prescription Drugs, Nov. 26, 2019.
Federal Resources
- The U.S. Department of Health and Human Services and the Food and Drug Administration published two potential pathways for safe importation in July of 2019: Safe Importation Action Plan, July 31, 2019
- The U.S. Department of Health and Human Services and the Food and Drug Administration issued a notice of proposed rulemaking (NPRM) that, if finalized, would allow for importation of certain prescription drugs from Canada: NPRM: Importation of Prescription Drugs, Dec. 23, 2019. Comments period closed on March 9, 2020.
- The U.S. Department of Health and Human Services and the Food and Drug Administration announced new draft guidance that describes how a manufacturer could import prescription drugs, including biological products, originally intended for sale in other countries: Draft Guidance: Importation of Certain FDA-Approved Human Prescription Drugs, Including Biological Products, under Section 801(d)(1)(B) of the Federal Food, Drug, and Cosmetic Act, Dec. 23, 2019. Comments period closed on Feb. 21, 2020.
- President Trump signed an Executive Order on the importation of prescription drugs from other countries: Executive Order on Increasing Drug Importation to Lower Prices for American Patients, July 24, 2020.
- U.S. Department of Health and Human Services: Final Rule, published Oct. 1, 2020
- The U.S. Food and Drug Administration importation resources page: Importation of Drugs Originally Intended for Foreign Markets, updated May 19, 2022
- The U.S. Food and Drug Administration released a compliance guide intended to help small entities better understand the final rule: Importation of Prescription Drugs Final Rule Questions and Answers, May 25, 2022
- The U.S. Food and Drug Administration authorized Florida’s Section 804 Importation Program (SIP) Proposal for the Importation of Prescription Drugs from Canada in January 2024. Florida’s Agency for Health Care Administration must submit additional drug-specific information for FDA review and approval, ensure prospective drugs for importation meet FDA specifications and standards for authenticity and compliance, and relabel the drugs to be consistent with FDA-approved labeling prior to importation, as well as report quarterly to the FDA for the duration of the program. Florida’s SIP is authorized for two years from the date the FDA is notified of the first shipment of drugs to be imported: FDA News Release, January 5, 2024
States are implementing drug affordability boards — impartial entities made up of multiple stakeholders that would give a state the ability to limit how much its residents may pay for a certain high-cost drugs. States are taking various approaches to implementing this model.
This NASHP chart compares Prescription Drug Affordability Review laws: Comparison of State Prescription Drug Affordability Review Initiatives.
Colorado Resources
- Division of Insurance: Colorado 2023 Eligible Drug Dashboard and Resource List
- Colorado SB 21-175/Chapter 240, enacted June 16, 2021
- Colorado HB 23-1225, enacted May 10, 2023
- Division of Insurance: Colorado Prescription Drug Affordability Board Website
- Division of Insurance: Adopted Board Policies
- Division of Insurance: Adopted Rules
Maine Resources
- Maine LD 1499/Chapter 471, enacted June 24, 2019
- Maine LD 120, enacted July 2, 2021
- Maine Bureau of Human Resources: Maine Prescription Drug Affordability Board Website
- Maine Bureau of Human Resources: Report of the Maine Prescription Drug Affordability Annual Report: Recommendations to Reduce Prescription Drug Spending; March 2, 2022
Maryland Resources
- Maryland HB 768/Chapter 692, enacted May 25, 2019
- Maryland HB 1100/Chapter 425, enacted May 8, 2020
- Maryland HB 279/SB 202/Chapter 39, enacted April 11, 2023
- Maryland HB 200/SB 181/Chapter 101, enacted April 24, 2023
- Maryland Prescription Drug Affordability Board Website
- Maryland Prescription Drug Affordability Board: Regulations, last updated July 17, 2023
- Maryland Prescription Drug Affordability Board: Study of the Operation of the Generics Drug Market; published June 1, 2022
- Maryland Prescription Drug Affordability Board: 2022 Annual Cost Review Report; published December 31, 2022
- Maryland Prescription Drug Affordability Board: 2023 Annual Cost Review Report; published December 31, 2023
Minnesota Resources
- Minnesota SF 2744, enacted May 24, 2023
New Hampshire Resources
- New Hampshire HB 1280/Chapter 13, enacted July 16, 2020
- New Hampshire DHHS: Adopted Rules, effective December 2022
- New Hampshire DHHS: New Hampshire Prescription Drug Affordability Board Website
- New Hampshire DHHS: Prescription Drug Affordability Board Annual Report
Oregon Resources
- Oregon SB 844/Chapter 598, enacted July 19, 2021
- Oregon SB 192/Chapter 466, enacted August 3, 2023
- Division of Financial Regulation: Oregon Prescription Drug Affordability Board Website
- Oregon Prescription Drug Affordability Board: Final Rule: Selecting Prescription Drugs for Affordability Review; filed July 28, 2023
- Oregon Prescription Drug Affordability Board: 2023 Generic Drug Report for the Oregon Legislature; published June 2023
- Oregon Prescription Drug Affordability Board: 2022 Report for the Oregon Legislature; published December 2022
Washington Resources
- Washington SB 5532, enacted March 24, 2022
- Washington State Health Care Authority: Prescription Drug Affordability Board Website
States are increasingly looking beyond individual agencies and programs to harness the significant potential of their collective buying power through cross-agency collaboration to purchase prescription drugs.
To help states establish baseline data from each public purchaser on their plans, PBMs, and prescription drug benefits, NASHP developed a Checklist for Coordinating Public Purchasing of Prescription Drugs as a first step for identifying opportunities to better coordinate purchasing and lower drug costs.
NASHP is continuing to develop model policies to help states address drugs costs. Read NASHP’s October, 2019 Proposal for a State Purchasing Pool for Prescription Drugs, which would allow individuals and businesses to join a public drug plan, increase the size of the state purchasing pools, and secure lower costs.
California Resources
- Gov. Gavin Newsom’s Executive Order to carve prescription drugs out of Medicaid managed care and move the negotiation and purchasing of drugs under Medi-Cal to the Department of Health Care Services: Executive Order N-01-19, signed Jan. 7, 2019
- California Legislative Analyst’s Office: Analysis of the Carve Out of Medi-Cal Pharmacy Services From Managed Care, posted April 5, 2019
- Request for Proposals for the takeover, operation, and eventual turnover of administration of the Medi-Cal pharmacy services: Request for Proposal #19-96125, posted Aug. 22, 2019, closed Oct. 1, 2019
- Department of Health Care Services Stakeholder Engagement Presentation: Medi-Cal Rx: Transitioning Medi-Cal Pharmacy Services: from Managed Care to Fee-For-Service Presented on Sept. 26, 2019.
Delaware Resources
- 2019 House Resolution establishing the Interagency Pharmaceuticals Purchasing Study Group: Delaware HCR 35, passed April 18, 2019
- Delaware General Assembly: Interagency Pharmaceuticals Purchasing Study Group website featuring information on past meetings and group members
- Delaware General Assembly: Report from the Interagency Pharmaceuticals Purchasing Study Group, posted Jan. 2020
Minnesota Resources
- Office of the Attorney General: Advisory Task Force on Lowering Pharmaceutical Drug Prices website with information on upcoming and prior meetings, meeting minutes, agendas, and recordings
New Mexico Resources
- 2019 law establishing the Interagency Pharmaceuticals Purchasing Council: SB 131/Chapter 19, enacted March 28, 2019
- Department of General Services: Interagency Pharmaceuticals Purchasing Council website with information on upcoming and prior meetings, meeting minutes and agendas, and council members
Wisconsin Resources
- Gov. Tony Evers’ Executive Order establishing the Governor’s Task Force on Reducing Prescription Drug Prices: Executive Order 39, signed Aug., 20, 2019
- Gov. Tony Evers’ press release, announcing the members of the task force: Gov. Evers Announces Appointments to Governor’s Task Force on Reducing Prescription Drug Prices, Oct. 28, 2019
- Office of the Governor: The Governor’s Task Force on Reducing Prescription Drug Prices website with information on upcoming and prior meetings, meeting minutes, agendas, and recordings
Several states have enacted laws to authorize use of reverse auctions to negotiate higher value contracts with pharmacy benefit managers (PBMs). The reverse auction process allows states to make apples-to-apples comparisons across bids and leverages competition by requiring PBMs to compete against the lowest bidder over several rounds of bidding.
States Save on Rx Spending by Using Reverse Auctions for Pharmacy Benefit Manager Service Procurement, August 2020. This NASHP blog explores New Jersey’s experience with implementing reverse auctions.
A New Jersey official describes how the state implemented a reverse auction model in this webinar recording: How States Can Control Pharmacy Benefit Manager Contract Costs through Reverse Auctions.
Colorado Resources
- Colorado HB 21-1237/Chapter 217, enacted June 7, 2021
Louisiana Resources
- Louisiana SB 180/Act No. 102, enacted June 4, 2021
Maryland Resources
- Maryland HB 1150/Article II Section 17(c), enacted May 8, 2020
- Maryland Department of Budget and Management: Request for Proposal for Pharmacy Benefit Management Reverse Auction Platform and Professional Services, posted May 17, 2021
Minnesota Resources
- Minnesota SF 2/Chapter 12, enacted June 30, 2021
- Minnesota State Register: Request for Proposals for PBM Technology Platform Services, page 14, posted July 6, 2021
New Hampshire Resources
- New Hampshire HB 1280/Chapter 13, enacted July 17, 2020
- New Hampshire Department of Administrative Services, Division of Risk & Benefits: Request for Proposal For Pharmacy Benefit Manager Technology Platform Services, posted October 30, 2020
- New Hampshire Department of Administrative Services: Technology Vendor Contract, posted January 20, 2021
- New Hampshire Department of Administrative Services, Division of Risk & Benefits: Request for Proposal for Pharmacy Benefit Management Services, Posted April 30, 2021
- New Hampshire Department of Administrative Services, Division of Procurement Support Services, Bureau of Purchase Property: Reverse Auction Summary of Results
- New Hampshire Secretary of State: Pharmacy Benefit Manager Contract, posted September 15, 2021
New Jersey Resources
- New Jersey S 2749/P.L.2016, c.67, enacted November 21, 2016
- New Jersey Department of the Treasury Division of Purchase and Property: Bid Solicitation for Employee Benefits: Pharmacy Benefit Management, posted May 16, 2017
- New Jersey Department of the Treasury Division of Pension and Benefits: Request for Quotation For Technical and Professional Services for Pharmacy Benefits Manager, posted September 28, 2018
- New Jersey Department of the Treasury Division of Purchase and Property: Bid Solicitation for Employee Benefits: Pharmacy Benefit Management, posted March 13, 2019
Medicaid
Several states are implementing a “Netflix” subscription-based payment model that allows a state to negotiate agreements with drug manufacturers for unlimited access to hepatitis C drugs for a fixed, predetermined cost. Below are state resources.
Louisiana Resources
- Louisiana Department of Public Health: Solicitation for Offers: Pharmaceutical Manufacturer(s) to Enter Into Contract Negotiations to Implement Hepatitis C Subscription Model, February 2019
- Webinar: How States Pay for Hep C Drugs Using a “Netflix-style” Subscription Model Featuring Pete Croughan, Health Policy Advisor, Louisiana Department of Public Health. This webinar was held on May 15, 2019.
- Louisiana’s State Plan Amendment, approved June 2019
- Louisiana Department of Public Health: Louisiana launches hepatitis C innovative payment model with Asegua Therapeutics, aiming to eliminate the disease, June 2019
Washington Resources
- Webinar: How States Pay for Hep C Drugs Using a “Netflix-style” Subscription Model Featuring Donna Sullivan, Chief Pharmacy Officer, Washington Health Care Authority. This webinar was held on May 15, 2019.
- Washington’s State Plan Amendment, approved June 2019
- Washington Health Care Authority: Eliminating hepatitis C home page
States are executing outcomes-based contracts with drug manufacturers based on a specific drug and agreed-upon outcomes, and various approaches to measurement. These contracts are enabled by state plan amendments allowing states to negotiate supplemental rebates depending on a drug’s performance.
Alabama Resources
- Alabama’s State Plan Amendment, approved Dec. 20, 2019
Arizona Resources
- Arizona’s State Plan Amendment, approved April 28, 2020
Colorado Resources
- Colorado’s State Plan Amendment, approved February 2019
- Webinar: Medicaid Alternative Payment Models for Prescription Drugs – A Look at Three States Featuring Cathy Traugott, Pharmacy Manager, Colorado Department of Health Care Policy & Financing. The webinar was held on May 9, 2019.
Massachusetts Resources
- Massachusetts’ State Plan Amendment, approved July 2019
Michigan Resources
- Michigan’s State Plan Amendment, approved November 2018
- Webinar: Medicaid Alternative Payment Models for Prescription Drugs – A Look at Three States Featuring Trish Bouck, Pharmacy Management Division Director, Michigan Department of Health & Human Services, and Rita Subhedar, State Assistant Administrator, Michigan Department of Health and Human Services. The webinar was held on May 9, 2019.
Oklahoma Resources
- Oklahoma’s State Plan Amendment, approved June 2018
- NASHP Blog: As Drug Prices Rise, Oklahoma’s Medicaid Agency Advances Alternative Payment Models, December 2018
- Two-webinar series:Medicaid Alternative Payment Models for Prescription Drugs: Do They Add Value for States? Featuring Terry Cothran, director, University of Oklahoma College of Pharmacy, Pharmacy Management Consultants. The webinars were held Dec. 12, 2018 and May 9, 2019.
- Presentation: Value-Based Programs in Oklahoma Medicaid presented by Terry Cothran, Director, University of Oklahoma College of Pharmacy, Pharmacy Management Consultants, at NASHP’s annual health policy conference in August 2019
NASHP provided a grant to the Colorado Department of Health Care Policy and Financing to develop a new payment methodology for physician-administered drugs based on average acquisition costs.
Colorado Resources
- Webinar: State Tools to Lower Medicaid Prescription Drug Costs – Exploring Payment Methodologies for Retail and Physician-Administered Drugs Featuring Kevin Martin, Fee for Service Rates Manager, Colorado Department of Health Care Policy and Financing. The webinar was held on March 29, 2019.
- NASHP Blog: Colorado Develops New Payment Method for Physician-Administered Drugs – with the Potential to Save Millions, March 2019
- Presentation: Pharmaceutical Cost Containment Strategies for Colorado Medicaid presented by Kevin Martin, Fee for Service Rates Manager, Colorado Department of Health Care Policy and Financing, at NASHP’s annual health policy conference in August 2019
Massachusetts Enhanced Negotiating Authority
The Massachusetts Executive Office of Health and Human Services has the authority to directly negotiate supplemental rebate agreements with manufacturers for drugs covered by MassHealth. If an agreement cannot be reached and the drug meets certain price thresholds, the drug can be referred to the Massachusetts Health Policy Commission for further review.
Massachusetts Resources
- Authorizing legislation: Section 46 of the Massachusetts FY 2020 Budget
- Massachusetts Health Policy Commission home page
- Massachusetts Health Policy Commission: Drug Pricing Review, approved Feb. 5, 2020.
- Massachusetts Health Policy Commission: Final Regulation for Drug Pricing Review, approved Feb. 5, 2020
New York Medicaid Drug Benefit Budget Cap
The New York Medicaid program has the authority to negotiate with drug companies for supplemental rebates if drug spending is projected to exceed the annual spending limit. If the state is unable to reach an agreement, drugs may be referred to the New York Drug Utilization Review Board, which conducts a value assessment of the product.
New York Resources
- Authorizing legislation: New York SB S2007B/Chapter 57, enacted April 20, 2017
- New York Department of Health: SFY 2019-20 Medicaid Drug Cap Stakeholder Webinar, August 2019
- Presentation: Medicaid Drug Cap presented by Amir Bassiri, Chief of Staff to the Medicaid Director, at NASHP’s annual health policy conference in August 2019
- New York Department of Health: Medicaid Global Spending Cap Implementation homepage
