Posted: June 3, 2022
State Legislative Spotlight: Illinois & Kentucky
Illinois and Kentucky are two states that CSRO decided to target and spearhead the introduction of legislation in 2022. In Illinois, CSRO helped introduce legislation to prohibit payers from mandating that buy and bill be replaced with white bagging. SB 3924, sponsored by Senator Castro, and HB 4774, sponsored by Representative Lilly, both sought to accomplish this goal. CSRO developed and supplied model language, based on a Louisiana law, to assist with the formulation of these bills. Notably, the Louisiana law does not provide protections for practices that do not have an internal pharmacy and since this is fairly common among rheumatology practices, CSRO ensured that the language of these new bills would extend to practices lacking internal pharmacies.
CSRO then convened a coalition of provider organizations who all shared concerns with the increasing prevalence of mandates by payers to white bag provider administered drugs. To supplement its efforts on the ground, CSRO hired additional local lobbying resources as well. Opposition from health plans and PBMs was fierce, and ultimately the legislation was not heard before the end of 2022’s regular session. However, substantive progress was made in raising awareness about the issue, and CSRO expects efforts to continue in the fall when the Illinois legislature reconvenes.
Kentucky was the second state that CSRO decided to target. In this state, CSRO sought to update the state’s existing step therapy law to bring it in line with other state laws, which provides prescribers additional flexibility and protections. Working through the State Access to Innovative Medicines (SAIM) Coalition, of which CSRO currently serves as chair, CSRO was able to secure additional local lobbying resources and a robust grassroots coalition to support its efforts. This culminated in the introduction of SB 140 sponsored by Senator Max Wise.
CSRO staff supported the legislation by appearing to testify in committee, leading legislative negotiations with opposition, and coordinating the grassroots efforts of coalition members. SB 140 was a resounding success, following previous successes in Arizona, Arkansas, and Louisiana, and was officially signed into law in March following near-unanimous support in the legislature.
The efforts in Kentucky and Illinois are just two examples of how CSRO has a direct hand in helping advance the agenda of the rheumatology community. CSRO will continue to assess the political environment in states across the country, and apply its resources in this manner in the coming legislative sessions.
Accumulator Adjustment Programs
This year two states, Maine and Washington, have seen accumulator legislation signed into law, bringing the total number of states with legislation on the books to thirteen and Puerto Rico. Several states such as Massachusetts, Minnesota, New York, Ohio, Pennsylvania will continue to work on the issue for the remainder of the year. Due to a conflict with IRS rules regarding health savings account eligible high deductible health plans some states with existing laws have moved to exempt such plans from their laws or legislation.
In Pennsylvania specifically, CSRO staff participated in negotiations with opposition to help ensure the bill remained beneficial for the patients rheumatologists treat. CSRO staff also worked directly with the local lobbying team of the Pennsylvania Rheumatology Association to help coordinate grassroots support and strategy.
Non-medical Switching
Non-medical switching continues to be a politically difficult issue across the states. High drug costs being a leading component of increasing health care expenditures continues to be a pervasive narrative in state policy circles, and serves as a headwind legislation on this issue. Colorado did see some success this year, with non-medical switching protections being signed into law as part of a broader patient access package. This follows the signature of a law in New York at the end of 2021.
CSRO’s continued support of non-medical switching legislation in Iowa demonstrates the manner in which CSRO helps empower rheumatologists and state societies to participate in advocacy. Over the years, CSRO helped the rheumatology association craft letters of support, connected rheumatologists to media opportunities designed to support the legislation, and numerous rheumatologists took advantage of CSRO’s action center to communicate with their representatives in Des Moines.
Prior Authorization
The new Texas “Gold Card” law is an exciting development representing willingness to try new approaches towards reducing prior authorization burden. A number of states across the country pursued legislation in 2022 following Texas’s lead. The gold carding policy is new and unproven.
There remain numerous questions regarding the concept will be operationalized for prescription drugs, which is of chief concern to rheumatologists. Helping to ensure that state policy reflects the needs of the rheumatology community is one of CSRO’s main goals. To that end, CSRO took the time to comment on the Texas Department of Insurance’s proposed rules regarding the new law. CSRO’s full comments can be accessed CSRO's website here. CSRO intends to monitor implementation of the Texas law to inform its advocacy efforts across the states.
Rebate Pass Through & PBMs
In 2021, West Virginia passed a first-of-its-kind law requiring payers to reduce patient cost sharing amounts for prescription drugs commensurate with rebates received in conjunction with that patient’s purchase. Although no states have followed West Virginia’s lead so far this year, 15 states saw legislation introduced. CSRO has joined with the Patient Pocket Protector Coalition to coordinate on rebate pass through legislation across the country.
Step Therapy
Step therapy remains an issue area generating a great degree of success. To date, signature of laws in Colorado, Kentucky, and Tennessee have brought the total number of states with some form of law on the books to 35. States such as California, Pennsylvania, and New Jersey continue to work on legislation.
In addition to CSRO’s leadership in Kentucky, CSRO also serves as chair of the State Access to Innovative Medicines Coalition (SAIM). The coalition is the central coordinating vehicle for step therapy legislation across the country, which allows CSRO to influence policy, strategy, and legislation across the country. This helped CSRO staff work behind the scenes to formulate language in Colorado that was consistent with the model language supported by CSRO.
White Bagging
White bagging has emerged as an important issue to the rheumatology community. as a result, it has become a hot issue for state legislatures. Louisiana remains the only state with a prohibition on mandatory white bagging on the books, although practices lacking an internal dispensing pharmacy are excluded from the law’s protections. CSRO has worked proactively across the states to ensure that this exclusion is not replicated across states that have introduced legislation on this issue. In states such as Kentucky and Nebraska, CSRO staff met with stakeholders in order to secure amendments that would ensure all rheumatology practices would be protected by the proposed legislation. To date, thirteen states have seen legislation introduced on this issue.
