From state-level expansions of the federal No Surprises Act to insulin copay caps, these recently passed state bills or laws will have an impact on payers:
Illinois governor signs legislation expanding surprise billing protections
Illinois Gov. J.B. Pritzker signed three bills into law May 26 that build on the federal No Surprises Act and commence a study on rate-setting approaches in the state.
Kansas Medicaid contract talks halted despite governor's objection
Kansas' Medicaid contracts won't be negotiated until at least next January. On May 23, Republican state lawmakers overrode the Democratic governor's veto of legislation that prevents her office from seeking new contracts with payers for the state's Medicaid program.
Maryland caps insulin copays at $30 per month
Maryland Gov. Larry Hogan signed legislation May 16 that places a cap on insulin copays at $30 per month. The Insulin Cost Reduction Act caps the price for a 30-day supply of insulin for those on state-regulated commercial health plans and applies to all policies issued or renewed in the state starting in 2023.
Colorado passes PBM minimum rates bill opposed by payers
The Colorado General Assembly passed a bill May 10 that sets minimum rates for what pharmacy benefit managers can pay to a pharmacy for prescription drugs. Once signed by the governor, the legislation will apply to contracts starting Jan. 1 between a PBM and a pharmacy that is located in a county with a population of fewer than 100,000 people and owned by a licensed pharmacist. The Colorado Association of Health Plans opposed the legislation, saying it will raise premium prices
Delaware governor signs 12 weeks of paid family leave, health benefits into law
Delaware Gov. John Carney signed a statewide 12-week paid family and medical leave insurance program into law May 10. Employers with at least 10 employees in Delaware must contribute to the program, and employees who take leave are entitled to continued employee health benefits during leave. Employer and employee contributions for the program will begin in 2025.
State legislatures are coming for PBMs
In 2021 alone, 18 state legislatures across the country have introduced and passed laws aimed at regulating and creating more transparency around pharmacy benefit managers. Similar legislation has also been introduced at the federal level.