2024 Legislative Update

In the March 2023 issue of Total Pharmacy, we published our first review of state and federal legislative priorities. That review highlighted some of the key bills on the state level that were poised to change pharmacy practice and provided updates on key federal legislation. In this year’s legislative review, we’re highlighting some state-level legislation that has been passed since January 1, 2023, and the areas where legislators are anticipated to focus their efforts in 2024 and beyond.

Looking Back: 2023 Legislation

A total of 180 bills focused on scope of practice, payment, and pharmacist provider status were introduced in 43 states during the 2023 state legislative sessions, outpacing the 2022 legislative sessions by 2 bills. According to the National Alliance of State Pharmacy Associations,¹ by December 31, 2023, 55 bills in 32 states had passed and been signed into law—some of which were highlighted in our March 2023 issue of Total Pharmacy. Here are some others:

Legislative Outlook: 2024 and Beyond

Moving into 2024, pharmacy remains top of mind for both state and federal legislators. In an article published by health care consulting firm Avalere,² authors Kate Sikora, associate principal, and Lisa Joldersma, strategic adviser, suggested that states “will likely want to make their own mark on prescription drug pricing and access in stateregulated insurance markets” while federal legislators work to implement the Inflation Reduction Act. “Given ongoing concerns with health care workforce challenges, artificial intelligence, substance use disorders, and health inequities, state legislative sessions have a multitude of issues to cover,” Sikora and Joldersma added.

As of January 12, 2024, the National Academy for State Health Policy³ identified 91 bills in 28 states focused on pharmacy benefit managers (PBMs); from Alaska to Florida, states are fighting back against PBM practices that have resulted in high costs for patients and truncated reimbursement for independent pharmacies. Nearly 40 of the 50 states have passed PBM or health insurance–focused legislation since 2021, with the most recent efforts focused on PBM operations. Specifically, these targets include requirements for PBMs to pass on received rebates to patients or plan sponsors; efforts to limit spread pricing; and equivalent reimbursement for nonaffliated or 340B pharmacies and affliated pharmacies.²

States are also focused on the importation of prescription drugs⁴: There are 10 bills in 8 states addressing the issue. In Illinois, Michigan, Nebraska, New York, Ohio, Virginia, and West Virginia, legislators are seeking to establish wholesale prescription drug importation programs from Canada. If passed, these states would join Florida, which, on January 5, 2024, became FDA-authorized to import certain prescriptions from Canada at lower prices—the first time the FDA has granted this authority. In Pennsylvania, legislators are also interested in importing drugs from Canada: HB921 seeks to establish the Wholesale Prescription Drug Importation Program Design Act, which will require the state Department of Health to conduct a study on wholesale importation that will identify drugs with the highest associated consumer savings.

We will be tracking state and federal legislation throughout the year. Visit totalpharmacy.com to stay up to date on the latest bills, laws, and legislative priorities.

References

1. 2023 provider status end-of-year legislative update. National Alliance of State Pharmacy Associations. January 12, 2024. Accessed January 15, 2024. https://naspa.us/blog/resource/2023-provider-status-end-ofyear-legislative-update/

2. Sikora K, Joldersma L. States will prioritize drug affordability and access in 2024. Avalere. December 6, 2023. Accessed January 15, 2024. https://avalere.com/insights/states-will-prioritize-drug-affordability-andaccess-in-2024

3. 2024 state legislation to lower prescription drug costs. National Academy for State Health Policy. Updated January 12, 2024. Accessed January 15, 2024. https://nashp.org/2024-state-legislation-to-lower-prescriptiondrug-costs

4. Freed M, Cubanski J, Neuman T. What to know about the FDA’s recent decision to allow Florida to import prescription drugs from Canada. KFF. January 12, 2024. Accessed January 15, 2024. https://www.kff.org/policywatch/what-to-know-about-the-fdas-recent-decision-to-allow-florida-to-import-prescription-drugs-fromcanada