Recent Approaches and Innovations in State Prescription Drug Laws
Consumer Copayment Limits for Prescription Drugs: May 2019. Several state legislatures have responded to rising prescription drug costs with legislation imposing limits on consumer copayments for specific treatments or under certain conditions. this report highlights some of these initiatives.
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provisions enacted by the state in 2018; results to be determined or not yet tested
During the past two to three years, several states have enacted laws with novel or alternative approaches to state regulation related to prescription drug costs and prices. The laws described below are examples from Arizona, California, Connecticut, Louisiana, Maine, Maryland, Nevada, Oregon, Tennessee and Vermont. A separate list describes state executive waivers and actions not requiring enacted laws, in Louisiana, Massachusetts and Oklahoma. The list does not include pending legislation or laws from earlier years. NCSL’s Prescription Drug Database provides additional details and further examples of non-enacted measures, covering 2015 to 2018.
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transparency of drug costs
california law (sb 17), enacted oct. 19, 2017 as Chapter 603. Primary Sponsor: Sen. Ed Hernandez (D); passed senate (28y-10n) and assembly (66y-9n). this price transparency law applies to all drugs (brand and generic) with a wholesale acquisition cost of at least $40 when the price of these drugs increases more than 16 percent in the previous 12 months or 32 percent in the previous 24 months. requires pharmaceutical manufacturers to provide public and private purchasers (including state agencies, health insurers, and pharmacy benefit managers) with 90 days advance notice of price increases for prescription drugs currently in the market, including detailed information on the reasons and justification for such increases, aggregate and summarize public information. it also requires justification of the launch prices of new drugs. requires health insurers to submit rate information to report specific costs related to covered prescription drugs, including generic, brand, and specialty drugs. requires reporting the percentage of the insurance premium attributable to prescription drugs. Court update: Judge dismisses California drug pricing law lawsuit. a federal district judge in sacramento, cal. has dismissed a lawsuit seeking to block a California law that requires drug companies to give advance notice before large price increases. the judge ruled Aug. On January 30, 2018, the Phrma plaintiffs failed to show that the court had jurisdiction to hear the case and gave Phrma 30 days to refile, the AP reported.
Vermont Laws Vermont enacted two related state laws, first in 2016 and then in 2018, amending and expanding prior law. review both laws to get the full effect of the changes:
- vermont 2016: (s 216), enacted on June 6, 2016 as law 165; Lead Sponsor: Sen. Kevin Mullin (R) provides pharmaceutical cost transparency, requiring the state to annually identify up to 15 state-purchased prescription drugs ”on which the state spends significant health care dollars and for which the wholesaler’s acquisition cost has increased by 50 percent or more in the last five years or by 15 percent or more in the last 12 months, creating substantial public interest in understanding price developments for drugs”. The manufacturer of the drug provides a justification for the increase in the wholesale acquisition cost of the drug” in an understandable and appropriate format. requires adoption of rules requiring certain insurers to provide information on state health benefit exchange plan drug formularies; it also establishes drug dispensing fees, reimbursement, and out-of-pocket drug limits.
- vermont 2018 (s 92); signed on May 30, 2018 as minute no. 193; Main Sponsor: Sen. virginia ginny lyons (d) reviews provisions related to prescription drug price transparency and cost containment. 1) Expands provisions of Vermont’s Prescription Transparency Act of 2016 to require Vermont department health and access to health insurers with more than 5,000 covered lives to create lists of 10 prescription drugs for which the payer’s net cost has increased by 50 percent or more in the past five years or by more than 15 percent annually. the attorney general’s office will identify 15 drugs for which drugmakers must provide justification for the price increase(s). each manufacturer must also provide a separate version of its justification that will be made public. 2) prohibits pharmacy benefit managers from prohibiting or penalizing a pharmacy or pharmacist for providing information to a member about a cost-sharing amount for a prescription drug, disclosing to a member the cash price of a prescription drug, or sell a lower-cost drug to an insured if one is available. 3) requires prior authorization to refill a prescription with a drug or biological product other than the prescription originally filled; requires electronic notification from pharmacy to provider after dispensing of biologics. requires a pharmacist to select the lowest priced drug or interchangeable biologic.
- vermont attorney general implementation report, february 2018 [full text, pdf]
- report free goods or compensation provided by each sales representative to nevada licensed health care providers.
- Pharmacy benefit managers are required to report the dollar value of manufacturer drug reimbursements collected.
- all non-profit patient groups that are active in nevada to publicly report all sources of financial support. the intention is to make it more transparent when patient groups have a financial interest in lining up and lobbying on behalf of the pharmaceutical industry.
prescription drug transactions in the united states account for 10 percent of total health spending.
State legislatures consider an average of 1,000 measures each year that would affect pharmaceuticals.
State legislators can use this guide to inform future decisions or compare states to federal activity.
Over the past three years (2015-2017), there has been increased interest and activity in legislation related to the price, payment, and costs associated with prescription drugs. Due to this legislative interest, states have enacted a diverse set of policy initiatives, including this selection of enacted legislation with a total of 119 signed bills from 45 states.
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Of the measures included in this report, some seek to reduce overall costs or prices of prescription drugs, while others may shift costs from patients or payers to other entities. The legislation contained in this report represents a wide variety of approaches in a diverse mix of states and is intended to provide the reader with a comprehensive overview of all approaches taken by states in recent years to address costs, pricing and the payment of pharmaceutical products. medicines with attention to the specific measures taken by different states facing different healthcare challenges and landscapes.
In terms of general issues, legislation addressing “insurance coverage” has received the most legislative attention, with 29 states enacting one or more bills affecting coverage requirements and restrictions for commercial and exchange insurers here. Other topics, such as pharmacy benefit managers (pbms) and transparency issues, such as “gag clauses,” have garnered more attention from lawmakers more recently, as the national media has scrutinized these aspects of the health care systems.
this report is based on enacted legislation extracted from the ncsl online prescription drug database. NCSL’s comprehensive directory details 682 enacted laws and resolutions from all 50 states, D.C. and Puerto Rico Entries in this report are listed alphabetically by state and chronologically by year for each state. Below is a reference table of included topics that lists the states that have enacted relevant legislation.
A detailed subject index is included at the end of this document.
Enacted legislation by topic and number of states
americans with disabilities act (ada): list of compatible legislation
To retrieve the laws, including links to the full text: 1) select states as “all” 2) select topics such as: • cost sharing and deductibles : consumers • medicaid use and cost – prescription drugs • price and payment – industry • pharmacy benefit managers 3) select year as “all” (includes 2015-2018) 4) select status as “enacted” or “adopted”
issues beyond cost, pricing, access and payment are tracked and reported by ncsl onine. those topics include:
- biologics and biosimilars
- clinical trials and the right to try
- compound pharmacy regulation
- insurance/coverage – prescription drugs
- safety and errors: prescription drugs
- specialty pharmaceuticals
- utilization management – prescription drugs
- other prescription drug measures
the ncsl prescription drug policy resource center is supported in part by a grant from the laura and john arnold foundation, for research and educational resources conducted between november 2017 and 2019. editorial content is sole responsibility of ncsl.
 This search is based on the following database filters: Topics: Cost Sharing and Deductibles; pricing and payment of pharmaceutical products; use and cost of rx medicaid; pharmacy benefit managers.
 acais short for “the Patient Protection and Affordable Care Act,” also referred to as ppaca, aca, and “obamacare” in state legislative documents.
 the ncsl database is available online at http://www.ncsl.org/research/health/prescription-drug-statenet-database.asp.
Disclaimer: ncsl takes no position on state laws or legislation. this information is provided for general information and discussion. it is not intended to be legal or medical advice.
may 2018 – ncsl health program
richard cauchi, director of the program; colleen becker, policy specialist; charles separation-medaris, policy associate
nevada law (sb 539), enacted on June 15, 2017 as chapter 509; Lead Sponsor: Senator Michael Roberson (R) This law has several provisions to contain drug costs. The law requires the state to publish a list of all essential diabetes drugs, and drugmakers must also annually report the costs of manufacturing and marketing each product, along with other details. In addition, each year the state will identify products with price increases that exceed the Medical Consumer Price Index in the last 12 months or double the increase in the previous 24 months. manufacturers of those drugs must report additional information that justifies or explains their price increases. Nevada law makes public all information provided by the manufacturer. the law also requires:
connecticut law (h 5384) filed as Public Act No. 18-41, May 17, 2018. requires the state to annually list the 10 medications that represent a substantial state expense, when they are priced at $60 a month or more and with an annual cost increase of 20 percent or more. for these products, manufacturers will disclose research and development and other similar capital expenditures and, for specific price changes, will post justifications for all factors that caused the price increases on the state website. Manufacturers with new applications for drug approval will also “be required to file” an FDA Notice of Action with the state. health insurers and pbms are also required to submit details on the 25 most expensive, frequently used, and rapidly rising cost prescription products.
maine law (s 484). promulgated on May 1, 2018 as law no. 406 of 2018. Principal Sponsor Sen. Vitelli (D). expands provisions for prescription drug price transparency. requires the state health data organization to report the 25 most frequently prescribed drugs and the 25 highest cost drugs determined by the total amount spent on those drugs and the largest price increases. requires a new plan for data collection from manufacturers, with an annual report on prescription drug prices published beginning in 2019.
oregon law (h 4005), enacted on March 12, 2018. Lead Sponsor: Representative Robert Nosse (D) Requires prescription drug manufacturers to report annually to the Department of Consumer and Business Services prescription drug prices and costs associated with developing and marketing prescription drugs. this includes drugs that were priced at $100 or more for a one-month supply or for a course of treatment that lasted less than a month, and there was a net increase of 10 percent or more in the price of these drugs over the course of the previous calendar year. it also requires drug manufacturers to report the reasons behind significant increases in drug prices and authorizes the state to impose civil penalties on a manufacturer for failing to comply with reporting requirements. requires health insurers that offer a prescription drug benefit to report to the department the most frequently prescribed and highest-priced drugs, including those whose prices have increased dramatically. The law requires insurers to itemize the impact of these costs on insurance premium rates.
louisiana law (h 436) enacted as law no. 220 of 2017, of June 14, 2017. sponsors: representatives kirk talbot (r); h. bernardo lebas (d); commander thibaut (d); helena moreno (d); Paul Hollis (R) and Dustin Miller (R). requires drug manufacturers to provide transparency in prescription drug pricing information. Every pharmaceutical manufacturer or marketer ”engaging in any form of prescription drug marketing” to a physician, prescriber, or any member of their staff must provide the louisiana board of pharmacy with the current wholesale acquisition cost (wac) of each of the drugs approved by the us. Food and Drug Administration and marketed in the state by that manufacturer.
freedom of expression for unauthorized pharmaceutical use
Arizona Law (H 2382), enacted March 21, 2017. Principal Sponsor: Representative Lovas (R). creates a “law of freedom of expression in medicine”. relates to pharmaceuticals, allowing drug manufacturers to promote and market off-label drugs if the information consists of a “true promotion” of a drug, biologic, or device. prohibits the state or any medical board or subdivision from enforcing any federal or state restriction on manufacturers, health care institutions, or a physician from such “true promotion.” plan sponsor to provide coverage for the cost of any off-label use of a drug, biologic, or device as a treatment. The law conflicts with current federal law, 21 USC Sec. 331, which restricts drug manufacturers from promoting off-label uses. ♦ tennessee law (h 2220) second law of freedom of expression in medicine, enacted and signed on May 3, 2018
maryland law (h 631), enacted in may 2017. this law prohibits manufacturers of “essential drugs” from increasing prices to “unconscionable” levels . The law applies to generic and off-patent drugs on the World Health Organization’s list of “essential drugs,” which are considered the minimum pharmaceutical treatments necessary for a basic health care system. three manufacturers would be affected. allows the state medicaid agency to report to the attorney general drugs that cost at least $80 and have a wholesale cost increase of 50 percent or more in 12 months. the attorney general can use the agency’s information or can independently identify off-patent and essential generic drugs experiencing “unconscionable” price gouging. An “unconscionable” price increase is defined as an excessive price increase that is not justified by changes in production and for which consumers have no meaningful treatment alternative. if the attorney general fails to find an adequate explanation for the price increase, the matter can be referred to state court, which can decide whether to impose penalties on a manufacturer. The law specifies three specific remedies that a state court could apply to manufacturers: they can lower the price to a previously lower level; compensate all purchasers and insurance companies in maryland who paid the “outrageous” price of drugs; or impose civil penalties of up to $10,000 for each violation. • This maryland law was struck down by a federal court as a violation of the “dormant commerce clause” that restricts states from interfering with interstate commerce. other states’ legislation is considering alternative language to avoid this provision. According to state sources at the Center for Hospital Finance and Administration in October, “Maryland’s price gouging bill has been appealed to the Supreme Court. Judge Gorsuch wrote an appeal that would suggest he favors allowing states set rates.”
prescription drugs covered by health insurance
nevada law (at 381) of 2017, enacted June 1, 2017, as law no. 281. Primary Sponsor: Assembly Member Spiegel (D) Relates to health insurance, prohibiting an insurer from taking certain actions with respect to prescription drugs covered by individual and small group health insurance policies. restricts copays from increasing to a higher cost tier than original coverage for a drug prescribed under a formulary with more than one cost tier. The insurer can move the prescription from a lower cost tier to a higher cost tier only in January. On January 1, 2018, at the start of the policy year or when a new generic drug is approved by the FDA and added to the lower-tier list. it does not alter a pharmacist’s ability to substitute a generic or interchangeable biologic when available.
California law ‘caps on copays.’ (a 1860)of 2018; enacted Sept. 19, 2018. main sponsor: asm. monique limon extends the existing 2014 law through 2024, prohibiting an individual health insurance policy or group health care service plan contract that provides coverage for orally administered prescription anticancer drugs (used to kill or slow the growth of cancer cells) require a member to pay a total amount of copays and coinsurance in excess of $250 for a single prescription 30-day supply. (The old law capped at $200 per prescription.)
regulation of drug discount coupons
california law(at 265) of 2017; enacted oct 9 as act no. 2017-611. main authors: asm. wood (d) & chiu (d) prohibits a company or person that manufactures a prescription drug from offering a discount coupon, refund, product coupon, or other reduction in a person’s out-of-pocket expenses, including a copayment, coinsurance, or deductible, for any prescription drug if a lower-cost generic drug is covered by individual health insurance, health care services plan, or other health coverage with lower cost sharing. specifies exceptions to these prohibitions if the individual has completed any applicable step therapy and does not regulate “a pharmaceutical product at no charge, if the product is free to both the patient and his or her health insurer, health care service plan, or other coverage health”, the application is launched by a complaint.
prohibition of pbm “gag clauses” to lower prices for consumers
Laws recently enacted in at least 29 states block commercial pbm or health insurer contracts that may prohibit pharmacies from informing customers of available alternative prices for medications, including direct or generic payment. or brand name products that may be less expensive or comparatively more suitable for a patient. many bills also address the “copay recovery” situation. typical state language includes, “a pharmacy or pharmacist shall have the right to provide the insured with information about the insured’s cost-sharing amount for a prescription drug. neither a pharmacy nor a pharmacist shall be penalized by a pharmacy benefit manager for discussing any information described in this section or for selling a lower-priced drug to the insured if one is available.”
united states congress approves gag clause bills; signed by pres. trump : congress approved the law on the patient’s right to know the prices of medicines, s. 2554 by 98 votes in favor and 2 against on September 17. became public law no: 115-263. its goal is to end practices that prohibit pharmacists from telling customers they could save money by paying cash instead of using their insurance. Congress also approved s. 2553 (115), “meet the lowest price act of 2018” that prohibits gag clauses in medicare; became public law no: 115-262.), both were signed on Oct. 10. The president outlined legislation that “will completely end these unfair gag clauses once and for all.” Although the legislation is designed to save consumers money, a CBO score shows that it would lead to a slight decrease in federal revenue. senator’s office Susan Collins (R-Maine), who sponsored the bill, said that’s because the CBO believes pharmacy benefit managers would try to recoup some of the money they would lose if it were enacted.
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* includes 2004 minnesota statute. see map on last page ♦ read ncsl’s full report online | updated Oct. 1, 2018
requires brand name manufacturers to sell an already marketed drug to a developer of a generic version of that drug
maine law (s 432), enacted on July 4, 2018 the new law ”guarantees greater competition in the market for drugs and biological products, which will lower the cost of prescription drugs for Maine residents and the state. ”amends the maine pharmacy law to require that a drug distributed in this state must be available for sale in this state to a person seeking to develop an application for drug approval under the federal food, drug, and cosmetic law o Licensing of a biological product under the federal public health services act; establishes disciplinary actions for non-compliance.
wholesale import of prescription drugs
vermont law (s 175) approved by the house (141y-2n) and the senate (29y-0n) on 7 May 2018; enacted May 16, 2018. Creates a wholesale import program to purchase high-cost medications through licensed wholesalers, who will purchase the medications in Canada and make them available to Vermonters through a existing supply chain including local pharmacies. The new law requires the Vermont Human Services Agency, in consultation with stakeholders and the federal government, to design and submit an import proposal to the state legislature by January 1. July 1, 2019 and further requires the agency to submit its proposal to the federal government on or before July 1, 2019, for final approval. The import program must be operational within six months of approval of the financing strategy, certification, and approval by the federal government. • read vermont legislature first to approve importation of rx drugs | Is it safe and profitable to import medicines from Canada? view an infographic on importing wholesale | published by nashp.
establishes a state limit on medicaid drugs
new york law (ny s 2007; act no. 57 of 2017) , 04/20/2017 ”the legislature finds and declares that there is a significant public interest in the medicaid program managing drug costs in a manner that ensures patient access while providing financial stability for the state and participating providers. Since 2011, the state has taken significant steps to contain costs in the Medicaid program by imposing a legal cap on annual growth. however, drug spending continually outstrips other cost components…therefore, the department “will establish a medicaid drug cap as a separate component within the overall medicaid cap as part of a focused and sustained effort to balance growth in drug spending with growth in total Medicaid spending. It provides for the state’s Medicaid Drug Utilization Review Board (DUR) to follow “a recommendation that the drug manufacturer pay the department a target supplemental Medicaid reimbursement and the target amount of the reimbursement.” if the state fails to enter into a satisfactory reimbursement agreement, non-cooperating manufacturers will be required to submit a detailed financial report that includes “actual cost of development, manufacturing, production…administration, marketing, and advertising costs, including but not limited to , prescriber details, co-pay discount programs and direct-to-consumer marketing, prices used outside the US, and other specific statistics.Provides budget execution.
trade and cost-effective prescription drug coverage (state executive actions)
oklahoma approved value-based contract. On June 27, 2018, CMS approved a state plan amendment to “allow the state to negotiate supplemental reimbursement agreements involving value-based purchase agreements with drug manufacturers that could result in additional reimbursements to the state if they are not achieved.” clinical results”. this is the first approval in the nation of this approach. (cms statement, 6/27/2018).
• ncsl held three meeting sessions in 2017 to discuss value-based purchasing and contracting; see descriptions online. • oklahoma’s second contract, signed in september, is with pharmaceutical company melinta for a drug used primarily to treat bacterial skin infections. The state Medicaid program had required prior authorization before paying for the drug. a report on oklahoma published on 09/25/18 by nashp noted that under the new value-based contract, prior authorization will no longer be required. “in exchange for the drug being listed as first-line treatment, melinta guarantees that oritavancin will not result in a net increase in costs. while other medications used to treat bacterial skin infections may require hospitalization for administration, oritavancin does not. Although its purchase price is higher, oritavancin is not expected to cost the state Medicaid program more because it is expected to eliminate costly hospital stays required by other drug options.” however, under the value-based contract, if the state incurs higher costs, despite hospitalizations avoided, melinta will be required to cover those costs through additional reimbursement to the state.
louisiana has the latest publicly initiated medicaid buyout idea, with a new subscription-based payment model for hepatitis c (state agency description) unveiled 7/7 August 2018. In this plan “the state would pay a drug manufacturer or manufacturers for unlimited access to treatment for people in louisiana who are enrolled in medicaid or in the louisiana correctional system. the payment to the manufacturer would be equal to or less than what the state is currently spending to provide antiviral drugs to these populations.” The Department is seeking input from the public, health professionals, pharmaceutical companies, and others on a plan that will bring us much closer to the goal of eliminating Hepatitis C for vulnerable populations. through a request for information, the louisiana department of health solicits public input on the creation of a subscription-based payment model for hepatitis c medications. Under this payment model, the state would pay a drug manufacturer or manufacturers for unlimited access to treatment for people in louisiana who are enrolled in medicaid or in the louisiana correctional system. the payment to the manufacturer would be equal to or less than what the state is currently spending to provide the antiviral drug to these populations. “A successful subscription-based model would create an incentive for us to find and treat as many people as possible. For the drug manufacturer, this model would guarantee a fixed purchase price for a contracted period of time and allow them to extend the reach of their product to populations that would not otherwise have received treatment,” said Dr. rebekah gee, secretary of the louisiana department of health. Her next step is to assess public comments, which is due August 24, 2018.
massachusetts, by agency executive action, applied for a section 1115 medicaid waiver that would allow the state to choose which prescription drugs to cover based on the most beneficiary needs and which medications turn out to be the most suitable. more profitable. the state wants the power to negotiate discounts for the drugs it buys and exclude drugs with limited treatment value. According to the most recent data, Medicaid spending on prescription drugs increased about 25% in 2014 and nearly 14% in 2015. The Department of Health and Human Services declined to approve the plan on June 27, but state officials they were examining variances and amendments. • As states try to rein in drug spending, the feds slap a bold Medicaid move in the face. – analysis published by khn and npr, sep. january 21, 2018. cms denied a massachusetts proposal “that was seen as the boldest attempt yet to rein in medicaid drug spending. massachusetts planned to exclude expensive drugs that had not been shown to work better than existing alternatives. the state said medicaid drug spending had doubled in five years massachusetts wanted to negotiate prices for about 1 percent of the highest-priced drugs and stop covering some of them cms rejected the proposal without much explanation, other than Saying Massachusetts couldn’t do what it wanted and still get the drugmakers are required by law to give deep discounts to state Medicaid programs.” • “a setback for massachusetts in states’ campaign to rein in medicaid drug spending” – npr analysis and commentary. “Massachusetts planned to exclude expensive drugs that had not been shown to work better than existing alternatives. The state said spending on Medicaid drugs had doubled in five years. massachusetts wanted to negotiate the prices of about 1 percent of the highest-priced drugs and stop covering some of them. cms rejected the proposal without much explanation other than saying that massachusetts couldn’t do what it wanted and continue to receive the deep discounts that pharmaceutical companies are required by law to give to state medicaid programs.”- September 12, 2018. • states want to control drug prices. will the feds give it to him? – by Ruling Magazine, 5/7/2018 – “In an attempt to lower health care costs, Massachusetts is trying to exclude certain medications from its Medicaid program.”
legal analysis for state drug laws
Legal Resources for Drug Cost Containment Legal Challenges to Prescription Drug Laws Passed in 2017 Will Shape States’ Future Cost Containment Legislation: 2018 Case Analysis with Links to Individual Cases, Posted in 2018 by the National Academy for State Health Policy.
Opposing Views: Pharmaceutical Research and Manufacturers of America (Phrma) argue that state legislation (such as California’s SB 17) “attempts to dictate the national health care policy related to drug prices in violation of the united states constitution, singles out drug manufacturers as the sole determinant of drug costs despite the important role that many other entities play in costs paid by patients, and will cause market distortions, such as drug stockpiling and reduced competition.” They point out that the mandatory transparency bills do not fully consider the costs of drug development and post-marketing surveillance. marketing, and the value and savings that drugs bring to society.” Neither of these bills address the issue of affordability for ra the patients. it’s a big oversight. .”
rx ballot questions: rejected in 4 states by judges and voters
a judge in south dakota blocked a ballot measure intended to limit how much state agencies could pay for prescription drugs. in July 2018, the circuit judge ruled in favor of a group opposed to the measure, which had challenged the validity of the signatures used to bring the initiative to a vote. the measure would have prevented the state from paying more than the government pays for drugs. This is the second time this year a court fight has kept a drug pricing initiative off the ballot (a nearly identical measure did not make the ballot in the district of columbia) and similar initiatives have failed in ohio and california in 2016.
the new trump administration plan – may 2018
The trump administration announced on May 11 a “plan to lower prices and reduce out-of-pocket expenses.” The plan included more than 25 strategies grouped into four categories: improved competition, better bargaining, incentives to lower list prices, and lower out-of-pocket costs. (read ncsl review, posted Jul 2, 2018)
mr. Trump said his administration will get to work immediately, describing it this way: “everyone involved in the broken system – drug manufacturers, insurance companies, distributors, pharmacy benefit managers and many others – contribute to the problem”. trump said. “The government has also been part of the problem because previous leaders turned a blind eye to this unbelievable abuse. But under this administration, we are putting American patients first…I have instructed Secretary Azar to start advancing reforms that will bring high drug prices back to earth.”
The plan strongly favors value-based pricing, and the Department of Health and Human Services considers value-based transformation of the entire health care system a top priority. The same week the 21st state signed into law a no-gag clause, President Donald Trump said, “Our plan will end dishonest double dealing that allows the middleman to pocket rebates and discounts that should be passed on to consumers and patients. our plan prohibits the pharmacy gag rule that punishes pharmacists for telling patients how to save money. This is a total scam, and we’re going to end it.” This federal executive action is intended to affect Medicare transactions, however, state regulators have primary jurisdiction over much of the commercial and private market coverage.