State News

Illinois has passed a law prohibiting price gouging of certain prescription medications, reported by the Office of Senator Koehler. Effective January, 2024, House Bill 3957 prohibits manufacturers and distributors from engaging in price gouging of essential off-patent and generic medication, making Illinois the first state in the country to do so.

New York and Connecticut have recently enacted and expanded laws regulating facility fee
billing, reports Mintz. The regulations in New York, effective June 21, adopted patient notice
requirements and made New York the first state to place an outright ban on facility fees related
to preventative care. The Connecticut legislation, which goes into effect July 1, 2024, will
expand existing oversight of facility fee billing by prohibiting hospitals and health systems from
collecting facility fees for outpatient health care services provided on a hospital campus.

New Jersey Governor Phil Murphy signed three bills into law designed to lower prescription drug
costs in the state, reports New Jersey Business Magazine. The legislation includes establishes
a Drug Affordability Council to create prescription drug affordability policy reforms and requires
drug manufacturers to report pricing data to the state. Another bill, S3240, caps out-of-pocket
costs for insulin at $50 per month and requires insurers to cover certain diabetes medications. A
third bill, S3241, increases oversight of pharmacy benefit managers and requires them to
disclose certain pricing information.

Wyoming ranks 49 out of 51 states (including the District of Columbia) in terms of health system
performance, reports the Casper Star Tribune. The report cited defines performance based on
the rate of premature death, metrics related to reproductive and women’s health, and health
care access and affordability. The question of what kind of health care Wyomingites want
remains unanswered, and affordable health insurance is only part of the solution. Factors like
economic, social, cultural, and geographic barriers to health care must also be considered, as
well as new strategies to increase the efficiency of health care delivery.

Oregon has expanded its Medicaid look-alike program, Healthier Oregon, to all residents who
qualify, regardless of their immigration status, reports The Lund Report. The program began in
2021, originally covering those 19-24 and 55 years and older. State officials estimate 55,000
people will be covered through the program.

Maryland will now offer coverage for pregnant and postpartum people, regardless of citizenship
status, according to the Baltimore Sun. This is part of the Healthy Babies Initiative, which aims
to reduce the number of maternal deaths in the state. Starting July 1, 2023, pregnant, income-
eligible residents will be able to receive the same benefits available to other pregnant individuals
with Medicaid coverage, including physical and behavioral health care, dental care, prescription
drug coverage without copays, through the CHIP “unborn child” option, plus an additional four
months of postpartum coverage using Health Service Initiative authority.

Rhode Island has passed legislation that allows insured individuals to access HIV-prevention
and post-exposure medications without any out-of-pocket costs, reports the Rhode Island
Current. The CDC estimates that only about one-quarter of individuals at risk of HIV
transmission are using PReP due to high costs, which can be up to $2,000 per month without
insurance. In addition to requiring all health insurance carriers in the state to cover pre-exposure
prophylaxis (PrEP) and post-exposure prophylaxis (PEP), the legislation also authorizes
pharmacists to prescribe the drug to eligible patients, potentially decreasing wait times for
patients prescribed PEP, which is most effective if taken within seventy-two hours of potential
exposure. Rhode Island joins a growing list of states that have passed similar legislation,
including Maine, Nevada, and Virginia.

Lawmakers in Minnesota have allocated $1.1 million to establish a nine-member Prescription Drug Affordability Board and an eighteen-member Prescription Drug Advisory Council to provide expert advice to the board on cost issues, reports Minnesota Public Radio. The board, in consultation with the advisory council, will be responsible for conducting cost reviews of prescription drugs and establishing upper payment limits if the drug is determined to cause affordability challenges for the health care system or patients. The legislation also prohibits "excessive price increases" for generic or off-patent drugs. Distributors that raise the prices of generic drugs by 15 percent in one year or 40 percent over three years would face penalties.

Illinois will establish a state-based health insurance marketplace as well as a rate review process, reports WWTV News. Under House Bill 579, Illinois will join the eighteen other states with state-based marketplaces, offering plans sold under the Affordable Care Act with subsidies for those earnings above the Medicaid income threshold. In addition, House Bill 2296 authorizes the Illinois Department of Insurance will have the authority to modify or reject proposed premium rate increases that it determines to be unreasonable or inadequate. It also increases transparency for consumers by adding reporting requirements for insurance companies.