Wednesday, July 10, 2019

States' 2020 Agendas Target PBMs, Reinsurance and Opioid Crisis


by Jane Anderson
Going into 2020, state lawmakers likely will continue to target prescription drug prices with proposals largely aimed at PBMs, but they may also tackle bills on a wide range of topics, including reinsurance, the opioid epidemic and maternal mortality.
More than 260 bills to rein in the cost of prescription drugs — many of which specifically banned common PBM business practices — cropped up in the U.S. this past spring, and Gerard (Jerry) Vitti, founder and CEO of Healthcare Financial, Inc., says he anticipates more of the same going forward.
"The debate will be around drug pricing — around half of the [2019] bills are PBM-related," Vitti tells AIS Health.
While pharmacy and drug pricing measures are likely to heat up again in states through the fall and into 2020, other issues of interest to insurers also are likely to get some attention.
For example, lawmakers in additional states are likely to approve proposals asking CMS to grant them Affordable Care Act Section 1332 waivers to implement reinsurance programs designed to lower premiums in their individual marketplaces, says Alex Shekhdar, founder of Sycamore Creek Healthcare Advisors.
State lawmakers also are likely to continue tackling the opioid crisis, using federal funding to finance various prevention and treatment programs, he says.
Going forward, "we continue to see more red states attempt to expand Medicaid under flexible arrangements," Vitti notes. These arrangements might include work requirements, even though courts struck down Medicaid work requirements in Arkansas and Kentucky.
Vitti notes that some conservative-leaning states also may consider Medicaid beneficiary cost-sharing, adding, "there really is an appetite in state legislatures for these types of conservative policies."

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