State drug pricing legislation in the time of coronavirus  

Here in Washington the consensus is that the coronavirus pandemic has quashed all hope of serious drug pricing reform, at least for the foreseeable future. But states around the country, from Utah to New York, have enacted significant drug pricing reforms over the last month. (Yes, even while they were dealing with a pandemic.)

Below STAT walks through the various bills that have seen serious action since coronavirus hit the U.S. shores:

• Minnesota’s insulin affordability breakthrough. The Minnesota legislature is expected to vote as early as today on the Alec Smith Emergency Insulin Act, a first-in-the-nation program that will provide emergency insulin for Minnesotans at risk of rationing their insulin. The bill has been the subject of intense debate for more than a year, but a breakthrough came last week when a conference committee of top legislators announced they had reached a deal on a final bill. Drug makers have threatened to challenge the bill in court.
• Colorado formally seeks approval to import drugs. Colorado announced on March 9 that it submitted a plan to the Trump administration describing how it will import drugs from Canada if the Trump administration approves it. Colorado estimates it will save $36 to $60 million per year from importing drugs. Among the biggest savers: Valeant Pharmaceuticals’ Wilson Disease drug Cuprimine, for which Colorado says it pays $262 per unit. The state estimates it could buy the drug from Canada for 92 cents per unit, inclusive of a 45 percent markup. Colorado follows Florida which submitted its own importation plan last August. Both Vermont and Maine are expected to submit plans in the coming weeks, too. The federal government must approve the plans before states can start importing. 
• Kentucky and New York’s crackdown on PBMs. Govs. Andy Beshear and Andrew Cuomo of Kentucky and New York, respectively, both signed laws recently that significantly curtail the power of drug middlemen in managing the states’ Medicaid managed care programs. New York’s law basically cuts PBMs out of the program, while Kentucky’s law would require the state to contract with just one PBM. Both bills were written in response to anger over so-called spread pricing, where a PBM pockets the difference between what it charges a state for a drug and what it reimburses the pharmacy that dispensed it. 
• States embrace insulin copay caps. Governors in New York, West Virginia, Virginia, Utah, and Washington all signed so-called insulin copay cap bills in recent weeks. Utah’s new law limit copays to $30 for a 30-day supply, Virginia’s law limits them to $50 and New York, West Virginia, and Washington kept them to $100 for a 30-day supply. Utah’s new law also creates a so-called insulin discount program, under which a large portion of insulin rebates will be passed to customers at the pharmacy counter.
• One major setback for advocates: Washington Gov. Jay Inslee vetoed a bill that would have created a state prescription drug affordability board, which would have had the power to set limits on how much state and local governments pay for certain prescription drugs. The bill died as part of a mass veto, which Inslee has said will help right the state’s fiscal woes following the coronavirus pandemic. 
• Speaking of Maryland: That state’s legislature passed a bill in March that directs the affordability board to come up with a way to fund itself before Dec. 31. The bill notes that the board could propose fees on drug makers, PBMs, insurers, or distributors or use drug rebates to fund the program. It hasn’t yet been signed by Gov. Larry Hogan.