Category Archives: Cost Control

Tennessee and Connecticut Become the Latest States to Target Accumulator Adjustment Programs

In just the last few weeks, Tennessee and Connecticut joined the growing list of states to pass legislation banning the use of accumulator adjustment programs. As my colleague Erik explained earlier this month, manufacturers often provide cost sharing assistance programs to help patients afford certain high-cost specialty drugs. Insurers have in turn implemented “accumulator adjustment programs” that seek to reverse the impact of these programs by not counting the amounts provided by the manufacturer in calculating the patient’s annual out-of-pocket limit.… More

Three More States Bar Accumulator Adjustment Programs

Three additional states enacted legislation in recent weeks barring the “accumulator adjustment program” cost sharing framework. Accumulator adjustment programs seek to reverse the impact of manufacturer cost sharing assistance for prescription drugs by not counting amounts offset by such assistance toward a patient’s deductible. This can result in high patient out-of-pocket responsibilities after the manufacturer’s cost sharing assistance has been exhausted. For this reason, both drug manufacturers and patient advocates have sought to bar accumulator adjustment programs on both the federal and state levels.… More

California SB 17 Enacted

On October 9, California Governor Jerry Brown signed SB 17, legislation mandating advance notice and price transparency reporting for drugs experiencing greater than 16% increases in WAC over three calendar years and new drugs introduced at a WAC above the Medicare Part D specialty drug threshold.  The legislation will take effect January 1, 2018, although the reporting requirements to the Office of Statewide Health Planning and Development will begin in the first quarter of 2019.… More

Maryland Price-Gouging Legislation to Become Law Without Governor’s Signature

HB 631, Maryland’s first-in-the-nation “price gouging” bill, will become law without the signature of Governor Larry Hogan (R).  In a letter to Maryland Speaker of the House Michael Busch (D), Hogan stated that he would not sign the legislation due to concerns that it could violate the “dormant” application of the Commerce Clause of the U.S. Constitution.  However, Hogan declined to veto the legislation,… More

Massachusetts Senator Introduces Drug Transparency Bill Vesting CHIA and Attorney General with Oversight Authority

On January 19, 2017, Senator Mark C. Montigny introduced S.652 – “An Act to promote transparency and cost control of pharmaceutical drug prices.”  The bill currently sits in the Senate Committee on Health Care Financing, and covers the following categories of drugs: 1) the 10 costliest drugs to private payers in a given year; 2) the 10 drugs causing the highest annual increase in private payer spending;… More

Maryland ‘Price-Gouging’ Legislation Goes to Governor

In a lopsided 137 to 2 vote on April 10, 2017, the Maryland House of Delegates passed HB 631, which outlaws “price gouging” by manufacturers and wholesale distributors of certain “essential off-patent or generic drugs.”  Price gouging is defined as “an unconscionable increase in the price of a prescription drug.”

The legislation applies to drugs for which exclusive marketing rights have expired,… More

Supplemental Rebates for Medicaid Drugs Enacted with New York Budget

On Thursday, April 20, the Governor Andrew Cuomo signed into law New York’s 2017-18 budget.  The budget adds a new section 280 to the New York Public Health Law which requires the Commissioner of Health to set an aggregate Medicaid drug spending growth threshold for 2017 and 2018, and allows the Commissioner to refer drugs to the Drug Utilization Review Board for pricing reviews when the state is projected to exceed the threshold. … More