ASCO and State Affiliates Wrap Up Successful State Sessions

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After a fast-paced first half of the year, most state legislatures across the 50 states and Washington, DC, have adjourned for the year. The Association for Clinical Oncology (ASCO) and State Affiliates successfully collaborated to advance many shared 2023 state advocacy priorities, including those in the highlights below.

More States Enact Coverage for Fertility Preservation for Patients With Cancer

Montana enacted legislation requiring coverage of fertility preservation services for patients with cancer, and Utah enacted fertility preservation coverage for patients insured through the state’s Public Employees’ Health Program. ASCO worked with the Montana State Oncology Society and the Society of Utah Medical Oncologists (SUMO), respectively, to support these bills. Louisiana, Kentucky, and Texas each enacted fertility preservation legislation that covers egg and sperm cryopreservation.

In July, ASCO and the Hawaii Society of Clinical Oncology (HSCO) met with the Hawaii Office of the Auditor to discuss fertility preservation coverage. In the Hawaii legislative process, proposed insurance mandates go through an auditor’s review. An auditor’s report is expected at the end of the year, which the legislature will review before considering final legislation.

Legislation in Massachusetts and Vermont could receive consideration in the fall and in the next legislative session, respectively.

North Carolina Expands Medicaid

North Carolina became the 40th state to expand Medicaid, which will give more than 600,000 previously uncovered North Carolinians access to health care.

States Continue to Take Up Measures to Ban Copay Accumulators

ASCO continues to support legislation requiring insurers to count money from copay assistance programs toward a patient’s deductible. This year, Colorado, the District of Columbia, New Mexico, and Texas passed legislation banning copay accumulators.

In Missouri, Rhode Island, and Utah, legislation banning copay accumulators passed one legislative chamber—which is further in the process than similar legislation moved previously—and similar bills are pending in Michigan and Wisconsin. Additionally, North Dakota passed legislation requiring a legislative study on copay accumulators, and SUMO and the Michigan Society of Hematology and Oncology (MSHO) attended press events in support of copay accumulator legislation in their states.

Two States Enacted Electronic Prior Authorization Laws

Virginia and Washington both enacted laws requiring insurers to establish and maintain electronic prior authorization systems.

Step Therapy Protections Expanded in Two States

Maryland and Nevada enacted laws to expand the circumstances that would qualify a patient for exemption from a step therapy requirement.

Drug Pricing Legislation Picking Up Steam

Measures to create Prescription Drug Affordability Boards (PDABs) with the authority to set Upper Payment Limits (UPLs) on high-cost drugs were taken up in several states this year.

In Washington, HB 1269 would have removed an amendment ASCO and the Washington State Medical Oncology Society secured in earlier legislation to exempt physician administered drugs from UPLs. The bill did not make it out of the House.

In Minnesota, HF 17/SF 168, adopted as part of an omnibus bill, created a PDAB with UPLs. ASCO and the Minnesota Society of Clinical Oncology worked to secure a dedicated spot on the Prescription Drug Advisory Council for a community oncologist.

In Colorado, HB 1255, which expands an existing PDAB law to increase the number of drugs eligible for affordability review and UPLs, passed without amendment. ASCO and the Rocky Mountain Oncology Society weighed in raising concerns about the bill. ASCO submitted comments on the impact of UPLs on cancer care ahead of an August meeting, where the board selected five drugs for the first affordability review process. None of the selected drugs are used to treat cancer. The Association continues to monitor the PDAB’s activity.

A Nevada bill, AB 250, would have applied the maximum fair price under the Inflation Reduction Act to drugs in state-regulated health plans. ASCO and the Nevada Oncology Society raised concerns with the measure. The Governor vetoed it.

The Oregon legislature took up SB 404-1, which would have granted the existing PDAB authority to set UPLs. ASCO and the Oregon Society of Medical Oncology weighed in and achieved adoption of an amendment that delays addition of UPL authority for at least a year.

Indiana Establishes a Drug Repository Program

ASCO supported HB 1017 in Indiana, which establishes a drug repository program for patients to give back unused cancer drugs to a central or local repository. The Indiana Oncology Society submitted a letter in support of the measure and testified in person at a House Public Health Committee hearing in January. Governor Eric Holcomb signed the bill into law on May 4, and it took effect on July 1, 2023.

Oral Parity Efforts Advance in Michigan

ASCO and MSHO are supporting HB 4071 in Michigan, which would require that patient out-of-pocket costs for oral anticancer chemotherapy be no greater than out-of-pocket costs for intravenous chemotherapy. ASCO and MSHO sent a letter to the House Committee on Health Policy ahead of a hearing where an MSHO member testified and was quoted in a local news article. The bill passed the House and is awaiting consideration in the Senate Committee on Health Policy.

Nonmedical Switching Passes Iowa House, Hurdles Remain in Senate

This year, the Iowa House of Representatives unanimously passed HF 626, a bill protecting patients from nonmedical switching of medications during the plan year. This past year, the bill only made it through subcommittee. The legislation will carry over to 2024 and is expected to receive consideration in the Senate Health and Human Services Committee.

Looking Ahead

ASCO is using the interim period to plan and prepare for the 2024 legislate sessions with State Affiliates and coalition partners. Next year will be the second year of a 2-year state legislative session for most states, with legislation carrying over from 2023 to 2024. 

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