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Patient Access Reform in the States: Previewing 2023

If Washington’s new year gridlock is any indication of what’s to come, statehouses will in all likelihood be leading the way on health care policy in 2023.  

Breaking Barriers 

As ever, the most important priorities for access advocates are the breaking down of barriers that keep patients from their FDA-approved therapies. 

  • Utilization management techniques like prior authorization and step therapy remain in force and unchecked in numerous states. Reforming them will be at the top of patient advocates’ agendas in the new year. 
  • Patients across the country are also still subjected to co-pay accumulator programs, which limit the benefit of patients’ co-pay assistance. It’s just one approach insurance companies use to pocket prescription drug savings meant for their insured members. More than a dozen states have already stepped in to protect patients from these costly schemes, and legislators from coast to coast are ready to follow their lead this year. 
  • In addition, momentum is building in many states to end non-medical switching. The practice, by which insurers and pharmacy benefit managers force already stable patients to change medications for reasons unrelated to their health, occurs far too often. 

Keeping Up With Innovation 

Legislative activity isn’t just limited to curtailing bad policies, however. It’s also about enacting good ones.  

For example, states across the country have expanded access to mental health care and biomarker testing in recent years.  

And in an effort to keep up with the fast pace of innovation, some lawmakers will aim to codify coverage for cutting-edge tests and treatments. This is important in oncology, hepatitis C and mental health, among other conditions.  

Promoting Transparency 

Finally, patients will continue to fight for a level playing field in policymaking processes with big corporations and special interest groups.  

It’s long past time pharmacy benefit managers provided the public a more transparent accounting of their business practices. And for legislatures to guarantee patients a seat at the table on states’ Prescription Drug Affordability Boards. Patients’ presence during decision making is necessary to protect themselves from policies — like use of quality adjusted life years — that seek to save money by undervaluing lives. 

Even if Congress continues to get bogged down in 2023, patient access advocates will have their hands full with what promises to be a busy year of state health care legislation. 

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