The Source Blog
Recent Action in Pharmaceuticals
Introduced: Status: Enacted
A utilization review program shall use documented clinical review criteria that are based on sound clinical evidence and are evaluated periodically to assure ongoing efficacy. A health carrier may develop its own clinical review criteria, […]
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Cal. Health & Safety Code §§ 127675 through 127686: Prescription Drug Pricing for Purchasers – California
Introduced: Status: Enacted
It is the intent of the Legislature in enacting this chapter to provide notice and disclosure of information relating to the cost and pricing of prescription drugs in order to provide accountability to the state […]
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Tex. Occ. Code §§ 157.051 through 157.060: Physicians– Authority of Physician to Delegate Certain Medical Acts – Texas
Introduced: Status: Enacted
A physician may delegate to an advanced practice registered nurse or physician assistant, acting under adequate physician supervision, the act of prescribing or ordering a drug or device as authorized through a prescriptive authority agreement.
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Or. Rev. Stat. §§ 743B.250 through 743B.258: Health Benefit Plans: Individual and Group — Grievances and Appeals – Oregon
Introduced: Status: Enacted
Provides the process for appeal and external review. Requires an insurer to provide all information relating to benefit design and provider networks. States that an insurer must have an external review program to assess whether […]
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Or. Rev. Stat. § 743A.082. Diabetes management for pregnant women: Health Insurance: Reimbursement of Claims – Oregon
Introduced: Status: Enacted
States that a health benefit plan may not require a copayment or impose a coinsurance requirement or deductible on the covered services, medications and supplies that are medically necessary for a woman to manage her […]
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Or. Rev. Stat. §§ 743.028 through 743.035: Health and Life Insurance — General Provisions (Forms and Standards) – Oregon
Introduced: Status: Enacted
The Department of Consumer and Business Services, in consultation with the Oregon Health Authority, shall develop by rule a form that providers in this state shall use to request prior authorization for prescription drug benefits.
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Or. Rev. Stat. § 678.390. Authority of nurse practitioner and clinical nurse specialist to write prescriptions or dispense drugs; notice; requirements; revocation; rules: Professional Nurses (Prescriptive Authority) – Oregon
Introduced: Status: Enacted
The Oregon State Board of Nursing may authorize a certified nurse practitioner or certified clinical nurse specialist to write prescriptions, including prescriptions for controlled substances listed in schedules II, III, III N, IV and V.
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District Court: Federal Trade Commission Office of Administrative Law Judges Status: Pending
The FTC filed a civil antitrust lawsuit against three of the largest prescription drug benefit managers that administer about 80% of all prescriptions in the […]
Merck & Co., Inc. v. Becerra, et al. – Federal
District Court: District of Columbia Status: Pending
A complaint filed by Merck, a multinational pharmaceutical company, alleges that the drug price negotiation process detailed in the Inflation Reduction Act (IRA) violates the […]
FTC v. Amgen Inc. & Horizon Therapeutics Plc. – Federal
District Court: Northern District of Illinois, Eastern Division Status: Pending
The FTC filed a lawsuit requesting a temporary restraining order and preliminary injunction to block Amgen Inc. from acquiring Horizon Therapeutics. Amgen agreed to purchase […]
PhRMA v. Stolfi – Oregon
District Court: District Court of Oregon Status: Decided
PhRMA is challenging Oregon’s drug price transparency laws HB 4005, 2018 (Disclosure Law) and HB 2658, 2019 (Advance Notification Law) alleging that the laws are […]
Pharmaceutical Care Management Association (PCMA) v. Mulready – Oklahoma
District Court: District Court of Western District of Oklahoma Status: Decided
The 2019 Oklahoma law, Patient’s Right to Pharmacy Choice Act, targets PBM conflict of interest by prohibiting higher reimbursement rates for PBM-owned pharmacies and bans […]
State of Ohio v. OptumRx – Ohio
District Court: Ohio Court of Common Pleas (Franklin County) Status: Pending
On March 15, 2019, Ohio’s attorney general Dave Yost sued OptumRx in Ohio state court, claiming that between 2015 and 2018, the PBM failed to pass […]
Pharm. Care Mgmt. Ass’n v. Gerhart – Iowa
District Court: Southern District of Iowa Status: Decided
Trade association representing pharmacy benefits managers (PBM) brought action against State of Iowa, seeking declaration that statute that regulated how PBMs established generic drug pricing […]
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Trends in Pharmaceuticals
State Pharmaceutical Legislation
Click on highlighted states to see all legislative action to regulate pharmaceutical price and competition in the 2019 session. Click to see 2018 trends for a side-by-side comparison.
2019 Drug Pricing Transparency Legislation
Pharmaceutical price transparency legislation requires disclosures from drug manufacturers and insurers to help lawmakers and the public better understand how drugs are priced and how those prices affect insurance premiums. Click to see 2018 trends for a side-by-side comparison.
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Key:
- Enacted
- Considered
2019 Pharmaceutical Rate-Setting Legislation
Rate setting legislation either establishes the price of a prescription drug or sets the maximum amount a payer can pay for a drug. Click on highlighted states to see rate-setting legislation considered or enacted in the 2019 session. Click to see 2018 trends for a side-by-side comparison.
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Key:
- Enacted
- Considered
2019 Drug Importation Legislation
Click on highlighted states to see drug importation legislation considered or enacted in the 2019 session. Click to see 2018 trends for a side-by-side comparison.
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Key:
- Enacted
- Considered
2019 Drug Price Gouging Prohibition Legislation
Price gouging prohibitions typically empower the state Attorney General to act if the price of a drug is raised above a threshold. Click on highlighted states to see legislation considered in the 2019 session. Click to see 2018 trends for a side-by-side comparison.
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Key:
- Enacted
- Considered
2019 Pharmacy Benefit Manager Regulation Legislation
Legislation to regulate Pharmacy Benefit Managers (PBMs) typically include provisions that 1) require PBMs to register with the state, 2) mandate disclosures by PBMs, or 3) prevent PBMs from incentivizing the use of mail-order pharmacies. Click to see 2018 trends for a side-by-side comparison.
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Key:
- Enacted
- Considered