We’re previewing some of our most popular sessions in the lead-up to our annual Access Insights Conference. This blog is adapted from the upcoming session, “Hot Topics in Government Channels and State Price Transparency.” 

 

Patient out-of-pocket costs are rising. With specialty pharmacy prescription revenues growing to $178 billion in 2020 (up 9% from 2019), and 1 in 4 Americans reportedly unable to afford their prescriptions, these are extremely disconcerting trends for life sciences manufacturers as patient initiation and adherence to therapy is essential for achieving successful treatment outcomes.

Due to these trends and an overwhelming need for drug price transparency, almost half of all states have signed state price transparency measures into law (with more on the way) over the past few years. These laws place complex new compliance and reporting obligations on pharmaceutical manufacturers, requiring them to report on drug prices and price increases in an attempt to limit drug costs. 

A few months ago, I wrote about the basics of state price transparency reporting. Because the landscape is constantly changing and evolving, I wanted to give an update on the latest news from individual states regarding price transparency.

 

Minnesota

Minnesota is expected to release the final version of its state price transparency bill (SF 1098) prior to the effective date of January 1, 2022, as opposed to the previous date of October 1, 2021. New drafts of the user guide and definitions have been released, but more changes are expected prior to the effective date of the bill. If you’re interested in a deep dive, you can view all regulation text updates here.

 

North Dakota

North Dakota has issued guidance that the first reports for the quarterly WAC reports are expected to be submitted via email during the reporting window between October 1 – October 15.  While the web portal is still in development, New Drug or Price Increase reports are expected to be emailed to the state at drugtransparency@nd.gov. The state has advised not to include any confidential report information in the body of the email or attachments.

 

Maine

Maine has recently passed LD 686, expanding on the Maine Health Data Organizations (MHDO) power to requisition “additional pricing component data” from manufacturers that indicate having launched a new high price drug or taking a qualified price increase. While no new reports have been enacted since LD 686, manufacturers are more likely to get requests for additional information.

 

Oregon

Oregon’s annual registration fee has been released on the state web portal by logging on and navigating to ‘Drug Prices’ > ‘Billings’ > ‘Details’ > ‘Print Payment Coupon’ to get all the details. Note that there is an annual baseline fee of $400 plus an additional fee per report that was submitted over the course of the year.

 

Q4 2021 State Price Transparency General Updates

The latest version of the Procedure Tracker and Reference deck (v3.4) is preparing to release at the start of Q4 with all the details from above contained as well as updated templates, user guides, and reference material. 

 

If you have any questions about navigating these state policies, optimizing your operational readiness, or avoiding compliance risk, reach out to price.transparency@integrichain.com and our team of experts can help guide you through.

 

Learn more about IntegriChain’s State Price Transparency capabilities 

 

Sources:

1. 2021 Economic Report on U.S. Pharmacies and Pharmacy Benefit Managers

2. Kaiser Family Foundation Poll

About the Author

John Whitridge

John Whitridge

Senior Consultant, Advisory Services