State Legislative Measures: Payer Familiarity With Efforts to Control Drug Costs

Researchers recently assessed payers’ familiarity and perceptions of 4 types of state-level prescription drug initiatives. According to the findings, where were presented at AMCP Nexus 2018, generic substitution (GS) and step-therapy (ST) were top concerns for payers, while manufacturer-sponsored drug coupons or copay cards (CB) and pricing transparency (PT) legislation were less familiar with payers.

Recently, many state lawmakers are addressing prescription drug costs through legislation, according to the study researchers led by Stephen Wilson, analyst at Xcenda, and colleagues. However, they explained that there is little information about payers’ awareness and concerns regarding the initiatives. In order to assess payer familiarity, the researchers conducted a blinded, web-based survey with current US pharmacy and medical directors from health plans and pharmacy benefit managers in June 2018. The survey respondents were asked about their familiarity with, perception of, and support for state legislative efforts concerning the GS of interchangeable biologics, bans on CB, ST guidelines, and PT. For their answers, respondents used a 5-point scale.  

Survey respondents indicated that they stay informed on legislative development from a variety of sources including the Academy of Managed Care Pharmacy (78%), conduct research internally (73%), and law firms (9%). Further, the researchers found that when preparing for new legislation, 60% pursue lobbying, 53% develop risk-mitigation strategies, and 40% rely on consultants.

According to the findings, most respondents were extremely or very familiar with legislation for GS (73%) and ST (62%). Further, fewer than half were as familiar with PT (44%) and even fewer with CB (38%). The researchers found that concerning the financial impact of legislation on businesses, the highest proportion of respondents rated GS as extremely or very impactful (64%), followed by ST (58%), CB (49%), and PT (29%). Additionally, when respondents were asked which legislative effort they supported, respondents who were extremely or very familiar with the initiatives overwhelmingly favored legislation for GS (88%), CB (94%), and PT (80%). They were split for ST legislation support (43% support).

“GS and ST are top concerns for payers, as evidenced by high levels of self-reported knowledge and familiarity, rating of initiatives as critical to business, and high anticipated financial impact to their organization,” Mr Wilson and colleagues said. “Respondents are less familiar with CB and PT legislation and perceive them to have lower financial impact on their business.”

“Findings also suggest payers may anticipate that PT effects will be minimal beyond the impact on manufacturers,” the researchers concluded.

The study authors noted that additional research is needed to better understand payer rationale and strategies for addressing state legislative issues.

—Julie Gould