State Policies and Issues
States Can Help Patients Pay Less for Their Medicines
America’s biopharmaceutical companies agree that, for too many Americans, the health care system is not working and needs to change. No one should struggle to afford the medicines they need. Unfortunately, some patients continue to bear more of their medicine costs at the pharmacy counter.
That’s why our companies are advocating for common-sense reforms to make insurance work like insurance and ensure that patients can access and afford the medicines their doctors prescribe.
Unfortunately, some state policy proposals put access to current and future medicines at risk, threaten ongoing research and development into new treatments and cures and jeopardize the high-paying jobs supported by the biopharmaceutical industry.
We believe there is a better way to help patients pay less for their medicines without sacrificing access to medicines, innovation and jobs.
pills in hand
Click the button below to learn more
Alabama
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340B
Download the fact sheet on the 340B program in
https://cdn.aglty.io/phrma/Fact Sheet - 340B State Profiles New York 2026.pdf
https://cdn.aglty.io/phrma/Fact Sheet - 340B State Profiles California 2026.pdf
https://cdn.aglty.io/phrma/Fact Sheet - 340B State Profiles Texas 2026.pdf
https://cdn.aglty.io/phrma/Fact Sheet - 340B State Profiles Alabama 2026.pdf
https://cdn.aglty.io/phrma/Fact Sheet - 340B State Profiles Alaska 2026.pdf
https://cdn.aglty.io/phrma/Fact Sheet - 340B State Profiles Arizona 2026.pdf
https://cdn.aglty.io/phrma/Fact Sheet - 340B State Profiles Arkansas 2026.pdf
https://cdn.aglty.io/phrma/Fact Sheet - 340B State Profiles Colorado 2026.pdf
https://cdn.aglty.io/phrma/Fact Sheet - 340B State Profiles Connecticut 2026.pdf
https://cdn.aglty.io/phrma/Fact Sheet - 340B State Profiles Delaware 2026.pdf
https://cdn.aglty.io/phrma/Fact Sheet - 340B State Profiles Florida 2026.pdf
https://cdn.aglty.io/phrma/Fact Sheet - 340B State Profiles Georgia 2026.pdf
https://cdn.aglty.io/phrma/Fact Sheet - 340B State Profiles Hawaii 2026.pdf
https://cdn.aglty.io/phrma/Fact Sheet - 340B State Profiles Illinois 2026.pdf
https://cdn.aglty.io/phrma/Fact Sheet - 340B State Profiles Indiana 2026.pdf
https://cdn.aglty.io/phrma/Fact Sheet - 340B State Profiles Iowa 2026.pdf
https://cdn.aglty.io/phrma/Fact Sheet - 340B State Profiles Kansas 2026.pdf
https://cdn.aglty.io/phrma/Fact Sheet - 340B State Profiles Kentucky 2026.pdf
https://cdn.aglty.io/phrma/Fact Sheet - 340B State Profiles Louisiana 2026.pdf
https://cdn.aglty.io/phrma/Fact Sheet - 340B State Profiles Maine 2026.pdf
https://cdn.aglty.io/phrma/Fact Sheet - 340B State Profiles Maryland 2026.pdf
https://cdn.aglty.io/phrma/Fact Sheet - 340B State Profiles Massachusetts 2026.pdf
https://cdn.aglty.io/phrma/Fact Sheet - 340B State Profiles Michigan 2026.pdf
https://cdn.aglty.io/phrma/Fact Sheet - 340B State Profiles Minnesota 2026.pdf
https://cdn.aglty.io/phrma/Fact Sheet - 340B State Profiles Mississippi 2026.pdf
https://cdn.aglty.io/phrma/Fact Sheet - 340B State Profiles Missouri 2026.pdf
https://cdn.aglty.io/phrma/Fact Sheet - 340B State Profiles Montana 2026.pdf
https://cdn.aglty.io/phrma/Fact Sheet - 340B State Profiles Nebraska 2026.pdf
https://cdn.aglty.io/phrma/Fact Sheet - 340B State Profiles Nevada 2026.pdf
https://cdn.aglty.io/phrma/Fact Sheet - 340B State Profiles New Hampshire 2026.pdf
https://cdn.aglty.io/phrma/Fact Sheet - 340B State Profiles New Jersey 2026.pdf
https://cdn.aglty.io/phrma/Fact Sheet - 340B State Profiles New Mexico 2026.pdf
https://cdn.aglty.io/phrma/Fact Sheet - 340B State Profiles North Carolina 2026.pdf
https://cdn.aglty.io/phrma/Fact Sheet - 340B State Profiles North Dakota 2026.pdf
https://cdn.aglty.io/phrma/Fact Sheet - 340B State Profiles Ohio 2026.pdf
https://cdn.aglty.io/phrma/Fact Sheet - 340B State Profiles Oklahoma 2026.pdf
https://cdn.aglty.io/phrma/Fact Sheet - 340B State Profiles Oregon 2026.pdf
https://cdn.aglty.io/phrma/Fact Sheet - 340B State Profiles Pennsylvania 2026.pdf
https://cdn.aglty.io/phrma/fact-sheets/340b/2025/Fact Sheet - 340B State Profiles Rhode Island.pdf
https://cdn.aglty.io/phrma/Fact Sheet - 340B State Profiles South Carolina 2026.pdf
https://cdn.aglty.io/phrma/Fact Sheet - 340B State Profiles South Dakota 2026.pdf
https://cdn.aglty.io/phrma/Fact Sheet - 340B State Profiles Tennessee 2026.pdf
https://cdn.aglty.io/phrma/Fact Sheet - 340B State Profiles Utah 2026.pdf
https://cdn.aglty.io/phrma/Fact Sheet - 340B State Profiles Vermont 2026.pdf
https://cdn.aglty.io/phrma/Fact Sheet - 340B State Profiles Washington 2026.pdf
https://cdn.aglty.io/phrma/Fact Sheet - 340B State Profiles West Virginia 2026.pdf
https://cdn.aglty.io/phrma/Fact Sheet - 340B State Profiles Wisconsin 2026.pdf
https://cdn.aglty.io/phrma/Fact Sheet - 340B State Profiles Wyoming 2026.pdf
https://cdn.aglty.io/phrma/Fact Sheet - 340B State Profiles Virginia 2026.pdf
Economic Impact
Download the fact sheet on Economic Impact in
Alabama_Eco Impact One Pager 2022_3.pdf
https://cdn.aglty.io/phrma/fact-sheets/economic-impact/Alaska_Eco Impact One Pager 2022_3.pdf
Arizona_Eco Impact One Pager 2022_3.pdf
Arkansas_Eco Impact One Pager 2022_3.pdf
California_Eco Impact One Pager 2022_2.pdf
Colorado_Eco Impact One Pager 2022_2.pdf
Connecticut_Eco Impact One Pager 2022_3.pdf
Delaware_Eco Impact One Pager 2022_2.pdf
DC_Eco Impact One Pager 2022_2.pdf
Florida_Eco Impact One Pager 2022_2.pdf
Georgia_Eco Impact One Pager 2022_3.pdf
Hawaii_Eco Impact One Pager 2022_2.pdf
Illinois_Eco Impact One Pager 2022_3.pdf
Indiana_Eco Impact One Pager 2022_2.pdf
Iowa_Eco Impact One Pager 2022_2.pdf
Kansas_Eco Impact One Pager 2022_2.pdf
Kentucky_Eco Impact One Pager 2022_3.pdf
Louisiana_Eco Impact One Pager 2022_2.pdf
Maine_Eco Impact One Pager 2022_2.pdf
Maryland_Eco Impact One Pager 2022_2.pdf
Massachusetts_Eco Impact One Pager 2022_3.pdf
Michigan_Eco Impact One Pager 2022_2.pdf
Minnesota_Eco Impact One Pager 2022_2.pdf
Mississippi_Eco Impact One Pager 2022_2.pdf
Missouri_Eco Impact One Pager 2022_2.pdf
Montana_Eco Impact One Pager 2022_2.pdf
Nebraska_Eco Impact One Pager 2022_3.pdf
Nevada_Eco Impact One Pager 2022_2.pdf
New Hampshire_Eco Impact One Pager 2022_2.pdf
New Jersey_Eco Impact One Pager 2022_2.pdf
New Mexico_Eco Impact One Pager 2022_2.pdf
New York_Eco Impact One Pager 2022_2.pdf
North Carolina_Eco Impact One Pager 2022_2.pdf
North Dakota_Eco Impact One Pager 2022_2.pdf
Ohio_Eco Impact One Pager 2022_2.pdf
Oklahoma_Eco Impact One Pager 2022_3.pdf
Oregon_Eco Impact One Pager 2022_2.pdf
Pennsylvania_Eco Impact One Pager 2022_3.pdf
Puerto Rico_Eco Impact One Pager 2022_2.pdf
Rhode Island_Eco Impact One Pager 2022_3.pdf
Tennessee_Eco Impact One Pager 2022_3.pdf
Texas_Eco Impact One Pager 2022_2.pdf
Utah_Eco Impact One Pager 2022_2.pdf
Vermont_Eco Impact One Pager 2022_2.pdf
Virginia_Eco Impact One Pager 2022_3.pdf
Washington_Eco Impact One Pager 2022_2.pdf
West Virginia_Eco Impact One Pager 2022_2.pdf
Wisconsin_Eco Impact One Pager 2022_2.pdf
STEM
Click the button below to download a PDF for STEM in
PhRMA State Fact Sheets - Alabama.pdf
PhRMA State Fact Sheets - Alaska.pdf
https://cdn.aglty.io/phrma/fact-sheets/stem/PhRMA State Fact Sheets - Arizona.pdf
PhRMA State Fact Sheets - California.pdf
PhRMA State Fact Sheets - Colorado.pdf
https://cdn.aglty.io/phrma/fact-sheets/stem/PhRMA State Fact Sheets - Connecticut.pdf
PhRMA State Fact Sheets - DC.pdf
PhRMA State Fact Sheets - Florida.pdf
PhRMA State Fact Sheets - Georgia.pdf
PhRMA State Fact Sheets - Hawaii.pdf
PhRMA State Fact Sheets - Illinois.pdf
PhRMA State Fact Sheets - Indiana.pdf
PhRMA State Fact Sheets - Iowa.pdf
PhRMA State Fact Sheets - Kansas.pdf
https://cdn.aglty.io/phrma/fact-sheets/stem/PhRMA State Fact Sheets - Kentucky.pdf
PhRMA State Fact Sheets - Louisiana.pdf
PhRMA State Fact Sheets - Maine.pdf
PhRMA State Fact Sheets - Maryland.pdf
PhRMA State Fact Sheets - Massachusetts.pdf
PhRMA State Fact Sheets - Michigan.pdf
PhRMA State Fact Sheets - Minnesota.pdf
PhRMA State Fact Sheets - Mississippi.pdf
PhRMA State Fact Sheets - Missouri.pdf
PhRMA State Fact Sheets - Montana.pdf
PhRMA State Fact Sheets - Nebraska.pdf
PhRMA State Fact Sheets - Nevada.pdf
PhRMA State Fact Sheets - New Hampshire.pdf
PhRMA State Fact Sheets - New Jersey.pdf
PhRMA State Fact Sheets - New Mexico.pdf
PhRMA State Fact Sheets - New York.pdf
PhRMA State Fact Sheets - North Carolina.pdf
PhRMA State Fact Sheets - North Dakota.pdf
PhRMA State Fact Sheets - Ohio.pdf
PhRMA State Fact Sheets - Oklahoma.pdf
PhRMA State Fact Sheets - Oregon.pdf
PhRMA State Fact Sheets - Pennsylvania.pdf
PhRMA State Fact Sheets - Puerto Rico.pdf
PhRMA State Fact Sheets - Rhode Island.pdf
PhRMA State Fact Sheets - South Carolina.pdf
PhRMA State Fact Sheets - South Dakota.pdf
PhRMA State Fact Sheets - Tennessee.pdf
PhRMA State Fact Sheets - Texas.pdf
PhRMA State Fact Sheets - Utah.pdf
PhRMA State Fact Sheets - Vermont.pdf
https://cdn.aglty.io/phrma/fact-sheets/stem/PhRMA State Fact Sheets - Virginia.pdf
PhRMA State Fact Sheets - Washington.pdf
PhRMA State Fact Sheets - West Virginia.pdf
PhRMA State Fact Sheets - Wisconsin.pdf
PhRMA State Fact Sheets - Wyoming.pdf
Programs and Initiatives
Download the sheet on Programs and Initiatives in
Clinical Trials
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State Policy Solutions
Share the Savings
Share the savings
On average, more than half of spending on brand medicines goes to health insurers, PBMs, the government and others, not the manufacturer that researched and developed the medicine. However, patients often do not benefit from these significant discounts in the form of lower out-of-pocket costs for their medicines.
That’s not right, and it needs to change.
If insurance companies and middlemen don’t pay the full price for medicines, patients shouldn’t have to either. These rebates and discounts should be directly shared with patients.
Make Insurance Work
Make insurance work
Many patients who have relied on patient assistance to access their medicines have no idea that health insurers and PBMs are engaging in practices that can make it harder or impossible for patients to get important treatments for chronic illnesses. This can result in confusion, inconsistency, and unpleasant surprises at the pharmacy counter.
We need to end this practice so that patients are getting the full benefit of programs meant to help them access their medicines.
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Cost Sharing Solutions
Offer lower, more predictable cost sharing options
Actual spending on medicines is growing at the slowest rate in years. Unfortunately, it doesn’t feel that way for patients. Insurers are increasingly using high deductibles and coinsurance that result in patients paying more for certain medicines out of pocket. Patients should have more choices when it comes to their medicine coverage.
Every state should require health insurers to offer at least some health plan options that exclude medicines from the deductible and offer set copay amounts instead of forcing patients to pay an amount based on the full list price of their medicines.
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Cover Medicines from Day One
Cover medicines from day one
Insurers increasingly require patients to pay high deductibles before receiving coverage of their medicines. This can lead to patients rationing or not taking their medicines, which can result in devastating consequences to their health.
Policymakers can help patients from day one by requiring all plans to cover certain medications used to treat chronic conditions with no deductible.
Additionally, insurers should be mandated to offer some plans that cover all medicines from day one.
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Cap Patient Cost Sharing
Cap patient cost sharing
Many commercially insured patients are being exposed to high out-of-pocket costs due to increasing use of deductibles and coinsurance. High cost sharing is a barrier to prescription medicine access, especially for patients with chronic, disabling or life-threatening conditions, who shoulder the largest share of the burden.
Cost sharing should not be so burdensome that it prevents patients with insurance from accessing necessary prescription medicines.
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Stop Gaming the System
Stop PBMs from "gaming the system"
Health insurance companies use middlemen called pharmacy benefit managers, or PBMs, to negotiate prescription drug prices and develop formularies that determine what medicines people can get and how much they must pay.
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Hold PBMs Accountable
Hold PBMs accountable under state law
Health insurance companies use middlemen called pharmacy benefit managers, or PBMs, to negotiate prescription drug prices and develop formularies that determine what medicines people can get and how much they must pay. PBMs are supposed to help lower costs for medicines, but they often enrich themselves over the interests of patients and their health plan clients.
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State Policy Concerns
Government Price Setting
Government price-setting policies come in a variety of forms, but they all lead to the government inserting itself between patients and doctors, threatening access to treatments and chilling research and development of new medicines. In fact, in other countries that have resorted to government price setting, patients have access to fewer new medicines and wait longer to get the medicines they need. Instead of pursuing proposals that could hurt patients and cripple innovation, we need policies that protect access to treatments and make medicines more affordable.
Prescription drug affordability boards are just one form of government price setting policy we’re seeing pop up in states around the country. These proposals would give bureaucrats the power to arbitrarily set medication prices in a given state. As a result, decisions about medicines would be a part of a political process that changes with elections and the whims of politicians.
Under this policy, the state would evaluate whether certain medicines and treatments are “worth” paying for, meaning the state’s bureaucracy could come between patients and the treatments their doctors prescribe. This spells disaster for patients as they could face barriers to obtaining life-saving medication.
people in suits listening
340B
Big tax-exempt hospitals and clinics abuse a little-known federal program to charge huge markups on medicines, sometimes 1,000% or more, to boost their profits, while they pass the bill to patients, taxpayers and employers through higher drug costs. They get away with this by exploiting, sometimes illegally, the 340B hospital markup program. This government program was created in 1992 to help patients access more affordable medicines. Today, the 340B program has become less about patients and more about boosting the bottom lines of hospitals and for-profit pharmacies.
man reading prescription on bottle
Related Resources
Insurers are blaming medicines for premium hikes in Massachusetts. The state's own data suggests otherwise.
Commercial insurers are seeking double-digit premium increases in Massachusetts and pointing the finger at prescription medicines. But the state’s numbers don't back it up.
Why it matters: When one part of the health care system is singled out as the cost driver, it lets the actual drivers — and the middlemen profiting from the status quo — off the hook. Patients and state policymakers deserve the full picture.
By the numbers:
- Total health care spending in Massachusetts reached roughly $83 billion in 2024, according to the state’s Center for Health Information and Analysis (CHIA).
- Spending on medicines, after rebates and discounts: $12.3 billion — less than 15% of total spending and less than both hospital outpatient and inpatient services alone.
- Hospital spending: $29 billion — more than one-third of all health care spending in the state.
- Rebates and discounts provided by biopharmaceutical companies in Massachusetts totaled more than $4 billion in 2024. For commercial health plans, these rebates lowered what plans paid for medicines by nearly 30%.
Yes, but: Those savings too often do not reach patients. Insurers and pharmacy benefit managers (PBMs) negotiate significant discounts behind the scenes — then can still require patients to pay based on the full price at the pharmacy counter. Coverage on paper does not always mean access in practice.
Between the lines:
The big picture: Insurers and the PBMs they own wield enormous influence over the prescription drug supply chain — deciding what medicines are covered, where patients can fill prescriptions and how much they pay.
The bottom line: If policymakers and stakeholders are serious about lowering costs, they need to fix the real drivers of higher spending – like middlemen who can block access to lower-cost medicines.
Learn more at PhRMA.org/PBMs.
Will May
340B is growing, but it is unclear if Illinois patients benefit
A program distorted: Congress created the federal 340B program in 1992 to help vulnerable and uninsured patients access medicines. What once served fewer than 100 safety-net hospitals is now the second-largest federal prescription drug program—topping $81 billion and serving as a cash cow for large hospital systems, for-profit pharmacies, pharmacy benefit managers (PBMs) and other middlemen.
There is no requirement that hospitals use 340B program profits to help patients afford the medicines they need. Big, tax-exempt hospitals abuse this loophole to buy medicines for as little as a penny and mark them up by 1,000% or more—passing the cost on to patients, employers and taxpayers.
The incomplete picture in Illinois: Illinois tax-exempt hospitals and clinics are exploiting the federal 340B program for profit, but they aren't required to disclose what they earn from 340B markups, where that money goes or how it affects patients, employers and taxpayers.
However, reporting in Crain's Chicago Business describes findings highlighted in a recent Illinois Central Management Services (CMS) memo on the program:
- Illinois hospitals generate more than 2.5x as much in estimated 340B-related profit as they spend on charity care.
- Large 340B hospitals charge roughly 7% more on average than comparable non-340B hospitals, with outpatient prices nearly 20% higher.
- The current program is estimated to cost Illinois employers about $224 million a year.
What Minnesota reveals next door: Minnesota's annual 340B transparency report shows an even clearer picture. Large hospitals, clinics and their for-profit partners generated at least $1.48 billion in net revenue from 340B markups in a single year.
Three things from Minnesota’s report stand out:
- Big hospitals profit more than true safety-net providers. Just four large hospitals in Minnesota captured half of the $1.34 billion that went to 340B covered entities.
- Prescriptions for low-income patients are a key source of 340B profits. $261 million came from markups on prescriptions filled for Medicaid patients in Minnesota—costs borne by taxpayers.
- Middlemen are in on it. Contract pharmacies—often owned by the three largest PBMs—received $120 million from the program in Minnesota alone.
The bottom line: 340B is a hidden tax on Illinois employers, taxpayers and patients—with no way to confirm the program is doing what it was meant to do.
Learn more at PhRMA.org/340B.
Will May
State price-setting boards create more questions than answers
The big picture: States are rolling out complex drug price-setting efforts—but there is no evidence yet that patients are or will save money at the pharmacy counter.
What’s new: Longtime supporters of state government price-setting and prescription drug board members themselves are raising concerns about how these policies are playing out and whether patients will benefit or if such policies will make it harder for patients to get their medicines.
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State prescription drug board architects are uncertain about workability: “Maureen Hensley-Quinn, Senior Director of Coverage, Cost and Value at the National Academy for State Health Policy, said that even when states successfully cap what health plans pay, the complexity of the rebate system means it isn’t always clear whether those savings reach consumers,” according to Pluribus.
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Prescription drug board members have echoed similar concerns. Dr. Sayeh Nikpay, vice-chair of the Minnesota prescription drug board, cautioned that lowering prices through upper payment limits (UPLs) would not guarantee affordability: “If you lower costs, there’s nothing to say that insurers aren’t going to increase your cost-sharing in the next year.” (MN prescription drug board meeting, 05/30/2024)
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Patients have been vocal in their opposition to upper payment limits and government price-setting, like Jennifer Reinhardt, a mother to a child with cystic fibrosis in Colorado, who said that the Colorado prescription drug board is “…an experiment, and it’s really gross that they’re doing it on people who are really sick.” Reinhardt added that “the fact that many rare disease patients are alive today is a testament to the value of these treatments. We shouldn’t be forced to go the extra mile to educate [the board] on the value of a therapy, including its impact on long-term health and well-being. Yet proof of life isn’t always enough –the [board] could still decide that a medicine ‘isn’t worth it’ because it has higher costs and so few people are using it. It’s unkind to put families like mine—and the entire rare disease community—under that kind of stress.”
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State health officials point to broader supply chain distortions that are impacting prices. Annalisa Steeber, of the Minnesota Department of Health, told Minnesota prescription drug board members that “...[what] patients and payers are paying is significantly higher than the price the manufacturer is setting.” (MN prescription drug board meeting, 07/23/2024)
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Concerns have grown about advancing UPLs within the supply chain: In their policy recommendations for the 2025 annual legislative report, the Oregon PDAB Vice Chair Amy Burns recommended disbanding the board due to concerns about the board’s effectiveness and broader affordability and access issues. Although the Board did not adopt this recommendation, several board members raised related concerns, including fellow board member John Murray’s assertion that they “don't know how [a UPL’s] gonna ripple through the system. I worry about just attacking one part of the cost of the medication. Without addressing all the other areas where it goes.” (minute 33:30)
The bottom line: State bureaucrats promise savings through government price-setting policies like upper payment limits—but more often deliver more bureaucracy, higher administrative costs and disruptive supply chain impacts, with no clear evidence that patients will pay less.
The remedy: Focus on practical reforms—protect cost-sharing assistance and patient assistance programs, hold health plans and PBMs accountable to protect patients from discriminatory health plan features and ensure negotiated savings reach patients directly at the pharmacy counter.
Learn more at PhRMA.org/States.
Reid Porter