Arizona Governor Signs Formulary Bill

April 9, 2025

EGWP marketplace medicaid Medicare

Legislation impacting formulary management has been signed by Arizona Gov. Katie Hobbs (D). SB 1102 prohibits a PBM from limiting or excluding coverage of a prescription drug if the drug was previously approved during the plan year and an individual continues to be an enrollee of the plan. The bill also requires impacted enrollees and their prescribing provider to be notified at least 60 days in advance of formulary changes, including removal of a drug.

Patients must also be informed of the process for exceptions to a formulary change, as well as how drug denials are handled by the PBM. The new law goes into effect on Jan. 1, 2026.

Initiatives

Calls grow for Drug Patent reform

In a recent blog post, the Pharmaceutical Care Management Association (PCMA) highlighted increased attention to pharmaceutical companies’ abuse of drug patents. Last month, the Supreme Court unanimously ruled in favor of a generic drugmaker in a “skinny labeling” case, a victory for patients. Skinny labels allow generic and biosimilar competitors to launch products for non-patented indications, helping accelerate […]
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August 11, 2026

EGWP marketplace medicaid Medicare

perspectives

AHIP calls for Bipartisan reform to address health care cost drivers

On July 23, AHIP President and CEO Mike Tuffin wrote an opinion piece in The New York Times saying, “common-sense bipartisan reforms are needed to promote competition in care delivery and prescription drugs, protect consumers from providers and drugmakers’ anticompetitive practices and transition away from the perverse incentives of fee-for-service medicine.” Tuffin notes that health […]
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August 11, 2026

EGWP marketplace medicaid Medicare

Solutions

PCMA urges preserving patient access and flexibility in new fertility benefits rule

PCMA recently submitted comments to HHS, DOL, and the Treasury (the Departments) in response to the proposed rule establishing a new category of limited excepted benefits for fertility services. PCMA supports the Departments’ goal of expanding access to fertility care while encouraging employer innovation but urged several targeted refinements to ensure the framework is operationally […]
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August 11, 2026

marketplace medicaid

Illinois enacts new AI security law

Illinois recently enacted the Artificial Intelligence (AI) Safety Measures Act to implement new security and reporting requirements for developers of the largest frontier AI models. The law requires covered developers to assess and mitigate catastrophic risks, report significant safety incidents within 72 hours, and undergo independent third-party audits beginning in 2028. The law was modeled […]
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August 11, 2026

EGWP marketplace medicaid Medicare

legislation

Delaware strengthens primary care spending

As part of his affordability agenda, Gov. Matt Meyer (D) signed legislation to make permanent a requirement on insurers to spend at least a minimum level on primary care. The primary care services measure, SB 1, will establish minimum primary care spending for carriers, with the state monitoring the uptake and compliance program. The bill […]
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August 11, 2026

marketplace medicaid

legislation

Finance democrats announce health coverage agenda

On July 30, Senate Finance Committee Ranking Member Ron Wyden (D-OR) released a Request for Information (RFI) seeking stakeholder input on policies affecting the commercial health insurance market, including coverage and affordability. The RFI is the latest in a series of requests related to Democratic Committee Members’ health affordability agenda. The request directs stakeholders to […]
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August 11, 2026

marketplace medicaid Medicare

legislation

House and Senate Committees advance health care legislation

Multiple Congressional committees recently advanced health care proposals focused on price transparency and affordability. The House Energy and Commerce (E&C) Committee advanced the Lower Costs, More Transparency Act by a 45-0 vote to expand transparency requirements for hospitals, health plans, and PBMs. The Senate HELP Committee advanced the Patients Deserve Price Tags Act, which would […]
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August 11, 2026

EGWP marketplace medicaid Medicare

legislation

340B Program reforms introduced in Congress; CMS proposes payment reforms

On June 29, Senate Health, Education, Labor, and Pensions (HELP) Committee Chair Bill Cassidy (R-LA) released a discussion draft bill proposing several reforms to strengthen oversight of the 340B Drug Pricing Program by reducing fraud and abuse, increasing transparency and reporting, and clarifying program participation rules. Relatedly, on July 7, Reps. Scott Peters (D-CA) and […]
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August 11, 2026

medicaid Medicare