During the 2022 state legislative session, the Association for Clinical Oncology (ASCO) and state societies teamed up to advocate for policies aimed at improving access to equitable, high-quality cancer care. ASCO has tracked more than 500 state bills and has submitted 46 letters and counting to state legislators to address various policy developments, from access to care to utilization management.
Medicaid Expansion: Missouri Oncology Society President Dr. Joe Muscato testified adamantly against a proposal for a constitutional amendment that would undermine the state’s voter-approved expansion of Medicaid expansion. His testimony plus the overwhelmingly negative response at the Senate Appropriations Committee hearing helped ensure there was no Senate floor vote.
The North Carolina Senate passed Medicaid expansion, which would make close to 500,000 North Carolinians eligible for coverage. Though expansion did not receive a House vote, House and Senate leadership are expected to further negotiate a path forward to passage.
In South Dakota, Medicaid expansion will be on the November ballot, and if approved by voters, 27,000 additional residents will be eligible for coverage.
Short-Term Limited Duration Plans: ASCO opposed legislation in Kansas and Wisconsin that would have allowed non-Affordable Care Act (ACA) compliant short-term limited duration (STLD) health plans to be renewable for up to 36 months. While the lower cost plans can be attractive to patients, STLD plans do not provide coverage for cancer care and many other pre-existing conditions. Governor Laura Kelly vetoed the proposal in Kansas and the Wisconsin bill failed in the House.
Medicaid Closed Formulary: ASCO submitted comments raising concerns about an Oregon 1115 waiver proposal that included a closed prescription drug formulary, which may have prevented patients with cancer from accessing the best treatment for their condition. After the comment period, the Oregon Health Authority (OHA) revised the waiver to eliminate the closed formulary language.
Fertility Preservation: ASCO and state societies supported legislation in several states that would require health plans to provide coverage for fertility preservation services to patients with cancer. In Maine, Governor Janet Mills signed a bill into law set to go into effect in 2024. In Hawaii, a resolution passed calling for the State Auditor to complete a cost analysis report before the 2023 legislative session. No insurance mandates can pass in Hawaii without an Auditor’s report. Legislation is still pending in Massachusetts and bills were introduced but failed to pass upon adjournment in Kentucky, Louisiana, Virginia, and Washington.
Telemedicine: Mississippi and Tennessee both enacted laws requiring the reimbursement of audiovisual telemedicine appointments at the same rate as in-person appointments.
Drug Pricing: ASCO worked closely with the Washington State Medical Oncology Society (WSMOS) to oppose a bill allowing for upper payment limits on certain high-cost specialty drugs. Despite language adverse to cancer care in the initial bill, robust advocacy throughout the legislative process secured some favorable amendments in the final enacted version. Though no drug can receive an upper payment limit until January 1, 2027, ASCO and WSMOS will track implementation and ensure the oncology perspective is heard. A similar law passed in Colorado in 2021; no drug has been given an upper payment limit yet.
Step Therapy: This session, Colorado, Kentucky, and Tennessee each passed new laws to reform step therapy protocols and protect patient access to timely cancer care. California and Pennsylvania are currently considering similar proposals. ASCO has partnered with State Affiliates in each of these states to submit letters of support for these bills.
Prior Authorization: This session, Michigan lawmakers enacted ASCO-backed legislation that requires insurers to cite evidence-based, peer-reviewed literature when issuing a prior authorization denial and sets deadlines for insurers to respond to requests. Dr. Jerome Seid, a member of the Michigan Society of Hematology and Oncology (MSHO) Board of Directors, testified in support of this bill.
In Louisiana, lawmakers unanimously enacted legislation that instructs insurers to implement and maintain a program that allows for the selective application of prior authorization requirements based on a clinician’s performance and adherence to evidence-based medicine. The Louisiana Oncology Society (LOS) and ASCO submitted a joint letter in support of the legislation. “Gold Card” legislation, which provides physicians with high approval rates on prior authorization requests with gold cards to bypass the process, was introduced in Colorado, Indiana, Kentucky, Mississippi, and Missouri. Though these bills failed, “Gold Card” bills are clearly becoming more common across the county. The 2021 Texas Gold Card Law was the first of its kind and is currently in the rulemaking process.
Copay Accumulator: Maine and Washington became the 13th and 14th states to ban copay accumulator programs, which allow insurers to take drug discounts meant for patients. Bills are still pending in Delaware, the District of Columbia, Michigan, New York, Ohio, Pennsylvania, and Wisconsin. Legislation also was introduced and failed in Alabama, Colorado, Florida, Indiana, Iowa, Minnesota, Mississippi, Missouri, Nebraska, Rhode Island, and Utah. ASCO is an active participant in the All Copays Count Coalition (ACCC) and continues to work with state affiliates to support these bills.
While most state legislative sessions have ended, a handful of state legislatures meet year-round, and several will hold special sessions before the end of the year. ASCO will continue to monitor and advocate for policies to improve cancer care. Visit ASCO’s State Advocacy site for resources including a state legislative calendar, state fact sheets, and an infographic on the state legislative process.
Visit ASCO in Action for the news and updates on federal and state policy issues.