This Month in State Policy

Expedited Partner Therapy and Syphilis Screening

Policymakers in the Missouri House health care committee passed HB398, 9-0 which modifies several state health care provisions including changes to the state’s existing expedited partner therapy (EPT) law. EPT is a clinical practice that allows health care providers to treat partner(s) of patients diagnosed with an STI without examining them first. HB398—along with its partner bill SB317 in the Missouri Senate—would add trichomoniasis to the list of STIs for which EPT is permissible. It would also allow EPT for any STI “designated as appropriate…by the Dept. of Health and Senior Services” or “recommended” in CDC guidelines. Finally, the bill’s language expands the authority of who can administer EPT from “physicians” to encompass any “health care professional” licensed under statute to prescribe medications.

Both bills would also require prenatal syphilis screening during the third trimester of pregnancy; Missouri law currently requires testing just at the first prenatal visit. The section to increase syphilis screenings during pregnancy in HB398 appears to be the language also included in HB803, which NCSD covered in January.

Regulations Across PBMs and 340B Contract Pharmacies

State lawmakers across several jurisdictions are eyeing legislation that could enforce new standards for two highly debated pharmacy-related practices.

In Wisconsin, SB737—introduced by state Senate President Mary Felzkowski (R-Tomahawk) and Rep. Todd Novak (R-Dodgeville)—would mandate that pharmacy benefit managers allow patients to use any licensed pharmacy without penalty. Pharmacy benefit managers (PBMs) act as third-party administrators between insurance carriers, pharmaceutical manufacturers, and pharmacies, negotiating prices for drug costs and sometimes limiting which pharmacies patients can go to as a result. Because of their influence on medication access, many state lawmakers feel PBMs are not operating with enough regulatory oversight or transparency.

Meanwhile New York could become the first state to force PBMs to reveal publicly how much they profit annually from rebates issued by drug manufacturers. Governor Kathy Hochul (D) endorsed A6764, which would increase reporting requirements for PBMs on aggregated rebate payments received through contracts. New York is already one of 27 states that require PBMs to share rebate details with state departments according to the National Academy for State Health Policy.

In contrast, pharmacy related practices might be subject to less restrictive parameters in a few jurisdictions. SB71, introduced by Colorado state Senator Dafna Michaelson Jenet (D – Commerce City), would prevent pharmaceutical manufacturers from limiting hospitals’ use of contract pharmacies for dispensing 340B medications. 340B refers to the federal program that mandates discounted outpatient drugs for qualifying covered entities (like certain clinics or health departments) serving vulnerable patient populations to stretch scarce federal dollars.

In addition to SB71 in Colorado, policymakers in at least three other states this year—New Hampshire, Mississippi, and South Dakota—reviewed similar bills that would prohibit pharmaceutical manufacturers from restricting the use of contract pharmacies.

Reproductive Health Care

Republican policymakers in Wyoming disagreed with Governor Mike Gordon (R) and overrode his veto of HB64. The bill would require any patient seeking chemical abortions to have a transvaginal ultrasound and enforce a 48-hour waiting period. “Chemical abortion” references non-surgical terminations of pregnancy, which are commonly done with the combination of two drugs: mifepristone and misoprostol. Governor Gordon vetoed the legislation due to the bill’s “invasive nature and lack of exceptions for victims of rape and incest,” according to WyoFile.

Lawmakers in the Wyoming House voted 45-16 and the Senate voted 22-9 to override making the bill law.

Medicaid

NCSD noted last month that Idaho policymakers could rescind voter-enacted Medicaid expansion by passing HB138, a “reform-or-repeal” bill. However, while HB138 narrowly passed the Idaho House, it fell short in the Senate. Policymakers alternatively rallied behind a different Medicaid bill that appeared to offer more widespread appeal to legislators. The new bill listed as HB345 passed quickly through both chambers across party lines. Unlike its predecessor, HB345 does not repeal Medicaid expansion but restructures it significantly. The legislation would add work requirements for “able-bodied” Medicaid beneficiaries, offer tax credits to individuals eligible for expanded Medicaid who purchase health care on the state marketplace, and would contract with a third-party managed care organization to provide oversight of the program. While other jurisdictions have implemented or considered enforcing work requirements for Medicaid, data from KFF suggests that such policy reforms may not be effective. Governor Brad Little (R) signed the bill into law on March 20, officially codifying the overhaul to Medicaid as the new state standard.