State Officials’ Focus on Affordability Includes Prescription Drugs

When Michigan Gov. Gretchen Whitmer (D) spoke about the need for affordable healthcare and housing last month, she joined a chorus of governors of both major parties who have made affordability a focus of their annual state of the state addresses.

“Affordability is our highest priority,” said Indiana Gov. Mike Braun (R).

“Affordability has become one of the most talked-about issues in national politics today, and it’s refreshing to hear previous skeptics acknowledge it matters,” said Vermont Gov. Phil Scott (R).

“Affordability isn’t a joke or some hoax,” said Arizona Gov. Katie Hobbs (D), apparently referring to comments reportedly made by President Donald Trump dismissing affordability as a “hoax” created by Democrats. “It’s a real and consequential challenge that families across Arizona must grapple with every day,” Hobbs said.

The focus on affordability in state capitols isn’t just talk. State lawmakers have been introducing legislation aimed at lowering the cost of everything from diapers (Maine HB 721) to utility bills. One common area of focus is healthcare and prescription drugs, in particular.

Legislators have actually been working to address the cost of prescription drugs for years, with a few themes figuring prominently, including drug pricing transparency, pharmacy benefit manager (PBM) regulation and, more recently, prescription drug affordability boards (PDABs).

Continuing Focus on PDABs and PBMs in 2026

As of March 2, 28 states had introduced 104 bills concerning prescription drug pricing and payment, according to the National Conference of State Legislatures’ prescription drug database.

At least eight states have considered over a dozen bills dealing with PDABs, according to the LexisNexis® State Net® legislative tracking system. Bills in four of those states, Hawaii (SB 2933), Louisiana (SB 401), Virginia (HB 483/SB 271) and West Virginia (HB 5149), would establish PDABs.

A bill introduced last year in Maine, and enacted in January (SB 314), meanwhile, makes changes to the Maine PDAB's structure and duties, including shifting its focus from establishing prescription drug spending targets for public payers to assessing strategies to reduce prescription drug costs for both public and private payers. Those strategies include reference-based pricing, transparency requirements for supply chain entities, and upper payment limits.

Legislation concerning PBMs is also ongoing, with NCSL’s database identifying 24 states that have introduced over 100 such measures this year. About 50 measures in 18 states deal substantively with PBMs, based on their bill summaries.

Challenges to Affordability Efforts

The continuing wave of legislation underscores the considerable attention state lawmakers are placing on healthcare affordability. But efforts to rein in costs are open to challenges—and criticism.

In September, researchers at the Center for Health Policy and the Law at Georgetown University Law Center warned that the pharmaceutical industry is fighting back against the prescription drug affordability proposals by employing a novel legal strategy involving the U.S. Constitution’s implicit restriction on states’ authority to pass laws that impinge on interstate commerce.

“Under this so-called Dormant Commerce Clause, a state cannot discriminatorily favor in-state commerce while burdening out-of-state commerce,” the researchers wrote. “Even when a state law does not engage in this kind of economic protectionism, it may still violate the Dormant Commerce Clause if the law’s in-state benefits are far outweighed by the burdens it imposes on interstate commerce.”

While the report says the Supreme Court has historically only recognized these two categories of Dormant Commerce Clause violations, some lower courts have recognized a third category of state laws that seek to regulate transactions occurring beyond a state’s borders. Drug companies have “repeatedly” used this argument to invalidate state prescription drug laws affecting out-of-state companies, the report said.

Meanwhile, some states that have implemented PDABs have since scrapped them. Only a handful of states’ PDABs have statutory authority to set drug price upper payment limits (UPLs). And so far, Colorado’s is the only one that has actually approved such a limit, on the rheumatoid arthritis and autoimmune disease drug Enbrel.

“This groundbreaking upper payment limit on Enbrel has the potential to save $32 million from drug spending,” Sophia Hennessy, lead policy research coordinator for the Colorado Consumer Health Initiative, said in a statement at the time. “We’re thrilled with the board’s decision today that helps ensure more patients can afford their vital medications.”

But Michael Hodin, CEO of the Global Coalition on Aging, and Peter Pitts, president of the Center for Medicine in the Public Interest—groups with ties to the pharmaceutical industry—wrote last year: “PDABs have wasted millions in taxpayer dollars and threatened access to crucial treatments and the stability of the supply chain—all while delivering zero savings to patients, disincentivizing biomedical innovation, and potentially harming healthy aging.”

Research by the Partnership to Fight Chronic Disease, which also has connections with pharmaceutical companies and associations, found that PDABs and their price limits “will likely increase patient costs and hinder access to prescribed medicines.”

Still, consumers’ worries about the high cost of healthcare are likely to trump such criticisms in the minds of state lawmakers, particularly this year.

“Heading into this midterm election year,” said the health policy research firm KFF when it released polling in late January, “the cost of health care tops the public’s economic anxieties and more than 4 in 10 voters say the issue will have a major impact on their vote.”

—By SNCJ Correspondent BRIAN JOSEPH

Handful of States Considering PDAB Bills

So far this year, at least eight states have taken up legislation concerning prescription drug affordability boards. Measures in four of those states would establish PDABs, while a measure enacted in Maine (SB 314) makes changes to the structure and duties of the state’s existing PDAB.