Jay Phillips

Natural disasters have continued to grow in number, strength and size since weather data has been recorded. Recently, California was subject to the largest wildfire in the state’s history; an estimated 1.2 million acres has already burned, and fire season is far from over. The East Coast and Gulf Coast have seen a stream of hurricanes for the past several years. So far this year, we’ve seen nine hurricanes form in the Atlantic Ocean alone with three making landfall. Many states continue to see flooding worsen as levees grow higher along the Mississippi, drainage infrastructure fails, or record rainfalls strike overnight. Hawaii continues to watch the eruption of Kilauea as well as manage Tropical Storm Olivia.

In March, Florida enacted HB 7087, which creates several one-time tax exemptions related to hurricane response, preparedness and recovery.

The cost of nursing home/assisted living care has continued to rise. The average daily cost of nursing home care in the United States is $235, with a high of $800 per day in Alaska, and a low of $147 in Oklahoma. The increasing cost of care for loved ones has placed burden on the federal and state governments, as well as the American people searching for cheaper alternatives.

States are increasingly pursuing new streams of revenue to effectively operate and minimize debt. Some states have established or are pursuing a “millionaire’s tax” to minimize budget shortfalls and increase state revenue. The tax is primarily an income tax. California, Connecticut, New Jersey and New York have all established a such a tax. Massachusetts chose to not enact their version of the millionaire’s tax. In Arizona, a ballot measure is up for approval. Every state’s tax structure is different, but it boils down to taxing an individual which makes upward of $250,000 or more.

Gag clauses are at the forefront of state policy decisions as state policymakers attempt to reduce the cost of prescription medications. Gag clauses are established in PBM-pharmacy contracts prohibit pharmacists from informing consumers, unless asked, about cheaper ways to purchase prescriptions or access more effective alternatives, i.e., a lower cost generic drug or newer brand name drug with better outcomes. From 2016 to 2018, 22 states enacted legislation to prohibit the use of gag clauses to provide consumers and pharmacists more ability to communicate about cheaper options. Another nine states have legislation still pending. Eight states have legislation regulating pharmacy benefit managers, or PBMs, through audits, licensing and maximum allowable cost statutes that do not directly address gag clauses. More than eight states have Maximum Allowable Cost (MAC) statutes and auditing and licensing procedures enacted, however they also address gag clauses or claw backs specifically in their bill.