Prescription Drug Costs and Coverage: What Can States Do? An Action Kit for State Advocates January 2003

This kit takes stock of state initiatives to expand drug coverage and reduce drug prices. It is designed to help advocates understand the options available, to sort through the advantages and disadvantages of various approaches to expanding coverage or reducing drug prices, and to establish an agenda or focus for activities in their state. The kit also includes some campaign tools and case studies. Since most state programs have targeted Medicare beneficiaries, many of the state-based strategies highlighted in this kit focus on that population, although they can be made available more broadly. The campaign tools are general, rather than focused on particular legislative initiatives. They are designed to help you focus the public's and legislators' attention to the issues of prescription drug coverage and drug prices. These tools can be used regardless of the legislative strategy pursued. To help you in your own campaign activities, the case studies tell you how and why campaigns in other states succeeded or failed. We recognize that states have been very active on this issue. Some states have already passed legislation to expand coverage, while others are debating or are focusing on containing drug costs. However, even in states where there has been legislative action, opportunities may exist to do more to expand coverage or reduce drug prices.

• About This Kit provides a brief introduction and descriptions of each kit piece.
• Rising Prices, Lack of Coverage Keep Prescription Drugs Out of the Reach of Many briefly discusses the issue of rising drug costs and the impact on those without prescription drug coverage, particularly low-income seniors and persons with disabilities who have the greatest need for, and least access to, drug coverage.
• Setting an Advocacy Agenda lists the key options available to the states, outlines a framework for evaluating those options and developing an advocacy strategy, and summarizes how well each of the key options provides subsidized coverage for the most vulnerable populations.
• Option #1: Medicaid Expansion: The Deepest Coverage briefly describes and evaluates Medicaid expansions as an option for states to address the issue of drug coverage and costs. This piece is supplemented by Expanding Medicaid: State Options.
• Option #2: Pharmacy Assistance Subsidy Programs: The Nex Best Coverage Option describes and evaluates pharmacy assistance subsidy programs as an option for states to address the issue of drug coverage and costs.
• Option #3: Discount Programs: Some Price Relief but Little Help to Low-Income describes and evaluates discount programs as an option for states to address the issue of drug coverage and costs.
• Option #4: Bulk Purchasing: Price Relief for States, and Potentially, Some Consumers describes and evaluates bulk purchasing as an option for states to address the issue of drug coverage and costs.
• Other Options for Expanding Drug Coverage or Reducing Drug Prices outlines some additional approaches that states have taken or are considering. The Medicare Rx Discount Card Proposal provides a brief background on the Medicare Rx Discount Card and its possible impact on state legislative agendas in 2002.
• The Medicare Rx Discount Card Proposal
• Administering Drug Programs: Protecting Consumers' Interests suggests ways to protect consumers' interests if a Pharmacy Benefit Mangager (PBM) is used for program management and to ensure that cost-containment approaches are consistent with good medical care. This includes a discussion of strategies commonly used to contain pharmacy costs.
• Expanding Medicaid: State Options provides a detailed discussion of technical aspects of Medicaid expansion for seniors and the disabled.
• Six Good Reasons for States to Expand Drug Coverage or Reduce Drug Prices: Background for Building an Argument summarizes points and provides supporting facts that advocates can use when arguing for expanded drug coverage or reduced drug prices and making sure they include low-income assistance.
• State Pharmacy Assistance Programs and Discount Proposals is a state-by-state table of Medicaid expansions, pharmacy assistance subsidy programs, discount programs, and other strategies to expand coverage or reduce drug prices.
• Case Study: Maine—Innovations with Challenges discusses the multiple initiatives Maine has undertaken.
• Case Study: New York—Expanding to Offset HMO Pullouts profiles New York's pharmacy assistance program and recent program expansions.
• Case Study: Illinois—Keeping the Pressure On profiles Illinois's Circuit Breaker program.
• Media: Organizing A Successful Press Event provides a useful checklist to get your press event off the ground.
• Media: The Press Conference offers tips on venues, speakers and the press kit.
• Media: Getting Coverage—Sparking the Media's Attention discusses ways of getting coverage in various media outlets.
• Media: Getting Coverage—The Best Way to Approach Each Media Outlet illustrates in a chart format the media outlets and what you need to do.
• Glossary of Terms defines terms used in this kit.
• Additional Resources lists select sources for additional information and status of state activities.