Louisiana's 2026 legislative session, which adjourned June 1, enacted major healthcare reforms targeting Medicaid, drug pricing, and pharmacy benefit managers. Act 572 requires Medicaid authorization decisions within seven calendar days. SB 433 mandates coverage of FDA-approved weight loss medications. HB 870 requires insurers to favor lower-cost generics and biosimilars. SB 401 establishes a Prescription Drug Affordability Board to identify high-cost drugs and recommend cost-reduction strategies.

Illinois lawmakers concluded their May session by advancing major healthcare legislation to Governor Pritzker, including significant 340B protections prohibiting manufacturer interference and requiring a Department of Insurance study. The legislature also passed multiple insurance coverage mandates, downcoding restrictions, healthcare market oversight measures extending pre-transaction notices to private equity, patient billing protections prohibiting hospital liens on primary residences, and abortion medication privacy safeguards.

Five states enacted significant healthcare legislation during spring 2026 sessions. Arizona launched AI-powered Medicaid fraud detection, while Iowa banned insurers from using AI to deny prior authorizations under HF 2635. Missouri's comprehensive HB 2372 awaits gubernatorial approval, expanding Medicaid coverage and hospital transparency requirements. Maryland's Prescription Drug Affordability Board capped Ozempic payments at Medicare rates for state plans. Connecticut's budget bill (SB 1) overhauled Certificate of Need requirements for hospitals.

Colorado's Prescription Drug Affordability Board became the first state to set an upper payment limit on prescription drugs, establishing a $600 cap per unit for Enbrel effective January 2027. The state reviewed five drugs, finding three unaffordable. Nine states now have PDABs, with four authorized to set payment limits. The action faces ongoing litigation challenging constitutional grounds, with outcomes potentially impacting other states' affordability programs.

Twenty-five states and Washington, D.C. currently require private insurance coverage for fertility care, while only New York, Utah, and D.C. offer limited Medicaid coverage. In 2026, Virginia enrolled legislation requiring coverage for three IVF cycles by 2028, while Arizona and Hawaii advanced bills mandating coverage for iatrogenic infertility. Connecticut expanded its infertility definition under existing mandates, reflecting states' focus on incremental coverage expansions.

Healthcare policy groups including FARB, NAIC, NAMD, NASHP, and NCOIL serve as platforms for state policymakers to collaborate and shape emerging trends. In 2025, multiple organizations adopted model legislation on facility fees and site-neutral payments, with NCOIL passing its Prior Authorization Reform Model Act in November. Groups are now focusing on the Rural Health Transformation Program and 340B oversight for 2026.

Virginia's Senate passed legislation to establish a Prescription Drug Affordability Board with upper payment limit authority, with similar House legislation pending under new Governor Abigail Spanberger. Four states currently have PDABs with UPL authority. Colorado became the first to set a UPL in October, effective January 2027, using Medicare's maximum fair price as the benchmark, though legal challenges remain ongoing.

The National Council of Insurance Legislators adopted the Prior Authorization Reform Model Act and advanced artificial intelligence oversight policies at its Atlanta annual meeting. The Health Insurance Committee addressed charity care screening requirements and medical debt protections, while the Financial Services Committee continued developing AI governance standards requiring human professionals to make claim denial decisions. Legislators discussed expiring ACA tax credits' impact on market stability with state insurance commissioners.

Virginia and Utah wrapped up their sessions with significant healthcare legislation. Both states enrolled legislation that stands to have significant influences to the state of healthcare delivery and coverage and public health.

Over the past month, arguably no Governor and Legislature have been as proactive in healthcare reform as newly elected Indiana Gov. Mike Braun (R) and Indiana’s General Assembly. In late January, the Governor issued six executive orders pertaining to healthcare access, affordability and transparency.

Over the past two months, governors across the country have laid out key policy priorities for the next year in their State of the State addresses. This year, the majority of governors have made healthcare a key issue with several highlighting behavioral health, workforce, and affordability as priorities.  

With rising prescription drug costs a concern for consumers, state legislatures have taken an array of actions to contain costs. In recent years the establishment of Prescription Drug Affordability Boards (PDABs) has emerged as a strategy across the country. Eleven states have established a PDAB or a similar drug cost control entity. PDABs in four states (Colorado, Maryland, Minnesota, and Washington) have the authority to set upper payment limits (UPLs) on prescription drugs they determine to be unaffordable after review.

In 2025, state lawmakers are expected to prioritize healthcare affordability and access, building on key legislative trends from this year. Here are our thoughts on key trends and issues from 2024 and how they might show up in state capitols next year.