Colorado finalized the nation's first prescription drug upper payment limit, capping Enbrel at $600 per dose effective January 2027. Maryland conducted affordability reviews on four drugs and voted to set UPLs for Jardiance and Farxiga. Oregon reviewed 23 drugs with final recommendations expected March 2026, while Washington and Minnesota prepared for upcoming reviews.

Connecticut Governor Lamont signed comprehensive healthcare reform including mental health parity reporting and step therapy prohibitions. Iowa and Montana submitted federal waivers for Medicaid work requirements, seeking 100 and 80 monthly hours respectively. Oklahoma's Governor Stitt issued an executive order implementing "Make America Healthy Again" initiatives, including SNAP waivers to exclude soft drinks and ending public water fluoridation endorsements. Maine's legislature passed PDAB expansion legislation, but Governor Mills postponed her decision until January 2026.

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.