The total US spending on pharmaceuticals is projected to top $247 billion this year, while more than 120 million Americans take one or more prescription medications regularly in a year, according to the Centers for Medicare & Medicaid Services. And so, as the National Conference of State Legislatures points out, this helps explain why, in 2008, prescription drug policies continue to attract widespread attention and action in state capitols.

So far, more than 540 pharmaceutical bills and resolutions are under consideration in at least 41 states plus Washington, DC, and more than 100 have been filed for 2008 legislative sessions while the rest are carried over from last year. The proposals cover a wide range of state-sponsored approaches, from creation of subsidies or discount programs, to promoting safer pharmaceuticals and regulating the management, marketing and distribution of prescription products, according to the NCSL. The following examples are cited by the organization as widespread or “hot” topics this year…

Expanding Access: Discount and Subsidy Programs - A majority of states have established subsidy or discount programs to reduce prescription drug costs and provide direct relief to qualified low-income residents. In 2006-07, many states retooled their discount and subsidy programs to include Medicare Part D provisions; in 2008 proposed expansions and/or changes again are on the table in 15+ states;

Marketing and Advertising - A few states already require drugmakers to disclose marketing expenses, including gifts to prescribers. During 2008, at least 20 states propose legislation requiring marketing disclosures by drugmakers, regulating DTC of prescription drugs by drugmakers or prohibiting prescription info from being sold for commercial purposes. Washington DC passed such a bill last month;

Privacy and “Data Mining” - In 2006 New Hampshire became the first state to prohibit the sale or redistribution of prescription sales record information that identified patients or prescribers. In 2008, at least 12 states have similar proposals, using examples from 2007 laws signed in Maine and Vermont;

Medicare Part D Wrap Around Benefits and Services - Although federal Medicare pharmaceutical plans appear more stable this year, a dozen states are considering bills and resolutions intended to modify or adjust state pharmaceutical assistance efforts, in response to the federal Medicare Prescription Drug benefit launched in January 2006. Most bills reference the Medicare Modernization Act or “MMA.”

Pharmacy Benefit Managers (PBMs) - At least 13 states are proposing legislation to regulate PBMs. The bills seek to assure financial reliability, regulate the licensing of pharmacy benefit managers and/or mandate full disclosure of drug costs and financial contracts;

Prescription Drug Reuse/Recycling - Allowing or encouraging donation of unused pharmaceutical drugs is a popular idea - nine states passed such laws in 2006. For 2008 interest continues in 10 states, with some of the focus on cancer drug repository programs that allow an individual, health care facility or drugmaker to donate cancer drugs or supplies needed to administer cancer drugs for use by those who meet eligibility criteria;

Electronic Monitoring and Internet Prescribing - This is a relatively recent trend which gained momentum during the past three years. Proposed laws would allow for the development and regulation of electronic transmission of prescription drug orders, as well as establishing Internet prescribing practices to provide increased protection for consumers purchasing prescription drugs over the Internet. Additionally, several more states seek to establish electronic prescription drug databases to monitor the misuse, abuse and diversion of prescription drugs and controlled substances. In August Alaska became the final state to change laws and regulations to allow for e-prescribing;

Comprehensive Health Reforms - At least six states in 2008 are proposing “comprehensive” health expansions that include pharmaceutical policies as a visible component. Some measures have been approved by Task Forces or Commissions but not yet seen action in legislatures;

Other Topics of Interest - Several states propose legislation to create bulk prescription drug purchasing or multi-state purchasing programs; others are considering bills to create prescription drug importation or re-importation programs. Bills providing for income tax deductions, incentives or credits for pharmaceuticals or prescription drug-related programs were proposed in some states. Cost containment also continues as a focus in some states, using measures to establish or modify preferred drug lists and seek manufacturer rebates or discounts. Other ideas, such as regulation of mail order prescription drug sales, oversight of pharmaceutical wholesalers, local pharmacy audits and publicizing clinical trials also are possible trends during 2008.