States Are Taking the Lead on Prescription Drug Pricing Reform — What It Means for Patients and Pharmacies

Maryland Association of Counties – Online Article – November 10, 2025 – States Lead the Charge on Prescription Drug Pricing Reform – Across the country, prescription drug prices continue to rise, placing financial pressure on patients, employers, local governments, and healthcare providers. In response, state lawmakers are stepping in.

According to a recent Stateline report, at least 31 states have enacted nearly 70 new laws in 2025 aimed at reforming the complex drug pricing system — including pharmacy benefit managers (PBMs), drug manufacturers, wholesalers, and more. This marks one of the largest state-level shifts in drug pricing policy in recent history.

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The Growing Cost Burden on Local Governments

Counties and local government employers are among the hardest hit by rising prescription costs. They must continue providing healthcare benefits to public employees, first responders, and retirees — but higher drug prices mean higher insurance premiums and greater strain on local budgets.

Counties support reforms that improve affordability and transparency. However, many local governments have raised concerns about legislation that restricts PBMs too broadly, warning that it could limit their ability to negotiate lower prices and drive costs even higher.

This reflects a central tension in drug pricing reform:

How do we reduce patient costs while maintaining negotiation power and access to medication?

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States Are Testing New Approaches to Drug Affordability

Many states are now experimenting with drug affordability boards and price review mechanisms — an approach that is gaining momentum nationwide.

Maryland Leads the Movement

Maryland established the first Prescription Drug Affordability Board (PDAB) in 2019.
In 2025, its authority expanded to review drug costs for all Marylanders, not just state employees. The board is now evaluating high-cost chronic condition medications, including insulin and diabetes drugs.

Local governments supported the expansion because rising drug costs are directly increasing county healthcare spending.

Other States Are Following

• Colorado recently capped costs on a high-priced arthritis medication.

• California is preparing to launch state-produced generic insulin for $11 per pen in 2026 — a dramatic alternative to standard commercial pricing.

Supporters argue these measures:

• Increase access

• Reduce out-of-pocket costs

• Pressure manufacturers to justify pricing

Critics caution that:

• Price caps may discourage pharmaceutical innovation

• Some pharmacies may not be able to stock medications at capped rates

The debate continues — but the momentum is undeniable.

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A Shift From Federal to State Leadership

With federal drug pricing reforms moving slowly, states are taking the lead in reshaping the market.
This state-based strategy represents a significant change in how prescription drug policy is implemented in the U.S.

What remains universal:
Patients need medications they can afford, when they need them, without navigating layers of bureaucracy or financial barriers.

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What This Means for RescueMeds and the Communities We Serve

At RescueMeds, we see firsthand how high drug prices impact:

• Injured workers waiting for medication

• First responders needing ongoing prescriptions

• Families managing chronic conditions

Reforms that:
-Increase transparency
-Reduce cost barriers
-Strengthen access to medication

are critical to ensuring that patients receive timely care and remain on therapy.

We continue to advocate for patient-first, fair, and transparent medication access across all states.