State Medicaid budgets will be cut by a total of $665 billion over the next decade after President Donald Trump’s One Big Beautiful Bill slashes federal investment in the health insurance program, a new analysis shows.

Researchers at RAND Health, a nonprofit policy and research organization, analyzed state and federal data to estimate how much the loss of federal money would affect state Medicaid budgets. publishing their findings end of last month. Medicaid is a public health insurance program for low-income people financed jointly by state and federal funds.

The report found that the overall net impact on state budgets, outside of Medicaid programs, would be a reduction of $86 billion. This number is lower than the overall reduction in Medicaid budgets because while some states will have to spend more money from their general funds to cover Medicaid losses, others will have to spend less.

New federal regulations, such as work requirements for certain people enrolled in Medicaid, are intended to reduce the number of people on Medicaid, which means states that cover these people will no longer have to pay their share of medical bills, saving money. However, many states operate financial strategies such as “provider taxes” to qualify for additional federal money under Medicaid. The new law limits their ability, forcing them to operate general funds to cover the loss of income.

“The bill’s impact on Medicaid budgets and college enrollment is significant, but will vary greatly by state, and in some cases may be at least partially offset by savings in the state general fund,” Preethi Rao, senior economist at RAND and lead author of the study, said in her study statement.

The authors estimated that by 2034, there would be 7.6 million fewer people enrolled in Medicaid. Between 2025 and 2034, the federal government will save approximately $714 billion.

Medicaid budgets in Arizona, Iowa and Nevada will be reduced by more than 15%.

California and New York will see the largest combined declines in their Medicaid budgets, by $112 billion and $63 billion, respectively.

At the other end of the spectrum there are countries that do not rely as much on financial strategies, such as: state-directed payments AND supplier taxeswill not see such a significant impact. The report shows Florida will likely see less than a half-percent change in its Medicaid budget. North Dakota and Nebraska are also likely to see minimal impacts because their losses are expected to be offset by increased federal funding for rural health care.

The report found that state general funds in Tennessee, Mississippi, Oklahoma and Kentucky could see more than 2% savings by reducing Medicaid enrollment or limiting the types of care covered.

Several states with tiny Medicaid populations, including Wyoming and South Dakota, are expected to see their budgets escalate due to funding for the rural health program.

“As states plan for upcoming changes in funding and eligibility, understanding state-specific differences will be important,” Rao said.

Stateline reporter Anna Clare Vollers can be reached at: avollers@stateline.org

A novel analysis released this week shows that nearly one-third of the nation’s private-sector workers are covered by paid leave programs as more states require employers to provide medical and family leave.

Currently, the District of Columbia and 13 states have passed laws requiring paid leave for many workers, says a report from the National Partnership for Women & Families, a nonprofit organization that advocates for reproductive rights, health and economic justice, and workplace equality.

“States have changed the paradigm now that more than 46 million workers across the United States are covered by paid family and medical leave programs, leading the way for the rest of the country,” Jessica Mason, senior policy analyst at the organization, said in a press release.

Programs they differ in designbut they generally guarantee payments when employees take time off due to illness or to care for a child or other loved one. They are funded by employer and employee contributions, similar to unemployment insurance or payroll taxes, that cover part of an employee’s pay when he or she takes time off.

Report quotes tests shows that employers operating in multiple states often respond to local paid ill leave laws by providing paid ill leave to their employees even in places that do not have such requirements.

This year, Delaware, Maine and Minnesota started or planned to start offering benefits under novel paid leave programs. AND Tthe report cites growing momentum in six additional states: Hawaii, Illinois, Nevada, New Mexico, Pennsylvania and Virginia. If these states were to implement paid leave policies, The analysis found that 44% of workers nationwide would have access to paid family and medical leave.

In Virginia, lawmakers in both chambers approved bills guaranteeing up to 12 weeks of paid family leave. Although previous efforts were vetoed by former Republican Gov. Glenn Youngkin, current Democratic Gov. Abigail Spanberger is expected to sign the bill when the final version reaches her desk, Virginia Mercury reported.

In January address to lawmakers, Spanberger said that “being pro-business and being pro-worker are not mutually exclusive.”

“We can support business growth and invest in our workforce. We can attract new businesses and protect workers. … That’s why we will create a statewide paid family and medical leave program.”

Virginia is predicted to spend about $116.51 million on startup costs in fiscal years 2027 and 2028. By 2031, the program is expected to spend $2.1 billion annually on benefits financed by payroll taxes.

Opponents often cite the costs of paid leave programs and the burdens they place on businesses. Last month, Virginia Republican Del. Michael Webert, said that enormous corporations can afford the novel costs and administrative burdens, but not smaller employers.

“The impact is not going to fall evenly,” he said before the event House vote last month.

In much of the Midwest and South, state laws prohibit local governments from requiring employers to provide paid ill leave. IN 18 statescities are effectively deprived of the power to establish their own labor protection measures.

Stateline reporter Kevin Hardy can be reached at: khardy@stateline.org.

Dr. Carrie Frederick can recall many cases during her 14 years of practice in Oregon in which patients tried to negotiate forgoing cervical cancer diagnostic tests because of the cost.

The test, which usually comes after someone has already undergone abnormal screening, can range from $200 to $1,200 out of pocket.

Oregon will become the first state in the nation to require insurers to cover treatment for cervical cancer patients, and the policy could expand nationwide if up-to-date federal regulations go into effect early next year.

Both houses of the Oregon Legislature passed Bill was unanimously adopted on Wednesday, February 25 and awaits the signature or veto of Democratic Governor Tina Kotek. The provision will become law within a week, even if he doesn’t sign it, and will apply to plans starting January 1, 2027.

Cervical cancer is one of the few types of cancer that can be treated in its pre-cancerous stage, so screening is recommended every three to five years for women aged 21 to 65. It is also a cancer that According to experts, this can be preventeddue to the availability of the HPV vaccine for people under 26 years of age, preferably before exposing them to the virus that most often causes cervical cancer through sexual contact.

Advocates say wide access to low- or no-cost reproductive health care helps prevent cervical cancer for the most vulnerable in society. However, many clinics offering this service have had to do so close or limit services over the past year and a half after approval by the U.S. Congress keen cuts to Medicaid.

Oregon has a lower rate of cervical cancer cases per year than many other states. Jane Leo, Oregon government relations director for the American Cancer Society Cancer Action Network, said 140 cases were diagnosed statewide in 2025, with the same number or more expected in 2026. The organization estimates that in 2025, 13,360 up-to-date cases will be diagnosed across the country.

Leo said the cancer organization aims to eliminate cost sharing for all cancer treatments nationwide, and bills like Oregon’s are an crucial step.

“I hope my colleague in Washington will now insist,” Leo said. “You have to start somewhere, and I’m proud that Oregon was the first state to do it.”

When a routine Pap smear screening shows abnormal cervical cells, your obstetrician-gynecologist can gather more information about whether the cells are cancerous by performing a more thorough examination called a colposcopy. This procedure is more targeted, and Frederick said the medical community recommends a maximum of four biopsies, which are sent to a separate laboratory. Each biopsy has its own cost.

“I definitely found myself negotiating internally, like, can I afford two biopsies so the patient doesn’t get the bill?” said Frederick.

Frederick is the former legislative chair of the American College of Obstetricians and Gynecologists and began helping draft the Oregon bill in 2023. That was the year Oregon passed a similar bill on breast cancer diagnostic costs, and Frederick said he used that bill as a template.

The Cervical Cancer Screening Act was introduced for the third time in February, and its importance was underlined by Oregon Rep. Anne Hartman’s continued treatment for Stage 3 cervical cancer, which she said announced in November.

Published by the Health Resources and Services Administration up-to-date federal regulations in early January due to cervical cancer screening. In addition to the up-to-date guidelines for home testing, it included a requirement that most insurance plans must cover follow-up testing without cost sharing.

Dr. Julia Barnes, legislative chairwoman of the American College of Obstetricians and Gynecologists in Oregon, said there was some question as to whether the regulations were still necessary after the up-to-date guidelines were published, but decided they should still be codified at the state level.

“It gives Oregon the authority to actually enforce this law, and federal guidelines may change,” Barnes said.

The law has minimal or no fiscal impact on Oregon’s budget, assuming federal guidance goes into effect in January, Barnes said, which helped the bill pass without opposition.

The up-to-date law is a step toward reducing the incidence of cervical cancer, which has caused 50 deaths out of 140 diagnosed in Oregon, according to the American Cancer Society. Barnes said those who are treated and survive have lingering effects of radiation on vaginal tissue and complicated surgeries.

“It’s really terrible when you see people who are either delaying their follow-up because it’s going to cost them money, or they’re not aware of it, or they’ve missed the window to get the vaccine,” Barnes said. “We’re absolutely thrilled that it’s gone. It’s been a long time coming.”

Governor Josh Shapiro has joined a multi-state lawsuit against the Trump administration over the Centers for Disease Control and Prevention’s (CDC) decision to change the national childhood vaccination schedule.

The case is being led by Democratic attorneys general from Arizona and California. They are joined by Democratic attorneys general from 12 other states, as well as Shapiro, who serves as governor.

It names the U.S. Department of Health and Human Services, the Centers for Disease Control and Prevention (CDC), and their respective leaders, Secretary of Health and Human Services Robert F. Kennedy, Jr. and CDC Director Jay Bhattacharya.

Last year, Kennedy, a longtime and outspoken vaccine skeptic, removed and replaced all 17 members of the CDC’s Advisory Committee on Immunization Practices. Then in January, the CDC issued a up-to-date schedule of childhood vaccinations which repealed universal vaccination recommendations against hepatitis A, influenza, meningococcal disease, respiratory syncytial virus (RSV) and rotavirus. The move came after universal recommendations to vaccinate children against hepatitis B and against hepatitis B virus in children were abandoned.

Vaccines that the CDC previously widely recommended for children are now recommended for children with underlying health conditions or as options that parents can discuss with their doctors.

The lawsuit alleged that the CDC’s vaccine panel was wrongfully replaced and that the up-to-date recommendations were illegal, unscientific and “posed a direct threat to public health.”

American Academy of Pediatrics and other medical organizations filed a lawsuit seeking to block the up-to-date endorsements last month.

A spokesman for the U.S. Department of Health and Human Services said in a statement: “This is a publicity stunt disguised as a lawsuit. Under the law, the Secretary of Health has express authority to make decisions on the CDC’s vaccination schedule and the composition of the Advisory Committee on Immunization Practices. CDC’s vaccine schedule reforms reflect commonsense public health policies shared by peer developed countries.”

Most of the 20 peer countries identifiedrecommended fewer than 18 vaccinations for children which the CDC has previously advocated. However, the United States currently recommends fewer vaccines than all countries except Denmark, which is itself an outlier.

Although Democratic attorneys general often bring more litigation against Republican presidential administrations — and vice versa — Shapiro has signed on to many of the lawsuits pursued by Democratic attorneys general as governor.

Before being elected governor, he served as Pennsylvania’s attorney general.

Republican Attorney General Dave Sunday has largely remained mute on the matter. Asked about the lawsuit by Capital-Star, a spokesman for his office said: “Generally, the Governor’s office has the ability to represent its executive agencies under the Commonwealth Solicitors Act.

When a client told Curtis Taylor he had downloaded an app that billed himself as an AI therapist, the licensed Erie counselor knew he had to check it out for himself.

Taylor said the app “crashed” when he mentioned self-harm and didn’t correct him when he called the chatbot as a counselor, prompting him to file an ethics complaint against the company.

“I had a lot of fun pretending to be an advisor… I say I’m not,” Taylor said. “I have been vetted. I completed two master’s level programs to obtain my Ph.D. With my counseling license, I have completed 3,000 (supervised) hours.”

“I have permission. I’m a mandated reporter. And these are all things that artificial intelligence just isn’t and won’t be,” he continued.

Across the country, some people have died by suicide in high-profile cases where the deceased used an artificial intelligence chatbot to aid with their mental health. In the wake of these deaths, several states have introduced advanced laws restricting their operate, and Pennsylvania could be next.

Country House Bill 2100 will apply modern standards to AI chatbots and prohibit companies from providing mental health services to Pennsylvanians unless they are under the guidance of a licensed therapist.

Even then, AI cannot make individual treatment decisions, directly interact with clients in therapeutic communications, or make recommendations or treatment plans as part of a proposal. During a Tuesday hearing before a panel of House Democrats, testimony considered the uses and limitations of artificial intelligence in the mental health space shortly after another House committee considered the technology’s role in health care.

Taylor said he is not “anti-AI” and added that he uses it as a documentation or spreadsheet tool.

“I personally think it’s appropriate for students trained to be counselors to be able to use AI to role-play as clients. However, I don’t think AI has a place for role-playing as a counselor,” Taylor said.

He has clearly stated that he does not want insurers to view AI chatbots as a way to “segregate” customers with mental health issues in order to bypass a counselor, even if there is a nationwide shortage of providers.

More to consider

Madeliene Stevens, chair of the government relations committee at the Pennsylvania Counseling Association, shared other concerns about the operate of artificial intelligence, including potential breaches of confidentiality and lack of oversight.

“There are no current parameters on the types of information and data that AI technology can ingest and what it then does with it,” Stevens said.

Molly Cowan, director of professional affairs for the Pennsylvania Psychological Association, added that AI chatbots are “designed to keep people engaged” and using them for as long as possible.

“They don’t challenge false assumptions. They don’t give you new coping skills. They tell you to talk to them,” Cowan said.

She added that potential regulations should still allow the operate of technologies such as note-taking under human supervision.

However, Cowan cautioned that in settings with multiple types of providers – such as hospitals where doctors and psychologists work together – there may be situations in which one doctor can provide AI-enabled care while another cannot do so under the current proposal.

Other health care settings

Earlier Tuesday, a bipartisan group of lawmakers heard about ongoing applications of artificial intelligence in general health care settings, particularly hospitals.

As of 2024, 71% of hospitals were using predictive AI, compared to 32% of hospitals using generative AI, according to Paige Nong, an assistant professor at the University of Minnesota’s school of public health.

“When it comes to implementing technology in the healthcare system, it’s moving really fast,” Nong said.

Hospitals operating within larger systems or with higher operating margins were more likely to implement AI, while rural or critical access hospitals were less likely to implement AI. The most common applications were for planning, monitoring, or monitoring and predicting adverse events. One of the fastest growing applications is invoicing.

Standardizing “model cards” that summarize basic information about an AI tool — which Nong compared to nutrition labels on food — could aid rural or critical access hospitals looking to adopt the modern technology.

However, she detailed a divide in surveillance when AI was used for clinical purposes – such as supporting diagnosis or identifying risk factors – or for administrative purposes – such as documentation.

The former has guidelines from the US Food and Drug Administration, which also approves artificial intelligence-enabled devices, while the latter does not.

“It’s not clear who they might actually be looking for… (they) just don’t have that clarity,” Nong said.

Additionally, she noted that few systems were able to effectively evaluate the operate of AI, adding that only 57% of hospitals using AI also evaluate these tools.

For Peter Lazes, a clinical and industrial psychologist, the biggest concerns were a lack of input from frontline caregivers during development and too much focus on making money or cutting costs.

“So the tools are then not focused on the concerns of frontline staff or on the effective implementation of those tools,” Lazes said. “It’s not about pain points or problems for patients or staff… it’s about ways to make money.”

He said electronic health records – a “serious waste of time” – are now used more to document billing codes for reimbursement rather than clinical issues. Artificial intelligence tools such as transcriptionists are touted as effective time-saving solutions, similar to electronic health records, but “we see the same scenario with artificial intelligence.”

“If doctors and nurses are fired, the policy of these hospitals will be, ‘By the way, now that you have a few more minutes, you can admit three more patients.’ That doesn’t help the situation,” Lazes said.

Nong noted that while clinician satisfaction seemed to improve with such documentation tools, it did not appear to result in time savings. Lazes added that some doctors report that AI transcription takes longer because they have to correct AI errors.

Lazes proposed using state dollars to encourage the operate of cogeneration AI, in which development is driven by workers – such as doctors and nurses, rather than hospital executives looking for ways to cut costs.

Colorado Republican Sen. Rod Pelton (R) and Senate President James Coleman, a Democrat, speak during the sixth day of the special legislative session in August 2025. Colorado is among the states using state funds to aid residents purchase health insurance on the Obamacare exchanges. (Photo: Delilah Brumer/Colorado Newsline)

At least 10 Democratic-leaning states are using their own money to aid people buy Obamacare health plans, at least partially replacing federal tax credits that expired overdue last year.

State aid, partly offered through programs that existed before federal subsidies expired, is helping hundreds of thousands of people lower monthly premiums that would otherwise have risen to double or even triple what they were before federal aid ended. The savings can amount to hundreds of dollars per month.

But only New Mexico fully fills the gap left by the expiration of federal aid, offering it to people of all incomes; for most Americans buying Obamacare plans, the end of federal aid means much higher prices. And New Mexico and other states trying to cushion the blow to their residents will face mounting budget pressures as health care costs continue to rise.

In addition to the expiration of federal subsidies, Obamacare insurance costs have increased due to other factorsincluding labor shortages and rising prescription drug costs, driven in part by rising demand for GLP-1 drugs such as Ozempic and Wegovy.

The increased federal subsidies were made available under the American Rescue Plan Act in 2021 and then extended through the end of 2025 under the Inflation Reduction Act. Designed as a fleeting solution during the pandemic, they helped escalate the number of people buying health insurance on insurance marketplaces created by the Affordable Care Act – formally known as Obamacare – from 11.4 million people in 2020 to 24.3 million last year.

The increased subsidies were available to everyone, regardless of income. The additional federal aid provided to some of the lowest-income households has eliminated premium payments entirely for some people.

Congressional leaders allowed the grants to expire on December 31. As of the end of last month, the number of people in the marketplace’s coverage was down about 1.2 million compared to a year ago, according to data federal data.

Last year, the Congressional Budget Office estimated that the expiration of federal subsidies would escalate the number of people without insurance by 4.2 million until 2034.

Under the Affordable Care Act, each state can exploit the government’s online insurance marketplace, HealthCare.gov, or operate its own state-run exchange. Only 21 states and the District of Columbia with state-run markets can offer state-funded tax credits or subsidies, and at least 10 of them (California, Colorado, Connecticut, Maryland, Massachusetts, New Jersey, New Mexico, New York, Vermont, and Washington) do.

Matt McGough, a policy analyst at the research group KFF, said many people buying Obamacare plans “have fallen between the cracks of the health care system.”

“They may not be working or working enough hours to qualify for health benefits. They’re too young for Medicare. They’re making too much to qualify for Medicaid, and they really have no choice but to go to the marketplace,” McGough said.

He warned that relatively hearty people are most likely to forgo market coverage rather than pay more for it. This will leave the exchange with people who have the greatest health needs, raising costs and premiums for everyone. To avoid such a scenario, he said, “I want to be able to keep as many people in the market as possible.”

Major involvement in New Mexico

In New Mexico, Democratic Gov. Michelle Lujan Grisham and state lawmakers earlier this year he hit the state’s 5-year-old Health Care Affordability Fund for an additional $17.3 million to fully replace expired federal grants by June 30 for all enrollees, regardless of income.

The huge majority of the 82,400 New Mexicans who purchase insurance through the state marketplace qualify for state aid. Perhaps New Mexico is like that as a result one of the few states where the number of people buying Obamacare plans has increased this year: Enrollment is up 18% in New Mexico, while the District of Columbia, Maryland and Texas all saw single-digit growth.

“We feel really great that we’ve come together to really focus on the affordability challenges for New Mexicans, and we’re really proud of the gains we’ve made in insurance when we’re seeing losses elsewhere,” said Kari Armijo, cabinet secretary of the New Mexico Health Care Authority. She noted that a handful of Republican state lawmakers have joined Democrats in supporting the aid.

New Mexico’s Health Care Affordability Fund money comes from a 3.75% surtax on insurance companies. At the time of the fund’s creation, the surtax was expected to generate approximately $165 million in modern revenue annually.

Currently, the state uses almost half of the revenues from the additional tax to finance the remaining parts of its budget. But the New Mexico House earlier this month approved the bill which would gradually escalate the portion of the surtax earmarked for the Health Care Affordability Fund from the current 55% to 100% in 2028.

Legislative financial analysts recently questioned the long-term sustainability of this approach. Armijo acknowledged that continuing to replace expired federal grants “will deplete the fund over time.”

“It’s quite a significant amount and it will strain the programs we can provide with these funds,” Armijo said.

Paul Gessing, president of the Rio Grande Foundation, a conservative think tank in New Mexico, said the state is now “awash in oil and gas money,” allowing it to “spend money in ways that make little sense for the population as a whole and instead benefit a small portion of relatively wealthy New Mexicans.”

Gessing said the state should focus on reducing health care spending by recruiting and retaining more doctors and nurses to reduce doctor and nurse shortages, as well as by changing medical malpractice laws.

“I don’t think the state should make it a practice to use state funds to fill the gap when federal funding is transferred or eliminated,” Gessing said.

Other states

In California, where there were 1.9 million people adopted According to state data, the number of subscriptions on the state exchange in 2025 has already decreased by 32% compared to last year.

The state decided to spend $190 million this year to fully replace lost federal grants for people earning up to 150% of the federal poverty level ($23,940 for an individual) and partially replace them for people earning between 150% and 165% of the federal poverty level – just above Medicaid eligibility in the state. This year, approximately 390,000 people enrolling in higher education will receive state subsidies.

Like New Mexico, California has created in 2021 Health Care Affordability Reserve Fundfunded by general revenues and the penalties some have to impose pay when they pay taxes.

State Budget Democratic Governor Gavin Newsom proposed last month projects a “modest projected deficit” of $2.9 billion for fiscal year 2026–27, but that it could grow to $22 billion next year. California’s total annual budget is approximately $350 billion.

“Any amount of money you can put towards affordability makes a difference,” said Jessica Altman, executive director of the California marketplace. “Thinking about these trade-offs is a challenging but important conversation at the state level.”

In Colorado, the state is offering financial assistance through a modern program called Colorado Premium Assistance. It happened during August 2025 special sessionwhen Colorado lawmakers approved it up to $110 million partially replace federal grants this year. Aid will be available to anyone earning between 133% and 400% of the federal poverty level, or between $43,890 and $132,000 for a family of four.

“It’s clear that there is value to Coloradans. And having a state-based marketplace, as Colorado does, really allows us to develop state-specific solutions and have our policies and changes driven by the needs of the people who live here,” said Nina Schwartz, director of policy and external affairs for the Colorado marketplace.

However, Schwartz emphasized that state aid will not completely replace expired federal aid and, as a result, the number of people buying insurance on the exchange is decreasing. The number of appeals increased by 83% compared to last year.

“We are seeing an increase in the number of cancellations, and the number of people who canceled their plans during open enrollment has almost doubled compared to last year,” she said.

Other states are also favoring circumscribed aid. For example, Connecticut offers assistance to households with incomes up to 200% of the federal poverty level, and the state announced it will spend $115 million in 2026 to partially offset the expiration of federal grants.

Massachusetts has set committed $250 million to enhance the state’s existing subsidy program, helping to keep approximately 270,000 enrollees with incomes below 400% of the federal poverty level enrolled with stable premiums. By early January, about 25,000 Massachusetts residents had already canceled their plans for the marketplace.

Maryland has something modern premium assistance program which fully replaces federal aid for people earning less than 200% of the federal poverty level and partially replaces it for people earning between 200% and 400% of the federal poverty level. New York has been offering it since last year aid those registering on the market with incomes reaching 400% of the federal poverty level. And from 2023, Washington he offered state subsidies for anyone earning less than 250% of the federal poverty level.

Stateline reporter Shalina Chatlani can be reached at: schatlani@stateline.org.

A pharmacist at Mayo Pharmacy in Bismarck, North Dakota, reviews completed pharmaceutical orders for January. Advocates, providers, medical associations and state lawmakers are pushing for insurers to cover nonopioid pain medications. (Photo: Michael Achterling/North Dakota Monitor)

More and more states are requiring their Medicaid programs and health insurance companies to cover nonopioid pain medications as an alternative to opioids, which can be cheaper for insurers but also more addictive for patients.

Advocates, healthcare providers, medical associations and state lawmakers are pushing for coverage parity. This means prohibiting insurers from charging more for non-opioid drugs than for opioids, and prohibiting them from requiring prior authorization or staged therapy – requiring patients to try other drugs first – before including non-opioid drugs.

At least eight states have passed such laws: Arkansas, Illinois, Louisiana, Maine, Massachusetts, Oklahoma, Oregon and Tennessee. In states still considering legislation, the effort has been bipartisan, pushed by lawmakers in Democratic-leaning states such as Colorado and New York and Republican-leaning states including Kentucky and Missouri.

The issue has gained momentum in recent years as leading medical societies, such as the American Society of Regional Anesthesiology and Pain Medicine, have urged doctors not to prescribe opioids as a first-line treatment for pain. Meanwhile, bipartisan legislation introduced in Congress last year aims to expand access to non-opioid pain medications for Medicaid Part D enrollees. The matter was referred to the committee.

Dr. Patrick Giam, president of the American Society of Anesthesiologists, said the organization “believes it is important that insurance plans provide patients with the same availability of non-opioid therapies as opioid-based therapies.”

Non-opioid pain medications include prescription anti-inflammatory NSAIDs such as naproxen and ibuprofen, nerve blocking injections, some antidepressants, anticonvulsants, acetaminophen, and other medications. Opioids include oxycodone, codeine, morphine and fentanyl. The U.S. Food and Drug Administration encourages the utilize of non-opioid alternative pain relievers.

Last year, agency approved a novel drug called suzetrigine, available under the brand name Journavx, the first non-opioid painkiller in a novel class of painkillers. The medicine, available in tablets, can be prescribed for acute pain after surgery or injury. Manufacturer Vertex Pharmaceuticals is one of the founders of the Voices for Non-Opioid Choices initiative, which lobbies for the laws.

In Missouri, where GOP-sponsored legislation would prohibit insurance companies from denying coverage for a prescribed non-opioid drug or requiring a higher copay for a non-opioid drug, Missouri Insurance Coalition he argued that this measure will enhance health care costs and effectively create a “monopoly” for Journavx. Any tablet can Cost about $15 per pill out of pocket. However, legislators pointed to non-opioid alternatives.

Why non-opioids often cost more

Newer non-opioid drugs entering the market are more steep than opioids because there is no generic alternative yet, explained Sterling Elliott, a clinical pharmacist and lecturer at the Feinberg School of Medicine at Northwestern University in Illinois and a board member of Voices for Non-Opioid Choices.

“The price of many products is so high because the price of generic opioids is so low. Generic opioids are among the cheapest drugs you can find in the U.S. pharmaceutical supply,” Elliott said. “When a new entrant enters the painkiller market, market factors are configured to drive up the price.”

Elliott added that some insurance plans don’t cover prescription NSAIDs like ibuprofen because people prefer to pay out-of-pocket for lower-strength, over-the-counter versions of these drugs.

In New York, Democratic Assemblyman Phil Steck, co-author of a bipartisan bill that has not received a hearing, said challenging insurance companies is not basic.

“You’re trying to tell insurers what to do,” Steck said. “These are usually difficult undertakings… Our experience shows that… [legislature’s] The insurance commission is very difficult to deal with, so it hasn’t been dealt with as often as we would have liked.”

Non-opioid insurance coverage can vary significantly depending on the insurance plan, explained clinical pharmacist Emma Murter, who co-chairs the Society of Pharmacists’ Pain and Palliative Care advocacy committee.

“There are so many of them [non-opioid] medications that can be used to treat chronic pain,” Murter said. “It’s not obvious what is and what isn’t. It’s a very wild, disordered wild west.”

Murter stated that when it comes to filling prescriptions, she often has to “fight and appeal for some of these non-opioid therapies” with insurance companies.

Dima Qato, a professor of clinical pharmacy at the University of Southern California, said non-opioid prescription painkillers are less popular on insurance companies’ “preferred” drug lists. Because insurers may favor cheaper opioids, which could result in higher copayments or consumers paying more out of pocket.

That was the case with Chris Fox, a Washington lobbyist who serves as executive director of Voices for Non-Opioid Choices. Fox traveled to state capitols across the country to lobby for the bills. He recently had personal experience with pain medications following oral surgery.

“For everything except non-opioid medications, I expected to have $0 out-of-pocket,” he said. He paid $30 out of pocket for the non-opioid medication.

Fox added that his oral surgeon was not familiar with the availability of the novel, first-in-class, non-opioid suzetrigine. When he asked his doctor for a prescription for this drug, the surgeon wrote it out but also prescribed an opioid along with an antibiotic.

“He prescribed me hydrocodone just to be on the unthreatening side because he wasn’t very familiar with the drug [suzetrigine]– said Fox.

Addiction prevention

Speaking to Stateline by phone, Fox was on his way to the local sheriff’s office to return the hydrocodone he had not taken after surgery.

“I would say that we have neglected the opportunity to prevent opioid addiction where we can, which is in those patients who develop a new, persistent pattern of opioid use after exposure to a medically given opioid,” Fox said.

Although opioid overdose deaths have declined, these drugs still kill approximately 200 Americans a day.

Healthcare workers in hospitals also face problems with lower reimbursement rates for some non-opioid medicines.

Dr. Joseph Smith, an anesthesiologist at a surgical center in Virginia who has been in practice for thirty years, gave the example of a nerve-blocking pain pump. He added that administering a brand-name version of the drug could cost up to $400 for all the equipment. Smith, like Elliott, serves on the board of Voices for Non-Opioid Choices.

“So the hospital says, ‘Well, I can spend $400 or 25 cents on a drug pill,'” Smith said.

Smith treats many teenage teenage athletes with sports injuries. Studies have shown that taking drugs after surgery can enhance the risk of addiction.

“My goal when I get a 14-year-old or 15-year-old here is for them to never try a drug or be exposed to a drug,” he said.

Stateline reporter Nada Hassanein can be reached at: nhassanein@stateline.org.