Stephen Foxley is the director of public affairs and government relations at Regence BlueCross BlueShield of Utah. Before that, he worked as an associate at Foxley & Pignanelli.
Foxley is speaking about this year’s legislative session at our upcoming 2022 Utah State of Reform Health Policy Conference on April 7th in Salt Lake City.
In this Q&A, Foxley summarizes the key health policy work of the 2022 legislative session and highlights important budget items.
State of Reform: What do you think was the main theme of this short session? What were some of the prominent pieces of legislation that came out of this session in health policy?
Stephen Foxley: “I think it’s hard to not have the discussions start with COVID. Right at the beginning of the session, we were at the peak of the omicron surge. Now, we are in a much different place and have a really positive trajectory. I think a lot of lawmakers and the public felt like they were ready to turn the page on COVID.
There were two main bills from a health policy and business perspective that we were watching closely. There was House Bill 60, which was the vaccine passport bill, as well as House Bill 63, which was about COVID-19 vaccine exemptions. The vaccine passport bill failed while HB 63 ended up passing.”
SOR: Can you tell me more about what HB 60 would have done if it passed?
SF: “‘The business community really took the lead around HB 60 and 63. HB 60 did two things. One, it made vaccination status on equal footing as the other protected classes within the state’s non-discrimination act, as it was originally drafted. It was a separate section of the code, but it mirrored the same language and then it also removed the ability for a business to require a vaccine as a condition of admission or service.
Two, it would prohibit most businesses from being able to require a vaccine as a condition of work. It was amended several times and moved in a direction that was positive for business. But, it probably didn’t fully encompass the scope of businesses who would have a legitimate reason to be requesting a vaccine for their employees.”
SOR: Can you tell me about the pharmacy benefit manager (PBM) legislation surrounding 340B?
SF: “From the health insurance perspective, we saw a lot around prescription drug issues. For the 2022 session, I think the biggest subjects in that space were 340B issues, contract 340B pharmacies, and manufacturer coupons and how those are treated by health plans.
There were two bills by Senator Vickers: one was SB 139, prescription cost amendments, and then the other one was SB 236, pharmacy practice amendments. SB 139 was the main conversation around copay coupons. There is a national effort by drug manufacturers and patient advocacy groups to say that manufacturer coupons should be required to count towards a member’s deductible cost sharing and out-of-pocket max.
A few years ago, the Trump administration gave explicit permission to health plans to say that those do not need to count towards deductibles out-of-pocket max. The reason they gave was that it steers people toward more expensive branded drugs, when there may be a therapeutic alternative that is preferred by a formulary or a generic. You can see where manufacturers would not like this and as well as patient advocacy groups. They are looking at this as increasing costs for people that have those disease conditions.
The bill failed, but as a health plan, we agree that the drug pricing system is broken and doesn’t work very well for individuals. The question is, how do you solve a problem for people who have demonstrated financial and medical need to be on a drug in a way that doesn’t increase overall health care system costs? Those were the types of questions that we were asking and the types of solutions we were working towards.
We proposed a number of amendments and worked closely with Vickers, but ultimately, we wanted to make sure that if a manufacturer is giving a coupon, that that full coupon would be applied, that the value of that full coupon would be used. We wanted to make sure there was transparency about how those drugs were spent, and that there were exemptions when there are generics, therapeutic alternatives, or biosimilars.”
SOR: So what important items came out of the Social Services budget in this session and what are the next steps for the budget?
SF: “The state continues to make really significant investments in expanding the safety net around behavioral health services and crisis services. Another focus on Medicaid is the expansion population. They were the first to have physical medicine and behavioral health integrated with the ACOs [Accountable Care Organizations]. There’s a workgroup that’s been established to see about further integration for the TAM [Total Addressable Market] population.
Then you’ve obviously got the merger of the Department of Human Services and the Department of Health. The last thing would be the governor’s sustainable health collaborative, and could receive funding to the tune of something like $3 million to help get that established and running.”
SOR: What are the most important topics heading into the 2023 legislative session?
SF: “One, COVID will continue to be the wildcard around the state and hopefully we’re at the tail end of that. The things that we’re focused on are those issues that make health care affordable for individuals, families, and businesses. I think that the prescription drug pricing issue is the main conversation around that. I think what ultimately happens with the governor’s sustainable health care collaborative will be important.”
This interview was edited for clarity and length.