| |  | The Lead Brief | Legislating on sweeping health care issues in Washington is likely to stall this year, as many lawmakers on Capitol Hill focus on their own reelection bids ahead of the midterm elections, leaving the states to experiment with consequential health policy. Across the country, states are using their 2026 legislative sessions to test ideas that could eventually shape national policy, from drug pricing reforms to oversight of artificial intelligence. By the end of February, 43 states had kicked off their 2026 legislative sessions. Many are focused heavily on affordability and health system reforms. Here are key policy areas to watch: 1. Drug pricing - PBM reform: States have been enacting policies to rein in pharmacy benefit managers, or PBMs, on a much broader scale than lawmakers in Congress have in recent years. The companies, which serve as intermediaries between insurers and drugmakers, also have expanded into the pharmacy space.
In the Tennessee legislature this year, there’s a bipartisan proposal that would prohibit companies from owning both a PBM and retail pharmacies, a move that could force vertically integrated companies such as CVS Health to restructure their operations in the state. The measure aims to prevent PBMs from steering patients to the pharmacies with which they’re affiliated. CVS recently said enacting the legislation would lead to the closure of all of its locations — more than 130 pharmacies — in Tennessee. - Drug affordability boards: Nearly a dozen states have created their own prescription drug affordability boards, or PDABs, aimed at reviewing and reducing drug prices. The PDABs in four states — Colorado, Maryland, Minnesota and Washington — have the ability to directly set cap costs on medicines by setting upper payment limits.
There are currently 18 bills in 13 states regarding affordability boards, according to a tracker from the National Academy for State Health Policy. This session, the Virginia legislature is making its third attempt at setting up a five-person board to review the affordability of high-cost prescription drugs and weigh capping the price. Then-Gov. Glenn Youngkin (R) twice vetoed bipartisan legislation to create a PDAB in the state, which had come under fierce opposition from the pharmaceutical industry, in 2024 and 2025. → Virginia’s PDAB proposal also differs from established affordability boards in other states. If it becomes law, it could make the prices that Medicare negotiates on drugs through the Inflation Reduction Act available for the rest of the state’s population, according to Families USA. Patient advocates, including Families USA and AARP, have been pushing for the legislation’s approval under the state’s new Democratic governor, Abigail Spanberger. However, it’s unclear whether Spanberger will sign, veto or ask for changes on the measure. - Reference pricing: Florida’s legislature is debating a policy similar to President Donald Trump’s most-favored nation drug pricing agreements, tying certain drug payments to prices in other wealthy countries.
The proposal would require the state’s health agency to calculate a reference price for each drug using prices from a collection of peer nations. Drug companies would be required to submit disclosures of their international pricing on their products. Notably, the bill excludes countries with single-payer health care systems from being part of the pricing comparison, which narrows the pool of countries that are part of the calculations. 2. Artificial intelligence As Capitol Hill has lagged on imposing guardrails on artificial intelligence, states are increasingly stepping in to regulate the technology. Last year, Texas enacted a law intended to protect consumers, imposing disclosure and other requirements for AI systems used in various settings, including health care. Here are some of the topics being discussed: - Psychotherapy: In Kentucky, state legislators recently advanced a bill that aims to create some guardrails around using AI in psychotherapy, banning it from being used in therapy or to create therapy plans. Ohio also wants to prohibit the tech from being used to develop psychotherapy treatments. These types of proposals follow a new law established in Illinois last year.
- Patient-facing tech: New York lawmakers are mulling whether to ban AI chatbots from giving people “substantive” health treatment advice.
- Use by insurers: In 2025, four states — Arizona, Maryland, Nebraska and Texas — passed laws requiring humans to review AI-driven decisions about prior authorization requirements or health coverage. The legislature in Washington state just approved a similar bill, and a number of others — including Alabama, Florida, Hawaii and South Carolina — are considering similar moves this year.
- Use by providers: Louisiana seeks to limit health care providers from using AI to make diagnoses, generate treatment plans or recommendations, and communicate directly with patients without oversight by a person who is licensed to practice in the state. The legislation would allow providers to use AI for administrative tasks, such as processing billing or claims, and preparing or maintaining a patient’s records or notes.
In Colorado, proposed legislation touches on all four of these topics: It seeks to involve humans in the insurance claim process, require AI-enabled “mental health companion chatbots” to disclose that they are not a human able to practice psychotherapy, and it would compel providers to reveal to patients when a practice is using AI technologies — and how. 3. Care delivery rules States have restrictions on what tasks that health professionals — such as doctors, specialists, nurse practitioners, physician assistants and pharmacists — can provide while caring for patients, known as scope-of-practice rules. As some states grapple with physician shortages, legislatures are moving to reshape how care is delivered, and proposing to expand those rules. Nurses and advocates who support these laws argue it gives flexibility to providers, reduces shortages and improves access to care. Doctors and specialists view it as encroaching on their professions, warning it could weaken care standards. States including Indiana, Michigan, Mississippi, North Carolina, South Carolina and West Virginia are considering legislation that involve giving advanced practice registered nurses, or APRNs, more authority to practice or prescribe medicine without physician oversight. In New York, there are proposals in the state House and Senate that would allow a physician assistant who has practiced for 3,600 hours and 6,000 hours, respectively, to work and perform medical services without supervision by a doctor. A bill in Kansas would allow pharmacists to treat certain conditions, such as the flu, “consistent with the pharmacist's education, training and experience.” The American Medical Association derides these measures as scope-creep bills, and a poll of its members and those of other medical associations overwhelmingly view this as its top legislative priority for 2026. The group said that more than 150 bills involving scope-of-practice rules were defeated last year, and it anticipates even more to pop up in states this year. |
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