Snapshots of Recent State Initiatives in Medicaid Prescription Drug Cost Control

Issue Brief
  1. National Health Expenditure Accounts, CMS, accessed February 15, 2018, https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/NationalHealthAccountsHistorical.html.

    ← Return to text

  2. Chris Park, “Trends in Medicaid spending for prescription drugs,” Presentation at MACPAC Public Meeting, October 29, 2015, https://www.macpac.gov/publication/trends-in-medicaid-spending-for-prescription-drugs/.

    ← Return to text

  3. Drew Altman, “Prescription drug costs break through the partisan logjam,” Axios, May 2, 2017, https://www.axios.com/one-health-care-issue-breaks-through-the-partisan-logjam-2387900255.html and Kathleen Gifford, Eileen Ellis, Barbara Coulter Edwards, Aimee Lashbrook, Elizabeth Hinton, Larisa Antonisse, Allison Valentine, and Robin Rudowitz, Medicaid Moving Ahead in Uncertain Times: Results from a 50-State Medicaid Budget Survey for State Fiscal Years 2017 and 2018, (Washington DC, Kaiser Family Foundation, October 2017), https://www.kff.org/medicaid/report/medicaid-moving-ahead-in-uncertain-times-results-from-a-50-state-medicaid-budget-survey-for-state-fiscal-years-2017-and-2018/.

    ← Return to text

  4. National Health Expenditure Accounts, op. cit.

    ← Return to text

  5. Gifford et al., 2017, op. cit.

    ← Return to text

  6. Laura Snyder and Robin Rudowitz, Trends in State Medicaid Programs: Looking Back and Looking Ahead, (Washington DC, Kaiser Family Foundation, June 2016), https://www.kff.org/medicaid/issue-brief/trends-in-state-medicaid-programs-looking-back-and-looking-ahead/.

    ← Return to text

  7. 42 U.S.C. 1396r-8 (c)

    ← Return to text

  8. Snyder and Rudowitz, op. cit.

    ← Return to text

  9. Covered Outpatient Drugs Final Rule, Federal Register, Vol. 81, No. 20, February 1, 2016, https://www.gpo.gov/fdsys/pkg/FR-2016-02-01/pdf/2016-01274.pdf.

    ← Return to text

  10. See “Retail Price Survey,” CMS, accessed February 15, 2018, https://www.medicaid.gov/medicaid/prescription-drugs/retail-price-survey/index.html.

    ← Return to text

  11. Dr. John Coster, “Medicaid Coverage Policies for Prescription Drugs,” Presentation at MACPAC Public Meeting, December 14, 2017, https://www.macpac.gov/public_meeting/december-2017-macpac-public-meeting/.

    ← Return to text

  12. States that use PBMs in administering the prescription drug benefit in a fee-for-service setting pay the PBM administrative fees for these services. See Medicaid Pharmacy Trend Report, Second Edition, (Magellan Rx Management, 2017), https://www1.magellanrx.com/media/671872/2017-mrx-medicaid-pharmacy-trend-report.pdf.

    ← Return to text

  13. State Maximum Allowable Costs are upper limits states apply to multiple-source drugs included on state maximum allowable cost lists.

    ← Return to text

  14. Laura Snyder and Robin Rudowitz, op. cit.; Vernon Smith, Kathleen Gifford, Eileen Ellis, Robin Rudowitz, Molly O’Malley Watts, and Caryn Marks, The Crunch Continues: Medicaid Spending, Coverage and Policy in the Midst of a Recession Results from a 50-State Medicaid Budget Survey for State Fiscal Years 2009 and 2010, (Washington DC, Kaiser Family Foundation, September 2009), https://www.kff.org/medicaid/report/the-crunch-continues-medicaid-spending-coverage-and-policy-in-the-midst-of-a-recession/; Vernon Smith, Kathleen Gifford, Eileen Ellis, Robin Rudowitz, and Laura Snyder, Medicaid in an Era of Health & Delivery System Reform: Results from a 50-State Medicaid Budget Survey for State Fiscal Years 2014 and 2015, (Washington DC, Kaiser Family Foundation, October 2014), https://www.kff.org/medicaid/report/medicaid-in-an-era-of-health-delivery-system-reform-results-from-a-50-state-medicaid-budget-survey-for-state-fiscal-years-2014-and-2015/.

    ← Return to text

  15. Snyder and Rudowitz, op. cit.

    ← Return to text

  16. “Assuring Medicaid Beneficiaries Access to Hepatitis C (HCV) Drugs,” Medicaid Drug Rebate Program Notice, CMS, November 5, 2015, https://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Benefits/Prescription-Drugs/Downloads/RxReleases/State-Releases/state-rel-172.pdf.

    ← Return to text

  17. U.S. Congress, Senate, Committee on Finance, The Price of Sovaldi and Its Impact on the U.S. Health Care System, 114th Congress, 1st session, 2015, http://www.finance.senate.gov/imo/media/doc/1%20The%20Price%20of%20Sovaldi%20and%20Its%20Impact%20on%20the%20U.S.%20Health%20Care%20System%20(Full%20Report).pdf.

    ← Return to text

  18. Ibid.; Soumitri Barua, Robert Greenwald, Jason Grebely, Gregory Dore, Tracy Swan, Lynn Taylor, “Restrictions for Medicaid Reimbursement of Sofosbuvir for the Treatment of Hepatitis C Virus Infection in the United States,” Annals of Internal Medicine, August 4, 2015, http://annals.org/aim/fullarticle/2362306/restrictions-medicaid-reimbursement-sofosbuvir-treatment-hepatitis-c-virus-infection-united; KFF tracking of policy changes.

    ← Return to text

  19. A settlement in April 2017 made this provision permanent. See “Washington Settles Class Suit Over Denial of Hepatitis C Medication,” April 13, 2017, https://www.lexislegalnews.com/articles/16417/washington-settles-class-suit-over-denial-of-hepatitis-c-medication.

    ← Return to text

  20. The FDA approved Olysio (Janssen) in November 2013, Sovaldi (Gilead Sciences) in December 2013, Harvoni (Gilead Sciences) in October 2014, Viekira Pak (AbbVie) in December 2014, Technivie (AbbVie) in July 2015, Daklinza (Bristol-Myers Squibb) in July 2015, Zepatier (Merck) in January 2016, Epclusa (Gilead Sciences) in June 2016, and Mavyret (AbbVie) in August 2017.

    ← Return to text

  21. Gifford et al., 2017, op. cit.

    ← Return to text

  22. “Pharmaceutical Bulk Purchasing: Multi-state and Inter-agency Plans,” National Conference of State Legislatures, November 4, 2017 http://www.ncsl.org/research/health/bulk-purchasing-of-prescription-drugs.aspx.

    ← Return to text

  23. New York’s spending cap, called the “Global Cap” limits the year-to-year spending growth of the Medicaid program to the ten-year rolling average of the medical component of the CPI. If spending is expected to exceed the spending cap, the NY Department of Health and Department of the Budget develops a plan of action to bring spending back under the spending cap. See Gifford et al., 2017, op. cit. and “Monthly and Regional Global Cap Updates,” New York Department of Health, https://www.health.ny.gov/health_care/medicaid/regulations/global_cap/.

    ← Return to text

  24. As noted by the New York Public Health Law, Section 280, added as a result of NY SB 2007, April 20, 2017.

    ← Return to text

  25. NY SB 2007, April 20, 2017. https://custom.statenet.com/public/resources.cgi?id=ID:bill:NY2017000S2007&ciq=ncsldc3&client_md=e859cf75599f35248e4fb3672d5d7766&mode=current_text.

    ← Return to text

  26. A state’s Drug Utilization Review Boards oversees its Medicaid Drug Utilization Review (DUR) Program, which reviews therapies to ensure patient safety, as well as analyzing prescribing habits and cost savings. See “Drug Utilization Review,” CMS, accessed February 15, 2018, https://www.medicaid.gov/medicaid/prescription-drugs/drug-utilization-review/index.html.

    ← Return to text

  27. 42 U.S.C. 1396r-8 (d). See also “Assuring Medicaid Beneficiaries Access to Hepatitis C (HCV) Drugs,” Medicaid Drug Rebate Program Notice, Release No. 172, CMS, November 5, 2015, https://www.medicaid.gov/medicaid-chip-program-information/by-topics/prescription-drugs/downloads/rx-releases/state-releases/state-rel-172.pdf.

    ← Return to text

  28. Commonwealth of Massachusetts, “MassHealth Section 1115 Demonstration Amendment Request,” September 8, 2017, http://www.mass.gov/eohhs/docs/eohhs/healthcare-reform/masshealth-innovations/section-1115-demo-amendment-request.pdf.

    ← Return to text

  29. Ibid.

    ← Return to text

  30. See U.S. Congress, Senate, Special Committee on Aging, Sudden Price Spikes in Off-Patent Prescription Drugs: The Monopoly Business Model that Harms Patients, Taxpayers, and the U.S. Healthcare System, December 2016, https://www.aging.senate.gov/imo/media/doc/Drug%20Pricing%20Report.pdf.

    ← Return to text

  31. For example, in the case of Turing Pharmaceuticals’ Daraprim, only one manufacturer produced a generic drug, in essence making it a monopoly and allowing it to dictate prices.

    ← Return to text

  32. GAO, “Generic Drugs Under Medicare: Part D Generic Drug Prices Declined Overall, but Some had Extraordinary Price Increases,” GAO-16-706, August 2016, https://www.gao.gov/assets/680/679022.pdf.

    ← Return to text

  33. 42 U.S.C. 1396r-8 (c). See also “Medicaid Payment for Outpatient Prescription Drugs,” (Washington D.C., MACPAC, March 2017), https://www.macpac.gov/wp-content/uploads/2015/09/Medicaid-Payment-for-Outpatient-Prescription-Drugs.pdf.

    ← Return to text

  34. MD HB 631, May 27, 2017, https://custom.statenet.com/public/resources.cgi?id=ID:bill:MD2017000H631&ciq=ncsldc3&client_md=94762068a205033f5447793923805ee9&mode=current_text.

    ← Return to text

  35. David Gibbons and Alan Kirschenbaum, “First Generic Drug Price Gouging Prohibition to Become Law in Maryland,” FDA Law Blog, June 1, 2017, http://www.fdalawblog.net/2017/06/first-generic-drug-price-gouging-prohibition-to-become-law-in-maryland/; Michael Dresser, “Judge refuses to block Maryland price-gouging law,” The Baltimore Sun, December 4, 2017, http://www.baltimoresun.com/news/maryland/politics/bs-md-price-gouging-law-20170929-story.html.

    ← Return to text

  36. Plaintiff States’ [Proposed] Consolidated Amended Complaint, In. Re: Generic Pharmaceuticals Pricing Antitrust Litigation, United States District Court Eastern District of Pennsylvania, November __, 2017.

    ← Return to text

  37. See Katherine Young, Robin Rudowitz, Rachel Garfield, and MaryBeth Musumeci, Medicaid’s Most Costly Outpatient Drugs, (Washington D.C., Kaiser Family Foundation, July 2016), https://www.kff.org/health-costs/issue-brief/medicaids-most-costly-outpatient-drugs/.

    ← Return to text

  38. The Drug Price Competition and Patent Term Restoration Act of 1984, usually referred to as the Hatch-Waxman Act, created the current framework of balancing innovation incentives in the form of regulatory exclusivity with access to affordable drugs in the form of simpler approval processes for therapeutically equivalent generic drugs.

    ← Return to text

  39. “Pharmacist Substitution of Biosimilars: An Overview of State Laws,” M2 Health Care Consulting, May 30, 2016, http://www.m2hcc.com/pharmacist-substitution-of-biosimilars-an-overview-of-state-laws.html.

    ← Return to text

  40. Andrew Mulcahy, Zachary Predmore, and Soeren Mattke, “The Cost Savings Potential of Biosimilar Drugs in the United States,” (Rand Corporation, 2014), https://www.rand.org/content/dam/rand/pubs/perspectives/PE100/PE127/RAND_PE127.pdf.

    ← Return to text

  41. “Pharmacist Substitution of Biosimilars: An Overview of State Laws,” op. cit.

    ← Return to text

  42. Richard Cauchi, “State Laws and Legislation Related to Biologic Medications and Substitution of Biosimilars,” National Conference of State Legislatures, February 8, 2018, http://www.ncsl.org/research/health/state-laws-and-legislation-related-to-biologic-medications-and-substitution-of-biosimilars.aspx.

    ← Return to text

  43. NASHP’s Pharmacy Costs Work Group, “States and the Rising Cost of Pharmaceuticals: A Call to Action,” (NASHP, October 2016), http://nashp.org/states-rising-cost-pharmaceuticals-call-action/.

    ← Return to text

  44. CMS’s Outpatient Drug Rule published in early 2016 requires states to switch from an Estimated Acquisition Cost, for which states frequently relied on AWPs or WACs, to an AAC. States heavily relied upon AWPs and WACs prior to the ruling, and have been working to change their reimbursement policy to use AAC to comply with the regulations. The industry used to rely more heavily on AWPs, but due to several OIG reports and litigation (New England Carpenters Health Benefits Fund v. First DataBank) that showed that AWPs were inflated, this list price is not used as often. See Federal Register, Vol. 77, No. 22, February 2, 2012, p. 5345, https://www.gpo.gov/fdsys/pkg/FR-2012-02-02/pdf/2012-2014.pdf.

    ← Return to text

  45. “Medicaid Covered Outpatient Prescription Drug Reimbursement Information by State, Quarter Ending June 2017,” CMS, https://www.medicaid.gov/medicaid/prescription-drugs/state-prescription-drug-resources/drug-reimbursement-information/index.html.

    ← Return to text

  46. CMS provides AMPs on their website for generic drugs for use in calculating Federal Upper Limits (FULs). However, CMS does not provide AMPs for brand drugs on their website or to the public.

    ← Return to text

  47. Both federal statutory and supplemental rebates are available to the public at the state level through reporting on the Form CMS-64, but they are not broken out by drug. See https://www.medicaid.gov/medicaid/financing-and-reimbursement/state-expenditure-reporting/expenditure-reports/index.html.

    ← Return to text

  48. PBMs often argue that they are able to achieve greater rebates by keeping these rebates confidential. See, e.g., comments from Dr. William Shrank, then of CVS Health, at a 2016 event: “That competition that we have, and our ability to sort of not show our cards, allows us to negotiate more effectively and negotiate better prices, better deals for our clients and our members. So we believe that right now, while there are folks on the outside that don’t necessarily have clarity about all of that process, the folks that we’re dealing with every day, our clients do and we are doing our very best job to provide them with medications that are affordable and that meet their needs.”  Transcript from Alliance for Health Reform and CVS Health event “Value-Based Pricing for Prescription Drugs: Opportunities and Challenges” on April 15, 2016, available at http://www.allhealthpolicy.org/wp-content/uploads/2016/12/FINALTRANSCRIPT_HM.pdf, page 21.

    ← Return to text

  49. Pfizer, Inc. v. Texas Health and Human Services Commission, and Charles Smith, Executive Commissioner, Findings and Facts and Conclusions of Law, In the United States District Court for the Western District of Texas Austin Division, Filed September 29, 2017.

    ← Return to text

  50. Kaiser Family Foundation Health Tracking Poll, conducted April 17-23, 2017. Available in “Public Opinion on Prescription Drugs and their Prices,” (Washington D.C., Kaiser Family Foundation), https://www.kff.org/slideshow/public-opinion-on-prescription-drugs-and-their-prices/.

    ← Return to text

  51. Aaron Berman, Theodore Lee, Adam Pan, Zain Rizvi, Arielle Thomas, “Curbing Unfair Drug Prices: A Primer for States,” (Global Health Justice Partnership, August 2017), https://law.yale.edu/yls-today/news/new-ghjp-report-examines-curbing-unfair-drug-prices.

    ← Return to text

  52. Lori Reilly, Executive VP, PhRMA, Comments to Senator Susan Collins at Senate Health, Energy, Labor, and Pensions Committee hearing, “The Cost of Prescription Drugs: How the Delivery System Affects What Patients Pay, Part II,” October 17, 2017, https://www.help.senate.gov/hearings/the-cost-of-prescription-drugs-how-the-drug-delivery-system-affects-what-patients-pay-part-ii.

    ← Return to text

  53. Pharmaceutical Research and Manufacturers of America v. Edmund Gerald Brown and Robert David, Complaint for Declaratory and Injunctive Relief, United States District Court Eastern District of California, Filed December 8, 2017, http://phrma-docs.phrma.org/files/dmfile/sb17-complaint.pdf; Megan Messerly, “In lawsuit, Big Pharma argues Nevada law creates ‘effective cap’ on insulin prices,” September 6, 2017, https://thenevadaindependent.com/article/in-lawsuit-big-pharma-argues-nevada-law-creates-effective-cap-on-insulin-prices.

    ← Return to text

  54. VT SB 216, June 2, 2016, https://custom.statenet.com/public/resources.cgi?id=ID:bill:VT2015000S216&ciq=ncsldc3&client_md=5c9a42de573d05e6b51cc374a6c53a4a&mode=current_text.

    ← Return to text

  55. The Green Mountain Care Board and the Department of Vermont Health Access

    ← Return to text

  56. CA SB 17, October 9, 2017, https://custom.statenet.com/public/resources.cgi?id=ID:bill:CA2017000S17&ciq=ncsldc3&client_md=a654672f7d7167cb58ac6d9f34b894f4&mode=current_text.

    ← Return to text

  57. This could create an unintended windfall for pharmacies, as they could stockpile drugs with upcoming WAC increases at the lower rate. After the WAC increase, reimbursement would be based on the higher WAC (or within the next month, the higher AAC). See Adam Fein, “Thanks California! SB17 Will Trigger Massive Speculative Buying, Windfall Pharmacy Profits, and Supply Chain Disruption,” Drug Channels, October 11, 2017, http://www.drugchannels.net/2017/10/thanks-california-sb17-will-trigger.html.

    ← Return to text

  58. LA SB 59, June 14, 2017, https://custom.statenet.com/public/resources.cgi?id=ID:bill:LA2017000S59&ciq=ncsldc3&client_md=47b8e5485cab12b06de11e2a3905575c&mode=current_text;  and LA HB 436, June 14, 2017, https://custom.statenet.com/public/resources.cgi?id=ID:bill:LA2017000H436&ciq=ncsldc3&client_md=2103ef7e9ce00a3cc5c95a935b993612&mode=current_text.

    ← Return to text

  59. NV SB 539, June 15, 2017, https://custom.statenet.com/public/resources.cgi?id=ID:bill:NV2017000S539&ciq=ncsldc3&client_md=4cd738d13fffa3d1831e104a3f8cabed&mode=current_text.

    ← Return to text

  60. Denise Roland and Peter Loftus, “Insulin Prices Soar While Drugmakers’ Share Stays Flat,” The Wall Street Journal, October 7, 2016, https://www.wsj.com/articles/insulin-prices-soar-while-drugmakers-share-stays-flat-1475876764.

    ← Return to text

  61. In September 2017, a U.S. District Judge combined these lawsuits, some of which state attorney generals had brought forward, into one large class action. See Sarah Jane Tribble, “Timeline: Insulin Market Under Scrutiny,” October 30, 2017, https://kffhealthnews.org/news/timeline-insulin-market-under-scrutiny/; and James Cecchi and Steve Berman, In Re Insulin Pricing Litigation, Consolidated Amended Class Action Complaint, United States District Court District of New Jersey, https://www.hbsslaw.com/uploads/case_downloads/insulin/amended-complaint-hagens-berman-insulin.pdf.

    ← Return to text

  62. The law also requires that nonprofits that advocate for patients or medical research must report funding they receive from pharmaceutical companies on their websites.

    ← Return to text

  63. “Colorado state representative introduces new legislation aimed at making insulin pricing more transparent,” Steamboat Today, January 14, 2018, https://www.steamboattoday.com/news/colorado-state-representative-introduces-new-legislation-aimed-at-making-insulin-pricing-more-transparent/.

    ← Return to text

  64. The VA by law gets a 24% discount off of the non-federal average manufacturer price, but is also is able negotiate additional discounts in return for placing a prescription drug on their national formulary. See “Veterans Health Administration,” Health Affairs Policy Brief, August 10, 2017, https://www.healthaffairs.org/do/10.1377/hpb20171008.000174/full/.

    ← Return to text

  65. The nonprofit group AIDS Healthcare Foundation sponsored both the Ohio and California ballot initiatives.

    ← Return to text

  66. The California ballot initiative would not have applied to any Medi-Cal (California’s Medicaid program) managed care. The Ohio initiative did not have this exclusion.

    ← Return to text

  67. Full text of California Proposition 61, “Drug Price Standards” (2016) and Ohio Issue 2, “Drug Price Standards Initiative” (2017). Available at https://ballotpedia.org/California_Proposition_61,_Drug_Price_Standards_(2016) and https://ballotpedia.org/Ohio_Issue_2,_Drug_Price_Standards_Initiative_(2017).

    ← Return to text

  68. Seth Richardson, “What we learned from Issue 2’s failed campaign,”Cleveland.com, http://www.cleveland.com/open/index.ssf/2017/11/what_we_learned_from_issue_2s.html.

    ← Return to text

  69. Either through a subsidiary or directly, PhRMA spent over $56 million working against the Ohio ballot initiative.  (See Ohio Issue 2, op. cit.) The PAC that opposed the California ballot initiative spent over $111 million. Pharmaceutical manufacturers comprised all of the top 10 donors to the PAC in California, and accounted for over 60% of the spending. (See California Proposition 61, op. cit.).

    ← Return to text

  70. “State Prescription Drug Purchases. Pricing Standards. Initiative Statute,” (California Legislatives Analyst’s Office,  May 10, 2016), http://shea.senate.ca.gov/sites/shea.senate.ca.gov/files/lao_analysis_-_state_prescription_drug_purchases._pricing_standards._initiative_statute.pdf.

    ← Return to text

  71. California Proposition 61 and Ohio Issue 2, op. cit.

    ← Return to text

  72. Letter from Dr. Rebekah Gee to Dr. Joshua Sharfstein, April 12, 2017, https://kffhealthnews.org/wp-content/uploads/sites/2/2017/04/gee-letter-4_12_17.pdf; Letter from Dr. Joshua Sharfstein et al. to Dr. Rebekah Gee, “Subject: Hepatitis C in Louisiana: Recommendations on Drug Availability,” May 4, 2017, http://ldh.la.gov/assets/docs/HepatitisC/ResponsememotoSecretaryGeeHCV.pdf.

    ← Return to text

  73. A National Strategy for the Elimination of Hepatitis B and C, The National Academy of Sciences, Engineering, and Medicine, 2017, https://www.nap.edu/read/24731/chapter/1.

    ← Return to text

  74. Letter from Dr. Joshua Sharfstein et al., op. cit.

    ← Return to text

  75. “Update: Hepatitis C Drug Pricing,” Louisiana Department of Health, http://ldh.la.gov/index.cfm/newsroom/detail/4227.

    ← Return to text

  76. Ed Silverman, “Governors association plans a big strategy session over drug pricing,” Stat News, September 25, 2017, https://www.statnews.com/pharmalot/2017/09/25/governors-session-drug-pricing/.

    ← Return to text

  77. IL HR 88, May 11, 2017, https://custom.statenet.com/public/resources.cgi?id=ID:bill:IL2017000HR88&ciq=ncsldc3&client_md=5cf85784e00a848c8e3b6faeac6812bd&mode=current_text. This resolution also urges the federal government to monitor the high out-of-pocket costs for prescription drugs, an issue not as relevant in Medicaid.

    ← Return to text

  78. AR HR 1013, February 18, 2015, https://custom.statenet.com/public/resources.cgi?id=ID:bill:AR2015000HR1013&ciq=ncsldc3&client_md=898b12058e4c9b6232b37b0361075718&mode=current_text.

    ← Return to text

  79. See Anna Zaret and Darien Shanske, “The Dormant Commerce Clause: What Impact Does it Have on the Regulation of Pharmaceutical Costs?” (National Academy for State Health Policy, November 2017), https://nashp.org/wp-content/uploads/2017/11/DCC-White-Paper.pdf.

    ← Return to text

  80. Dr. Renee Williams, “TennCare Formulary Management Tools,” Presentation at MACPAC Public Meeting, December 14, 2017, https://www.macpac.gov/public_meeting/december-2017-macpac-public-meeting/.

    ← Return to text

  81. Jeremy Greene and William Padula, “Targeting Unconscionable Prescription-Drug Prices – Maryland’s Anti-Price-Gouging Law,” New England Journal of Medicine, July 13, 2017, http://www.nejm.org/doi/full/10.1056/NEJMp1704907.

    ← Return to text

  82. Silverman, op. cit.

    ← Return to text

KFF Headquarters: 185 Berry St., Suite 2000, San Francisco, CA 94107 | Phone 650-854-9400
Washington Offices and Barbara Jordan Conference Center: 1330 G Street, NW, Washington, DC 20005 | Phone 202-347-5270

www.kff.org | Email Alerts: kff.org/email | facebook.com/KFF | twitter.com/kff

The independent source for health policy research, polling, and news, KFF is a nonprofit organization based in San Francisco, California.