Lowering Prescription Drug Costs: ArrayRx, A State-Led Pharmacy Collaborative
Rising prescription drug costs strain state budgets, public employee benefit plans, Medicaid programs, corrections systems, and uninsured and underinsured residents alike. ArrayRx is a multi-state cooperative offering a transparent, state-governed pharmacy purchasing solution.
The program's core logic is simple: by pooling purchasing power, member states negotiate better drug discounts and rebates than any single state could secure independently. The larger the member pool, the greater the leverage - and the greater the savings flowing back to state programs and residents.
This Issue Brief provides a brief overview and history of ArrayRx, program services, state pathways to participation, and the various ways states administer programs.
State Legislative Actions to Address Healthcare Affordability
Healthcare affordability remains a leading concern across the United States, shaping decisions about insurance coverage and access to care. Approximately one-third of adults report delaying or forgoing needed care, and four in ten say they have skipped or reduced the dosage of a prescribed medication in the past year due to cost. These challenges disproportionately affect economically marginalized communities, including uninsured individuals, those with low incomes, rural residents, and Black and Hispanic populations.
State Futures in partnership with State Health and Value Strategies at Princeton University released this issue brief highlighting strategies state legislators are deploying to improve healthcare affordability, strengthen hospital financial assistance policies, and generate revenue to offset losses in federal healthcare funding. An accompanying brief, State Legislative Actions to Address Medical Debt, covers state efforts on that front.
Healthcare affordability remains a leading concern across the United States, shaping decisions about insurance coverage and access to care. Approximately one-third of adults report delaying or forgoing needed care, and four in ten say they have skipped or reduced the dosage of a prescribed medication in the past year due to cost. These challenges disproportionately affect economically marginalized communities, including uninsured individuals, those with low incomes, rural residents, and Black and Hispanic populations.
State Futures in partnership with State Health and Value Strategies at Princeton University released this issue brief highlighting strategies state legislators are deploying to improve healthcare affordability, strengthen hospital financial assistance policies, and generate revenue to offset losses in federal healthcare funding. An accompanying brief, State Legislative Actions to Address Medical Debt, covers state efforts on that front.
State Legislative Actions to Address Medical Debt
In response to ongoing changes in federal immigration policy and enforcement, states are taking an active role in shaping how immigration laws are carried out within their borders. As federal agencies implement new strategies that raise concerns about civil rights, local authority, and transparency, state lawmakers are taking steps to clarify and shape the role of state and local governments in immigration enforcement.
The healthcare affordability crisis has resulted in an estimated 100 million Americans, or 41% of adults, holding some form of medical debt. The consequences of medical debt are profound, from financial strain to worsened health outcomes, as people delay or forgo health services and medications to prevent further debt. Despite the success of the Affordable Care Act to reduce the uninsured, rising healthcare costs and new federal policy changes are slated to further drive families into medical debt.
State Futures in partnership with State Health and Value Strategies at Princeton University released this issue brief documenting how state legislators are stepping in with concrete strategies to cancel, reduce, and prevent medical debt. This issue brief outlines 1) the issue of medical debt and who is most impacted; 2) what legislation states are using to address the issue; and 3) how state legislators can use oversight to increase visibility around the burden of medical debt. Last updated: June 5, 2026.
State Legislators Address Immigration Detention Facilities
In response to ongoing changes in federal immigration policy and enforcement, states are taking an active role in shaping how immigration laws are carried out within their borders. As federal agencies implement new strategies that raise concerns about civil rights, local authority, and transparency, state lawmakers are taking steps to clarify and shape the role of state and local governments in immigration enforcement.
As the federal government expands its use of immigration detention facilities, states are taking steps to limit cooperation with federal law enforcement, assert oversight authority, establish enforceable standards in detention facilities, and protect the rights of detained individuals within their borders.
State lawmakers are deploying the full range of tools available to them — including legislation, direct oversight, litigation, and strategic communications — to ensure detention facilities meet basic standards of safety and transparency and to hold both federal agencies and private contractors accountable. These efforts reflect the commitment of states to protect vulnerable populations and push back against federal detention that conflicts with state laws and values.