Analysis of Legal Verbiage in State Legislation for Insurer Coverage of Early Eyedrop Refills in the United States.

Purpose: State laws on early eyedrop refills, implemented to help patients obtain their medications when they run out early, have many inconsistencies possibly impacting their efficacy and functionality. This study sought to examine different state laws and elucidate unique features and commonalities that may influence their effectiveness.

Design: A review of all state legislation to date regarding early eyedrop refills was performed.

Participants: All 50 states were included, with an in-depth review of the 33 states that had early eyedrop refill legislation.

Methods: The law database Nexis Uni (formerly LexisNexis) and each state's individual law code site were used to identify relevant laws (or proposed legislation) using keywords such as "eyedrop," "eye," "refill," and "early." Political data based on the year these laws were passed were obtained from the National Governor's Association and National Conference of State Legislatures. These data were aggregated and analyzed using descriptive statistics.

Main outcome measures: State law wording was analyzed for percentage of dosage period passed, days passed, and other requirements.

Results: Of the 33 states with early eyedrop refill laws, 14 were only days based, 8 were only percentage based, 4 had both, 4 had neither percentage nor days criteria, and 3 had neither but cited Centers for Medicare and Medicaid Services guidelines. These laws were passed between 2009 and 2023, with a notable increase from 2014 to 2018, rising from 10 to 29 states. Regionally, the Northeast had the highest adoption rate (88%), followed by the West (77%), the South (56%), and the Midwest (50%). Political climates varied: 14 states had Republican control, 2 had Democratic control, and 17 had mixed party control. Of the 17 states without an early eyedrop refill law 4 attempted passage but were not put into law for various reasons with the other 13 not appearing to have had any attempts at law passage.

Conclusions: State laws providing coverage for early eyedrop refills vary in terms of verbiage and requirements necessary to obtain a covered early eyedrop refill. Region, political climate, and year appear to play minor roles in early eyedrop refill verbiage and passage.

Financial disclosure(s): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.