The Role of State Attorneys General in Improving Prescription Drug Affordability

94 Pages Posted: 12 Oct 2021

See all articles by Michelle M. Mello

Michelle M. Mello

Stanford Law School; Department of Medicine

Trish Riley

affiliation not provided to SSRN

Rachel Sachs

Washington University in Saint Louis - School of Law

Date Written: October 11, 2021


Impact litigation initiated by state attorneys general has played an important role in advancing public health goals in contexts as diverse as tobacco control, opioids, and healthcare antitrust. State attorneys general also play a critical role in helping governors and legislatures advance health policies by giving input into their drafting and defending them against legal challenges. State attorneys general have entered the prescription drug affordability arena in both these ways—for example, by initiating lawsuits relating to price fixing by generic drug manufacturers and defending state laws requiring disclosures of pharmaceutical prices. Yet the scope of their collective efforts is not well understood, and little is known about factors that facilitate and hinder them in their pursuit of policy objectives relating to drug affordability. In this Article, we report findings from an empirical study of state attorney general activities relating to pharmaceutical pricing. Drawing from key informant interviews with attorneys working on drug pricing issues as well as a scoping review, we report on how state attorneys general are working to address the problem of drug affordability, how they make decisions about resource investments in this area, what positions them to be effective change agents in this space, and what challenges they confront in this work. We situate our results within the broader literature state attorneys general as policy actors, and we suggest measures that could extend their capacity to successfully tackle the complex issues that give rise to unaffordable drugs.

Funding Information: Grant funding from the Arnold Ventures is gratefully acknowledged.

Declaration of Interests: Mello discloses expert witness fees received from law firms representing generic drug company plaintiffs in a pharmaceutical antitrust lawsuit; Mello and Sachs disclose receiving consulting fees from the National Academy for State Health Policy for authoring reports on policy strategies to regulate prescription drug prices; Mello reports serving as an unpaid consultant to CVS Caremark; and Sachs reports receiving honoraria for her participation on the Institute for Clinical and Economic Review’s independent Midwest Comparative Effectiveness Public Advisory Council and West Health’s Council for Informed Drug Spending Analysis.

Keywords: Drug pricing, health law, state attorneys general

Suggested Citation

Mello, Michelle M. and Riley, Trish and Sachs, Rachel, The Role of State Attorneys General in Improving Prescription Drug Affordability (October 11, 2021). Southern California Law Review, Forthcoming, Available at SSRN:

Michelle M. Mello

Stanford Law School ( email )

559 Nathan Abbott Way
Stanford, CA 94305-8610
United States
650-725-3894 (Phone)

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Department of Medicine ( email )

Center for Health Policy / PCOR
Encina Commons
Stanford, CA 94305
United States

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Trish Riley

affiliation not provided to SSRN

Rachel Sachs (Contact Author)

Washington University in Saint Louis - School of Law ( email )

Campus Box 1120
St. Louis, MO 63130
United States

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