Health Care & Wellness
PDABs and UPLs: What They Are and Why They Matter for Drug Pricing Policy
May 15, 2025 | Mary Kate Barnauskas
Key Takeaways:
- Reproductive health policy remains a key battleground in state legislatures in 2025, and policy continues to evolve as states have tackled issues related to ballot measures, emergency abortions, and abortion medications this year.
- States continue to respond to 2024's abortion ballot measures, with Montana failing to get a fetal personhood amendment on the ballot while Missouri successfully referred a measure to repeal voter-approved reproductive freedom protections.
- Several states are clarifying medical emergency exceptions to abortion bans, with Arkansas and Kentucky enacting legislation and Texas advancing similar measures, though providers remain skeptical of these clarifications.
- Blue states are proactively codifying federal EMTALA protections for emergency abortions in state law, with Colorado, New York, and Washington enacting legislation in 2025 after Illinois led the way in 2024.
- Medication abortion remains a major battleground, with Republican attorneys general pursuing cases against out-of-state providers while red states advance legislation to expand civil liability and criminal penalties for abortion medications.
- Blue states are implementing shield laws to protect abortion medication providers, with New York, Vermont, and Colorado allowing practitioners to use practice names rather than personal names on prescription labels following legal challenges from other states.
Reproductive health policy remains a key battleground in state legislatures in 2025, and policy continues to evolve as states have tackled issues related to ballot measures, emergency abortions, and abortion medications this year.
Ballot Measure Battles Over Reproductive Health Policy
In 2024, ballot measures were the major focus of reproductive health policy, with measures making the ballot in 10 states, and voters in Colorado, Maryland, Nevada, New York, Montana, Arizona, and Missouri approving abortion protections. In response, lawmakers in Montana and Missouri countered the passage of such measures through legislatively referred measures.
In Montana, the legislature attempted to refer a measure (MT HB 316) to establish fetal personhood in the state constitution. However, constitutional amendments require a two-thirds vote of all members of the legislature to make the ballot, and lawmakers failed to reach this mark, with the measure receiving 91 of the 100 votes required.
In Missouri, lawmakers were successful in getting a measure on the ballot with HJR 73. The measure would repeal the right to reproductive freedom passed by voters and enact several other restrictions on abortion as well as ban gender-affirming care for minors. The measure will likely go before voters in 2026, but Governor Kehoe (R) could call a special election to put the measure before voters sooner.
Emergency Abortion Legislation
As abortion bans have gone into effect in recent years, several laws have been challenged in court by providers over unclear language on exceptions to bans, especially those for medical emergencies. As a result, several states considered legislation to clarify exceptions with Arkansas and Kentucky enacting legislation so far this year. Texas has also moved legislation (TX SB 31) following calls from Lt. Gov. Patrick (R) to clarify the exceptions. However, providers and abortion proponents have been skeptical of the clarifications. Notably, Kentucky Gov. Beshear (D) vetoed Kentucky’s bill over concerns that the measure could further restrict access to medical care, but the legislature voted to override the veto.
On the other hand, lawmakers in blue states have taken action to establish protections for emergency abortions. Last year, the U.S. Supreme Court dismissed a case centered around the Emergency Medical Treatment and Active Labor Act (EMTALA), which requires hospitals with emergency departments to provide stabilizing care to patients with a medical emergency. Under the Biden Administration, guidance was issued to specify that stabilizing care included abortions, leading to a lawsuit over Idaho’s abortion ban, which does not include an exception for when the pregnant woman’s health is at risk. Since the Supreme Court dismissed the case and refrained from ruling on the actual merits of the case, some lawmakers have expressed concern that the protections for emergency abortions under EMTALA are at risk. Last year, Illinois enacted legislation to codify EMTALA protections in state law with a definition of "stabilizing care” that includes abortions. In 2025, Colorado, New York, and Washington enacted similar legislation, and California and Connecticut still have bills under consideration.
Medication Abortion Legislation
Medication abortion continues to be a central point of contention in reproductive health policy both in statehouses and in the courts. Republican attorneys general in Texas and Louisiana are pursuing civil and criminal cases against a New York doctor who mailed abortion pills to individuals in their state, and Idaho, Missouri, and Kansas are continuing a lawsuit against the FDA over the approval of mifepristone, one of the two drugs used in the medication abortion regimen. These legal challenges could have significant implications for access to abortion medications nationwide.
In addition, several red states are advancing legislation to further restrict access to abortion medications. Texas and Louisiana have moved on legislation to expand civil liability relating to abortion medications, and Oklahoma is considering legislation to create a felony offense for the trafficking of an abortion-inducing drug.
In contrast, blue states are enacting measures to protect access to abortion medications. Following the lawsuits by Texas and Louisiana, New York Gov. Hochul (D) signed legislation (NY A 2145/S 36) to authorize prescribers of abortion medication to request the name of their practice rather than their name be included on an abortion medication prescription label. Similar measures have been enacted in Vermont and Colorado, and introduced in Maine, Rhode Island, Nevada, and California.
