A nationwide cross-sectional analysis of pending state legislation related to dermatology

State-level legislation is a principle driver of structural change in American health care; yet, physician participation in the policymaking process remains limited. Using the members-only American Academy of Dermatology Association legislative tracker, we conducted a nationwide cross-sectional analysis of 295 dermatology-related state bills through February 14, 2025. The scope of practice (29.5%) and pharmaceutical reform and drug access (25.1%) were the dominant legislative categories. Physician sponsors were involved in only 7.5% of bills compared with 26.8% sponsored by nonphysician health care professionals; the remaining 62.7% had sponsors with no documented health care background. These findings reflect persistent structural forces, scope of practice expansion, and pharmaceutical policy dysfunction that fundamentally shape dermatologic practice. We discuss the clinical implications of these trends, the organized nonmarket competition facing physician interests, and actionable pathways through which dermatologists can meaningfully engage in the legislative process, including through state dermatology societies, SkinPAC, and grassroots advocacy.