Prescription Drug Affordability Review Board
Page Updated: March 11, 2024
CHA Advocacy Principle: Limit administrative burden on hospitals and ensure policies improve affordability without compromising access and quality by shifting costs from pharmaceutical manufacturers to hospitals and patients.
What Has Been Completed:
Origin: Senate Bill (SB) 21-175, established the Prescription Drug Affordability Review Board (PDAB) to review prescription drug costs and set an upper payment limit for certain drugs.
SB 23-1225 makes changes to the board review process and allows the board to review as many prescription drugs as they would like SB 21-175 only gave the board the authority to review 12 prescription drugs) starting on Jan. 1, 2025.
In August 2023, the PDAB chose five drugs for affordability reviews – Enbrel, Genvoya, Cosentyx, Stelara, and Trikafta. The PDAB will post affordability reviews on its website. So far, the board has voted unanimously against setting an upper payment limit for Trikafta.
In February 2024, PDAB voted Enbrel unaffordable for consumers and started the six-month process to determine an upper payment limit for the drug. The DOI will initiate rulemaking to establish an upper payment limit for Enbrel with the Secretary of State and anticipates holding two rulemaking hearings on June 7 and July 19.
Background: The PDAB is a five-member board that evaluates drugs for affordability, performs affordability reviews, and then determines if a drug is “unaffordable,” at which point they can set an upper payment limit for commercial insurers regulated by Colorado’s Division of Insurance (does not apply to federally regulated plans). This is impactful to hospitals because the PDAB could act to limit reimbursement for hospitals, creating a gap between the purchase price and leading to a loss for the hospital or decreased access to treatment for patients.
Resources:
- PDAB Website
- CHA Comment Letter on Affordability Reviews (Nov. 27, 2023)
- 2023 Eligible Drug Dashboard
- PDAB Newsletter Subscription
- Finalized PDAB Rules
- PDAB Staff Memo: Affordability Reviews – Suggestions Regarding Selection Criteria Consideration and Data Details
- PDAAC Recommendations for Selection Criteria
- CHA Letter to PDAB on the Upper Payment Limit Methodology (Oct. 6, 2022)
- CHA Letter to PDAB on Upper Payment Limit Rulemaking Hearing (Jan. 13, 2023)
Meetings/Dates of Note: All PDAB and PDAAC meetings for 2024 can be found here
CHA Staff Contact: Adeline Ewing, CHA manager, public policy, [email protected]