Prescription Drug Affordability Review Board
Page Updated: Oct. 13, 2023
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 all prescription drugs (the board currently has the authority to review 12 prescription drugs) starting on January 1, 2025.
At the beginning of August, PDAB chose five drugs for affordability reviews – Enbrel, Genvoya, Cosentyx, Stelara, and Trikafta. Stakeholders can provide feedback on the selections as described in the Stakeholder Engagement Guide.
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
- 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:
CHA Staff Contact: Adeline Ewing, CHA policy analyst, [email protected]