Minnesota, Maryland, and Colorado PDAB representatives discuss efforts to lower prescription drug costs

By

Shane Ersland

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The cost of prescription drugs in the U.S. has increased by almost 40 percent over the past decade, according to data from GoodRx. The National Academy for State Health Policy hosted a meeting Thursday to highlight the work prescription drug affordability boards (PDABs) are doing to try to curb rising costs.   

PDABs are independent entities that assess and address the cost and affordability of prescription drugs. PDABs in some states have the authority to set upper payment/price limits (UPLs) on drugs they find to be unaffordable.

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Eleven states have established PDABs: Maryland, Colorado, Minnesota, Maine, Massachusetts, New Hampshire, New Jersey, New York, Ohio, Oregon, and Washington. 

Minnesota is new to the arena, as its PDAB was established by legislation last year. Its first meeting was held on March 26, when Tony Lourey was elected as its chair. Lourey noted that many Americans have declared bankruptcy due to high drug costs.   

“We’re all faced with constituents and friends that are struggling with the high cost of prescription drugs,” Lourey said. “Many declare bankruptcy over those costs. No drug is effective if you can’t afford it. That’s how we got started on this, is through consumers and their struggles with insulin, inhalers, (and) EpiPens.”

Minnesota Attorney General Keith Ellison formed a task force in 2019 to address the state’s rising prescription drug costs. The task force’s recommendations played a key role in the formation of the state’s PDAB, Lourey noted. 

“We’re just now standing it up. I’m pinch-hitting as chair of the board; we don’t have (a permanent) one yet. The pharmaceutical supply chain is so complex, and so much data is not public. This will help us unpack what’s going on in the supply chain before the drug gets to consumers. There’s also costs to the system. We’re intentionally inviting all the players in the supply chain to give their perspective so it’s not one-sided. We’re trying to drive improvements in our healthcare system to help people.”

— Lourey

Maryland was the first state to authorize a PDAB in 2019. Andrew York, its executive director, said it uses three tools to try to address prescription drug affordability.

“We often need more information about the actual cost to patients, (and) we do that through a cost review,” York said. “The next thing is UPLs—this is a novel policy—but it’s a tool to make drugs more affordable. And finally, they can make general policy recommendations. Maryland is at the first step [in the process]; cost reviews. Our board selected six drugs for the cost review process, and announced them in May.”

The Maryland PDAB will conduct cost reviews for Dupixent, Farxiga, Jardiance, Ozempic, Skyrizi, and Trulicity. Board members will decide whether to pursue UPLs on the drugs following their cost reviews.

“Everything is on the table in terms of looking at policies to make drugs more affordable. The primary goal is to make prescription drugs more affordable for patients.”

— York

Colorado’s PDAB was established in 2021. It has conducted affordability reviews on Enbrel, Trikafta, Genvoya, and Stelara. It found Trikafta and Genvoya not to be unaffordable, but found Enbrel and Stelara to be unaffordable. Which means board members could decide to set UPLs on both Enbrel and Stelara.

Colorado PDAB Director Lila Cummings said board members spent a significant amount of time reviewing the affordability of the drugs, and heard from many community members in the process. 

“You have patient representatives through prescribers and providers that help us gather diverse perspectives,” Cummings said. “In terms of the actions to gather more perspectives, they want to hear more from patients as far as drugs being affordable. As the board was setting up the program, they took considerably longer in the rulemaking process; it took a year-and-a-half. And [members reviewed] multiple rounds of drafts setting up their program. We responded to a request for surveys, and worked to do outreach to specific advocacy groups.”

2 thoughts on “Minnesota, Maryland, and Colorado PDAB representatives discuss efforts to lower prescription drug costs”

  1. PDABs actually just decide what insurance is allowed to pay for your medicine. If insurance doesn’t cover the cost set by drug makers- the drug maker has the option to leave the state. Nothing guarantees the manufacturer will drop the price and retain patients will retain access. This is a scary system where patients can lose access to life saving drugs.

    Reply
  2. PDABs actually just decide what insurance is allowed to pay for your medicine. If insurance doesn’t cover the cost set by drug makers- the drug maker has the option to leave the state. Nothing guarantees the manufacturer will drop the price and patients will retain access. This is a scary system where patients can lose access to life saving drugs. It is to save the state money and brought to you by insurance sponsored groups to save them money. No money goes to patients. Be careful

    Reply

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