Colorado Prescription Drug Affordability Board discusses criteria for selecting drugs to review


Boram Kim


The Colorado Prescription Drug Affordability Board (PDAB) convened on Friday to discuss the prioritization of selection criteria for drugs to be reviewed and identified. 


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The PDAB is tasked with conducting an affordability review and establishing upper payment limits on 12 initial prescription drugs for 2024. The Division of Insurance (DOI) presented members of the board with a list of 21 selection criteria, which the board must consider and finalize between now and its June 23rd meeting.

The drug selection criteria include total patient utilization, patient expenditures, pricing changes, and therapeutic classification.

Colorado’s all-payer claims database (APCD) provides the basis for certain selection criteria and represents Medicaid and Medicare Advantage, 40 commercial payers, and 75% of insured Coloradans. The PDAB will have information on every selection category for every drug that qualifies, including access to other state and federal databases related to prescription drugs. 

However, APCD is limited because of the gap that exists for uninsured and certain insured populations in Colorado, making health equity one selection criterion where data availability and quality limit the board’s ability to assess accurately, according to DOI officials. 

“We were talking about the health equity impact data, [which] we know …  is important [in these determinations],” said DOI’s director of price drug affordability Lila Cummings in her presentation to board members. “We also understand the ability to analyze [health equity impact] is a newer kind of metric and something where if the board were to weight health equity very highly, we would want to point out that there are some underlying concerns with the quality of the data that you’re looking at.”

Board members will be able to move forward with weighting and determining the selection criteria with the data sets that are available. 

While the PDAB has adopted the rules and corresponding policies guiding its program, the rule on UPLs was not adopted at its Jan. 13th meeting and is currently being revised as the board finalizes the review process.

The rule on UPLs would be the approved methodology for establishing the amount commercially insured Coloradans pay in out-of-pocket expenses and health plans would reimburse pharmacies and providers for specified prescription drugs.

DOI will present a list of drugs that meet the initial eligibility criteria to the board for approval at their March 31st meeting. The board will prioritize the selection criteria at that meeting before finalizing them in May for review by the Prescription Drug Affordability Advisory Council and the general public. 

Based on that input, PDAB could potentially select the first drugs for review at its June meeting.