The Prescription Drug Affordability Advisory Council (PDAAC) held its most recent meeting on July 13th to develop a recommendation of 20 drugs for consideration of upper payment limits (UPL) by the Prescription Drug Affordability Board (PDAB).
The Department of Regulatory Affairs has created an interactive, user-focused dashboard for its list of drugs eligible for affordability review. PDAB developed a list of 50 eligible drugs for the council to advise and provide input on. The council’s input is a statutory requirement for the board to consider.
While the meeting didn’t result in a finalized recommendation of drugs due to requests for additional data analysis by council members, PDAAC proposed a list of drugs to remove from the prioritized list because market alternatives were either available or would become available soon. These include Humira, Copaxone, and Gilenya.
Kim Bimestefer, executive director of the Department of Health Care Policy and Financing (HCPF) and PDAAC member, laid out the state’s priorities.
“I wouldn’t mind if in the end we gave another [category], which was, say, three of the drugs that have a massive [wholesale acquisition cost (WAC)] … to get that message across to manufacturers [that price gouging is] not the type of behavior that Colorado and the United States are looking for.”
— Bimestefer
PDAAC’s draft recommendation to the board incorporates the following:
- Focus selection across three categories within already prioritized list:
- Highest average paid price per person per year
- Highest patient count
- Highest change in WAC with consideration for rebates
- Combine drugs with the same name and different dosages and strengths and consider for selection
- Select one drug from a single therapeutic class when there are multiple drugs in that class
- Do not select prescription drugs with approved and marketed equivalents and biosimilars
- Consider Social Vulnerability Index (SVI) in selection
SVI is a measure based on the county an individual taking the drug lives in that indicates the level of social vulnerability of the regions utilizing the drugs. PDAB will be utilizing SVI as a health equity measure in the review process.
The selection criteria used to develop the 50 prioritized drug list, such as patient count and total amount paid, will shift when PDAB enters its affordability review stage. PDAB will consider a larger data set with focus on current WAC, as well as the change in WAC, and the cost and availability of therapeutic alternatives for its final selection of up to five UPL drugs this year.
The council plans to reconvene on July 31st, ahead of the Aug. 4th PDAB meeting, to review a list of drugs prepared by PDAB staff based on the PDAAC draft recommendations.
In the meantime, PDAB staff will look at preparing some additional data sets requested by members, including exclusivity dates for patents, different lines of treatment for each drug that could impact utilization, and the quality and efficacy of market alternatives.