The latest government threat to access: Prescription Drug Affordability Boards

| June 10, 2024

The latest government threat to access: Prescription Drug Affordability Boards

Prescription Drug Affordability Boards (PDABs) might have a name that sounds good, but their decisions could end up limiting patients’ access to the treatments you prescribe.

PDABs are state-level boards created by the state legislature that are charged with looking at prescription drug prices as a way to control costs.  Unfortunately, as PDABs focus only on price, they may not assess value the same way you and your patients do, and they aren’t concerned with improving patient care.

There are currently a handful of PDABs operating across the country, with Colorado being the most developed. Since beginning its first value assessment last summer, patients and providers have voiced concerns with board composition, methodology, transparency, lack of consideration for stakeholder input and the use of a generally opaque and undefined process.

The first drug the Colorado PDAB assessed was Trikafta, a one-of-a-kind treatment for cystic fibrosis that has changed peoples’ lives. The PDAB deemed the drug “not unaffordable” and will not set an upper payment limit for the drug.

The first drug they assessed and deemed “unaffordable,” just this spring, is Enbrel. The board will now go through the process of setting an upper payment limit for Enbrel in the state.  Please note – this upper payment limit is not the price patients pay. Instead, it’s the maximum allowed price to be paid by payers in the state.  In fact, it does nothing to guarantee savings for patients at the doctor’s office or pharmacy counter but could lead to access challenges or higher out of pocket costs for patients depending on formulary shifts resulting from the new mandated price.

As the process is playing out in Colorado, this bad policy is spreading to other states.  According to the Value of Care Coalition, a group focused on PDAB policy that counts ACAAI as a member, there are at least ten states considering legislation related to PDABs.

In each state, advocacy organizations and professional societies are raising concern and opposing the bills. Threats to access and innovation posed by government price controls far outweigh any potential benefit to patients. These bills do nothing to ensure people get the medicine they need and do not ensure any savings from an upper payment limit is passed to the patients who need it.

Please watch for action alerts from ACAAI regarding PDABs – this is another issue we’ll continue to monitor and keep you advised.