After Colorado’s Unprecedented Prescription Drug Cap, What’s Next?

A relatively new type of government board took unprecedented action in Colorado last month when it placed an upper limit on the price of an arthritis and autoimmune disease medication.

The state’s Prescription Drug Affordability Board voted on Oct. 3 to cap the price of Enbrel at $31,000 a year for patients, making Colorado the first state in the nation to set a cost ceiling on a prescription drug.

About 2,500 Colorado residents take Enbrel, with about 60% of them privately insured, according to the board. Those patients previously paid, on average, $57,787 per year for the drug, with their insurance picking up $53,049 of the cost, per year.

The board’s move reduces the cost to patients and their insurance by 46%, down to $600 for a weekly dose. The price point was determined by board review of Medicare’s new “maximum fair price” list.

The action affects less than 0.1% of the 21st most populated state, but received a sizable reaction across the country, with supporters labelling it as an historic day for patient affordability and critics cautioning that it could have severe unintended consequences.

“We are so happy to see that Colorado’s Prescription Drug Affordability Board took action and set an upper payment limit on a medication that is unaffordable to many people who rely on it,” said Rhena Hicks, co-executive director of Freedom Virginia, a nonprofit promoting affordability in the Old Dominion State. “As the first state in the country to use a PDAB to lower the cost of prescription drugs, Colorado has set an important precedent that we should follow in Virginia to lower costs here.”

The National Infusion Center Association, a nonprofit representing infusion providers, however, said: “Setting an upper payment limit based on the MFP [Medicare Maximum Fair Price] does not guarantee lower out-of-pocket costs for patients. On the contrary, it could result in new formulary tiering strategies, increased utilization management, and additional cost-sharing burdens, each of which can delay or block access to medically necessary therapies like Enbrel for vulnerable patient populations.”

Amgen, the pharmaceutical company behind Enbrel, filed a lawsuit against the state of Colorado over the board’s decision in early November.

The suit alleges that in setting the price cap, Colorado’s board violated the U.S. Constitution’s supremacy and commerce clauses, along with the due process protections of the 14th Amendment. More specifically, Amgen claims the board’s price cap conflicts with federal patent authority, the state is attempting to regulate out-of-state economic activity and the board’s decision-making process lacked “meaningful standards” and was therefore “arbitrary.”

Still, the board’s decision has the potential to spur further action at the state level—not that state policymakers need a nudge. They’ve already shown they’re interested in prescription drug affordability.

Prescription Drug Affordability Bills Considered in Nearly Third of States

This year at least 16 states have considered legislation dealing with prescription drug affordability, including measures aimed at establishing prescription drug affordability boards. Six of those states have enacted measures dealing with the issue.

Several Pending Bills Seek to Address Drug Affordability

At least 37 bills addressing prescription drug affordability were introduced in 16 states this year, according to the LexisNexis® State Net® legislative tracking system.

At the time of writing, nine had failed, 10 had been enacted, two were awaiting gubernatorial action, and three had been vetoed, Virginia’s HB 570/SB 274 and HB 1724. Fifteen more were still pending in eight states: Georgia, Iowa, Massachusetts, Michigan, Minnesota, New Hampshire, Pennsylvania and Wisconsin. 

Among the pending bills are multiple proposals that would:

• promote transparency in drug prices, including Massachusetts SB 875 by Sen. Edward Kennedy (D) and Pennsylvania SB 190 by Sen. Sharif Street (D)], and

• create prescription drug affordability boards, including Iowa SB 264 by Sen. Molly Donahue (D), Georgia HB 931 by Reps. Karen Lupton (D) and Marvin Lim (D), and Michigan HB 4544 by Rep. Matt Longjohn (D) and SB 3 by Sen. Darrin Camilleri (D).

The proposals reflect state lawmakers’ desire to address drug affordability concerns that have risen to be among the top policy issues of 2025.

Yet, New Hampshire repealed its prescription drug affordability board via a budget a bill (HB 2). And another bill that is still pending in the state (HB 570) is aimed specifically at repealing that board.

New Hampshire did away with its board because policymakers there believe the price cap approach Colorado took with Enbrel ultimately causes more problems in the nation’s complex health care system, undercutting the sense that history was made in the Centennial State last month.

Several states have prescription drug affordability boards, although they are a fairly recent development, with the first having been created in Maryland in 2019. Only a small number of the boards, however, like those in Colorado, Maryland, Minnesota and Washington, have the authority to set price caps or upper payment limits as they’re called in policy speak.

The attention around Colorado’s recent decision on Enbrel could embolden more state legislators to authorize caps in their own states, although critics of this policy appear to be gaining steam as well.

As Miranda Yaver, assistant professor of health policy and management at the University of Pittsburgh, wrote in an op-ed for MSNBC, “improving prescription drug affordability is critical,” yet it remains unclear about how best to do it.

Colorado’s recent move is sure to just add more energy to the debate.

—By SNCJ Correspondent BRIAN JOSEPH

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