State Drug-Pricing Boards are Gaining Momentum

Now that the US government is negotiating drug prices directly with manufacturers, states want to get in on the action, too.

These efforts vary by state, but generally involve creating a board to review drugs’ affordability and sometimes setting upper price limits (UPLs). While none have implemented UPLs as of April, as the idea gains momentum, there are questions about UPLs and boards’ legality, practicality, and whether they will actually lower costs for patients.

A legal first
Colorado, for instance, enacted legislation to establish a prescription drug board in 2021, and drug prices have continued to rise since then. Over the last year, that board reviewed five drugs and declared three unaffordable, including biopharmaceutical company Amgen’s Enbrel, a biologic which treats autoimmune disorders like rheumatoid arthritis. The state then moved to set a UPL for “all purchases and payer reimbursements” in February 2024.

Enbrel can cost about $8,000 a month without insurance, according to GoodRx, and cost insurers in Colorado $46,772 per patient in 2022, according to the Colorado All Payer Claims Database—though Amgen advertises a co-pay program promising insured patients can pay “as little as $0 out-of-pocket for each dose.”

Amgen responded by suing the state in March 2024—the first legal challenge to this broader concept—alleging this move was unconstitutional. On March 28, a judge ruled that the company lacked standing and threw the case out, creating a path for Colorado to continue with its board.

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