As the\u00a0federal government negotiates\u00a0<\/u><\/a>with drugmakers to lower the price of 10 expensive drugs for Medicare patients, impatient legislators in some states are trying to go even further. Leading the pack is Colorado, where a new Prescription Drug Affordability Review Board is set to recommend an \u201cupper payment limit\u201d for drugs it deems unaffordable.<\/p>\n

In late February the board selected Enbrel,\u00a0Amgen<\/strong>\u2019s blockbuster drug for autoimmune conditions (list price\u00a0$1,850<\/strong>\u00a0per week), as\u00a0the first medication that would go through its process<\/u><\/a>.\u00a0Novartis<\/strong>\u2019s Cosentyx and\u00a0Johnson & Johnson<\/strong>\u2019s Stelara (both treat autoimmune conditions) will undergo affordability reviews later this year.<\/p>\n

Enbrel and Stelara are also on the\u00a0<\/strong>list of drugs<\/u><\/strong><\/a>\u00a0whose prices the federal government is negotiating \u2014 but only for Medicare patients<\/strong>. Prices may be published Sept. 1 \u2014 in time for President Biden to cheer the results in his reelection campaign. But they won\u2019t take effect until 2026, while the drug industry pursues a raft of lawsuits to stop the initiative.<\/p>\n

Colorado\u2019s plan is, in many ways, both broader and more prescriptive than the feds\u2019, covering all patients and potentially fixing an upper price limit rather than squabbling with the industry over an acceptable figure.<\/p>\n

Colorado\u2019s government said it anticipates similar litigation<\/strong>. A spokesperson for the state\u2019s Division of Insurance, which oversees the program, declined to make anyone available for an interview.<\/p>\n

The\u00a0Pharmaceutical Research and Manufacturers of America<\/strong>, the industry\u2019s main trade group,\u00a0said in a blog post<\/u><\/a>: \u201cPolicymakers in Colorado have created a system in which patients may face significant barriers to lifesaving medicines because of government price setting.\u201d<\/p>\n

The state has already said\u00a0<\/strong>604 drugs<\/u><\/strong><\/a>\u00a0met the first criteria to undergo an affordability review<\/strong>. The full list of drugs is linked from the board\u2019s webpage, along with a list \u2014 in order \u2014 of those it has slated for priority review.<\/p>\n

The Colorado board will spend the summer setting upper payment levels for drugs selected for price reviews. Drugmakers can then appeal.<\/p>\n

The board plans to examine how manufacturers price \u2014 and raise prices \u2014 for drugs. For generics, the board\u2019s director,\u00a0Lila Cummings<\/strong>, said at a Feb. 23 meeting, the criteria could include whether the price paid by wholesalers before discounts has increased at least 200 percent in the past year and whether a 30-day supply costs more than\u00a0$100<\/strong>. Branded drugs that cost more than\u00a0$30,000\u00a0<\/strong>a year or whose wholesale price has increased at least\u00a010 percent<\/strong>\u00a0in the past year could land in the board\u2019s sights, as could biosimilars that aren\u2019t at least\u00a015 percent<\/strong>\u00a0cheaper than the brand-name biologics they\u2019re intended to replace, Cummings said.<\/p>\n

The five-member board, appointed by Gov.\u00a0Jared Polis\u00a0<\/strong>(D), includes\u00a0two medical doctors, two pharmacists and a hospital executive<\/u><\/a>. A 15-member advisory council includes patient advocates, insurers, pharmacists and representatives of drug manufacturers.<\/p>\n

The Colorado law creating the board set out\u00a0a lengthy process<\/u><\/a>\u00a0for any drugmaker that decides to withdraw its product from the state over the price caps. (Note that the state is also\u00a0exploring importing<\/u><\/a>\u00a0cheaper drugs from Canada, without much success so far.)<\/p>\n

More than a dozen\u00a0<\/strong>states\u00a0<\/u><\/strong><\/a>are attempting to rein in drug prices<\/strong>\u00a0through a variety of tactics. It\u2019s early in U.S. regulators\u2019 work to control drug prices, and it\u2019s unclear whether the federal or state efforts will prevail.\u00a0<\/p>\n

What is clear is that patients need some relief:<\/strong>\u00a0Over\u00a030 percent\u00a0<\/strong>of adults report not taking medications as prescribed because of costs, and\u00a01 in 5<\/strong>\u00a0didn\u2019t fill a prescription,\u00a0according to KFF survey results published in August<\/u><\/a>.<\/p>\n

\n
This article is not available for syndication due to republishing restrictions. If you have questions about the availability of this or other content for republication, please contact NewsWeb@kff.org<\/a>.<\/em><\/p>\n
\n
\n
\n\t\t\t\t\t\t\t\t\t\t\tElisabeth Rosenthal: <\/span>
\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t erosenthal@kff.org<\/a>,\t\t\t\t\t\t\t\t\t\t\t
\n\t\t\t\t\t\t\t@RosenthalHealth<\/a>\n\t\t\t\t\t\t\t\t\t<\/p>\n<\/aside>\n
\n
\n
\n\t\t\t\tRelated Topics\t\t\t<\/h3>\n
\t\t\t\t
\n\t\t\tContact Us\t\t<\/a>
\n\t\t
\n\t\t\tSubmit a Story Tip\t\t<\/a>\n\t<\/div>\n<\/section><\/div>\n