Colorado PDAB Wants More Rebate Info, Patient Input, Lower Cost Thresholds

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By Luke Zarzecki / July 23, 2024 at 3:58 PM

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Colorado’s prescription drug affordability board (PDAB) recommends the state legislature take steps to strengthen consumer input, change eligibility thresholds and include more rebate data in the board’s process of reviewing prescription drugs in a report on its 2023 activities released this month.

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Colorado’s PDAB has made the most progress among the boards state governments have set up to deal with high drug costs, with Amgen’s Enbrel, Janssen Biotech’s Stelara and Novartis’ Cosentyx as the first three medications to be considered for upper payment limits in the state and the country. Colorado’s PDAB voted in February to consider a UPL for Amgen’s Enbrel; the company filed litigation in a Colorado federal district court arguing the actions were unconstitutional.

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Colorado state law requires the PDAB to submit an annual report to the governor and the general assembly. Among other changes, the report calls for a pathway patients can use to submit drugs for consideration.

“The Board recommends the General Assembly consider revising section 10-16-1406(1), C.R.S. to allow for consumers to identify prescription drugs for consideration for affordability reviews, recognizing that some parameters regarding this process could and should be established, either in law or in regulations,” the report says.

The PDAB recommends patient voices be heard earlier in the affordability review process. The report says the board discussed the possibility of including a consumer representative but said the PDAB did not come to an agreement.

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“The majority of Board members did not agree with this recommendation, as the Board reviews a widely disparate group of prescription drugs which require a high level of medical expertise,” the report says. “Board members highlighted the role of the Advisory Council in gathering consumer input as well as the many other opportunities for consumers to share their experiences and expertise.”

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Colorado Governor Jared Polis (D) signed a bill into law in June that would require the PDAB to consider input from the Colorado rare disease advisory council in determining which drugs are unaffordable for patients in the state and in setting potential payment limits. The new state law comes after a pared- back version of a bill would have nixed the board from considering orphan drugs all together.

The board also recommends reducing the eligibility threshold from a price of at least $30,000 a year for a drug and replacing it with a different, lower threshold after more research and discussion. It says the board also wants to identify drugs that impact the largest number of patients based on indication.

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As for rebates, the board hopes to have more information regarding existing and available rebate data from carriers. Colorado PDAB Director Lila Cummings previously said the board received data from SSR Health to estimate rebates when it discussed affordability for Enbrel.

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The Biotechnology Innovation Organization and the Colorado BioScience Association, in a public comment letter submitted for the PDAB’s July 3 meeting, pointed to a May 2021 Congressional Research Service report that found patients receive rebates from manufacturers.

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“In fact, insurers require patients to pay proportionately almost five times more out-of-pocket for prescription drugs than for hospital care. In addition, despite receiving significant rebates from manufacturers, “commercially-insured patients pay undiscounted list prices on one in five prescription brand name drugs, accounting for more than half of out-of-pocket spending on brand medicines,” the letter says. -- Luke Zarzecki (lzarzecki@iwpnews.com)​​