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Prescription Drug Affordability Review Board

Colorado Prescription Drug Affordability Review Board & Advisory Council

Colorado’s Prescription Drug Affordability Board (PDAB), established under Senate Bill 21-175, is a Type-1 Board within the Division of Insurance that will have the authority to review prescription drug costs and evaluate their impact on Coloradans. The Board may then recommend ways to address those costs and set an upper payment limit for certain drugs. The Board will appoint a multi-stakeholder Advisory Council to provide input to the Board to ensure its work is transparent and informed by a variety of stakeholders.

Applications for the Prescription Drug Advisory Council are currently open.

Prescription Drug Affordability Board (PDAB)

The Board will consist of five members who have both an advanced degree and experience or expertise in either health economics or clinical medicine. Board Members may not be employees, board members, or consultants to drug manufacturers, carriers, or pharmacy benefit managers, or their respective trade associations. The Governor, with the consent of the Senate, will appoint the Board by October 1, 2021. The Governor will designate one Board Member to serve as the Chair. Board meetings will be held every six weeks and term limits are staggered up to three years. 

Responsibilities of the Board
Under SB21-175, §10-16-1403, C.R.S, the Board has the following duties:

  • Collect and evaluate data on prescription drug costs to identify drugs that may be subject to an affordability review. 
  • Perform affordability reviews if certain drug costs triggers occur - including high wholesale acquisition costs and significant cost increases across various categories. The Board then determines whether a prescription drug is unaffordable for Colorado consumers by analyzing multiple factors set forth in statute.  
  • If a drug is found to be unaffordable, the Board may set an upper payment limit. The Board will not be able to set prices - the UPL caps the amount that in-state purchasers may pay for a drug, but does not impact the authority of manufacturers to set prices. 
  • Make policy recommendations to the General Assembly.
     

 

Board Member Requirements
  • An advanced degree and experience or expertise in health care economics or clinical medicine;
  • Must not be an employee, board member, or consultant of: a manufacturer or a trade association of manufacturers; a carrier or a trade association of carriers; or a pharmacy benefit manager or a trade association of pharmacy benefit managers.

Conflicts of Interest

  • Applicants shall disclose any possible conflict of interest and this may be considered in deciding to appoint an applicant to the Board.
  • Board members shall recuse themselves from any Board activity in any case in which they have a conflict of interest, and such conflicts of interest must be disclosed publicly and included in the report to the General Assembly.
  • Board members cannot accept financial benefits or gifts, bequests, or donations of services or property that suggest a conflict of interest or have the appearance of creating bias in the work of the Board.

 

 

Prescription Drug Advisory Council

The Board will appoint an Advisory Council to provide stakeholder engagement and input to the Board on prescription drug affordability. The Advisory Council will consist of 15 members with varied experience in health care. To the extent possible the Board shall appoint members who have experience serving underserved communities and who reflect the state’s diversity in terms of race, immigration status, income, disability, age, gender identity, and geography. Advisory Council meetings will be held every 3 months.

Council members must have knowledge of at least one of the following subject matters:

  • The pharmaceutical business model
  • Supply chain business models
  • The practice of medicine or clinical training
  • Health care consumer or patient perspectives
  • Healthcare cost trends and drivers
  • Clinical and health services research
  • The state's health care marketplace

 

Advisory Council Makeup

One council member is to be the Executive Director of HCPF or their designee. The Board will appoint the remaining 14 members and will meet the following requirements:

  • 2 health care consumers or who represent consumers 
  • 1 representing a statewide health care consumer advocacy organization
  • 1 representing consumers with chronic diseases  
  • 1 representing a labor union
  • 1 representing employers
  • 1 representing carriers
  • 1 representing pharmacy benefit managers
  • 1 representing health care professionals with prescribing authority
  • 1 employed by an organization that researches prescription drugs, including pricing information research
  • 1 representing manufacturers of brand name drugs
  • 1 representing manufacturers of generic drugs
  • 1 representing pharmacists
  • 1 representing wholesalers
  • 1 must be on eastern plains
  • 1 must be on western slope
  • Attempt to appoint members from each congressional district

Conflicts of Interest

  • Applicants shall disclose any possible conflict of interest.
  • The Board may consider such conflicts in deciding to appoint an applicant to the Council.
  • The Chair of the Council must report to the Board any conflicts of interest of the Council and these must be disclosed publicly.
     

 

Individuals interested in serving on the Advisory Council are highly encouraged to apply no later than November 15th.

Apply for the Advisory Council

Meeting Information

The Prescription Drug Affordability Board, in accordance with statute, will hold regular meetings every six weeks beginning November 12, 2021. All meetings are open to the public except portions of the meeting in which confidential information may be discussed. There will be opportunity for public comment at Board meetings. 

The Advisory Council will hold public meetings every 3 months and will allow for public comment.

Board and Advisory Council registration information, meeting agendas and minutes will be posted regularly. 

Please check this site regularly for Board & council meeting updates. 
 

FAQs

A type-1 Board within the Division of Insurance that is able to:

  • Collect and evaluate data;  
  • Review particularly costly drugs and  determine whether or not they are affordable for Colorado consumers; 
  • Establish upper payment limits (UPL) for drugs purchased in Colorado, when appropriate; 
  • Make policy recommendations aimed at improving prescription drug affordability for Coloradans. 

As prescription drug prices continue to skyrocket, Coloradans are struggling to afford the medications they need. On average 1 in 10 Coloradans are estimated to have skipped doses due to struggling with costs, rising to almost 1 in 5 in Pueblo. A prescription drug affordability board will give Colorado an avenue to address these high costs and help ensure consumers can access the medications they need, when they need them. An affordability board will bring together diverse stakeholders, improve transparency, and address the cost of drugs for Coloradans. 
 

The Board will be made up of five members with expertise in health care economics and clinical medicine. The Board will be supported by a staff and a stakeholder council of industry experts, and provide robust opportunities for public comment. Board Members will be unpaid and will recuse themselves from matters where they have a conflict of interest. The Board will operate with the express task of bringing transparency to drug costs and helping Coloradans afford the drugs they need. 
 

The Board will not be able to set prices. An upper payment limit (UPL) is a limit on what purchasers within the state of Colorado will be able to pay for specific drugs identified by the Board; it will not take away the power of payers and drug manufacturers to negotiate below the limit or for drugs outside the Board’s purview. 
 

There are certain statutory triggers that start the process of reviewing a specific drug. These triggers include high list prices and significant price increases that vary by drug category. These reporting triggers allow the Board to start an investigative process where they collect information, evaluate data, and discuss whether or not the drug is affordable for consumers in Colorado. The affordability review may result in the Board taking action, or not, depending on the specific circumstances of each drug reviewed
 

The Board will have the ability to evaluate any publicly available information on prescription drug costs that already exists in Colorado and in other states. Additionally, the Board may request information directly from manufacturers, carriers, or pharmacy benefit managers.

Proprietary information is protected from public disclosure. The Board will be able to go into executive session when discussing proprietary information. 
 

Questions about the Prescription Drug Affordability Board and Advisory Council can be sent to dora_ins_pdab@state.co.us.