State drug-pricing boards are gaining momentum

Prescription drug coverage, once a modest 3% of your health plan premium in the 1990s, now accounts for nearly 25%. The question is, how much further will it climb?

One potential solution gaining traction is states taking a cue from the federal government by creating their own initiatives to control prescription drug costs. Some states are establishing boards to assess drug affordability and, in certain cases, implementing "Upper Price Limits" (UPLs) that cap what manufacturers can charge for their medications within the state.

But is it legal? And will it work?

Colorado recently made a significant move in favor of consumers by challenging biopharmaceutical giant Amgen over its pricing for Enbrel, a drug used to treat autoimmune disorders like rheumatoid arthritis. Amgen charged uninsured patients around $8,000, insured patients up to $46,000, and offered some patients a $0 copay through its website. In response, Colorado set a UPL, which prompted Amgen to sue. On March 28, a judge ruled that Amgen had no standing in the case, marking a win for the state.

While this ruling is seen as a victory for consumers, some patient advocacy groups caution that it may not be a silver bullet. Lower UPLs could prompt manufacturers to pull certain drugs from the market in those states or reduce patient assistance programs to compensate for lost revenue.

Nevertheless, it’s a positive step toward addressing one of the largest contributors to rising insurance premiums.

Check out the full article from Caroline Catherman HERE