Presentation (CTI)

OBJECTIVES: State-level prescription drug affordability boards (PDABs) and the Centers for Medicare & Medicaid Services have spent years developing methods for reducing prescription drug costs. In 2024, several programs conducted their first analyses and published results. This analysis aimed to review their methodologies and compare the first set of published outcomes.
METHODS: Building upon previous research, data on drug eligibility criteria, affordability review selection criteria, and affordability review progress were extracted from publicly available PDAB materials. Findings were compared between state PDABs.
RESULTS: As of January 2025, eleven states have established a PDAB or a similar entity. In addition to states with “affordability review” PDABs with the authority to set upper payment limits (UPLs) for payers and “strategic” PDABs, which propose spending targets and policies, New York and Massachusetts have been authorized to use affordability reviews and direct negotiations with drug manufacturers to attain supplemental rebates. State PDABs, particularly affordability review PDABs, have had mixed progress to date. Colorado’s PDAB developed specific criteria for evaluating each drug through the evaluation process, selecting five drugs for full analysis. Board members of Maryland’s PDAB proposed drugs for consideration from a list of eligible drugs, collecting stakeholder input, with ongoing analysis. Other PDABs are still continuing their reviews, while Oregon’s PDAB, after initiating the review process, voted unanimously to pause reviews in 2024 to collect further information. Colorado’s PDAB and CMS, despite focusing on different drug pricing programs, both selected branded etanercept and ustekinumab for negotiation or analysis. Other overlaps have been identified with Maryland and Oregon, but analyses by the boards are incomplete.
CONCLUSIONS: Affordability review PDABs, along with CMS, have begun sharing reports following the first round of drug price reviews. The real-world impact of these findings will need to be monitored going forward as these and other states begin reviewing additional drugs.