Conway details Colorado’s Prescription Drug Affordability Board plan

Conway details Colorado’s Prescription Drug Affordability Board plan

September 15, 2021 Off By administrator

Colorado Insurance Commissioner Michael Conway gave an overview the state’s plan for implementing the recently passed Prescription Drug Affordability Board (PDAB) at a recent webinar hosted by the Colorado Department of Health Care Policy and Financing (HCPF).

The heavily debated SB 21-175 creates an affordability board to review the prices of prescription drugs in the state and establish upper payment limits (UPLs) for medications deemed to be too expensive. The board will collect and evaluate data from drug manufacturers and other stakeholders to make informed decisions about which prescription drugs are too expensive for consumers. It can also make policy recommendations to the legislature based on its findings.



See below the Division of Regulatory Agencies (DORA)’s timeline for implementing the board.


Image: Colorado Department of Regulatory Agencies (DORA)


Establishing UPLs is the board’s most important role, Conway said. Beginning in April 2022, for the first three years of its existence, the board can place up to 12 UPLs on 12 prescription drugs. After this, the board won’t be restricted to 12 UPLs per year, but Conway believes the yearly number will continue to be around 12.

The board will have five members, each of whom must have an advanced degree and relevant experience in health care economics or clinical medicine. These members are appointed by the governor, who will appoint one member as the “chair” of the board.

The bill also creates a 15-member Advisory Council to provide stakeholder input to the board. These members are appointed by the board, and will consist of HCPF Executive Director Kim Bimestefer and 14 other community stakeholders including a labor union representative, a health care consumer advocacy organization representative, and a pharmacy benefit management firm representative.

Conway said:

“ … because Kim is going to be on it, because HCPF’s tools are going to be available to that advisory board, I think that the information and the advice that the [council] is able to give to the PDAB — the actual board itself — is going to be vital.”

Applications for both the PDAB and the Advisory Council opened on Aug. 6, 2021. The governor must appoint the five PDAB board members by Oct. 1, 2021 (subject to Senate approval), and the board must appoint the 15 council members no later than Jan. 1, 2022.

Conway highlighted that Colorado’s affordability board has a broader jurisdiction than those of other states. While UPLs in other states only apply to “narrow subsets” of prescriptions, such as state employee plans, Colorado’s will apply to all purchases of and payer reimbursements for prescription drugs dispensed to Coloradans.

Conway explained why he thought the legislature made the “right decision” in granting the board such broad authority:

“I think it’s really tough to tell folks within the commercial market … that the state employee plan…

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