Colorado's Prescription Drug Affordability Board: Political Decisions Over Patient Needs

The Colorado Prescription Drug Affordability Board (PDAB) is facing scrutiny for its recent decision regarding upper payment limits (UPLs) that could harm patients' access to crucial medications. Bridget Dandaraw-Seritt, an advocate for patients and founder of Advocates for Compassionate Therapy Now, shared her concerns through an Op-Ed highlighting the severe challenges posed by UPLs, particularly concerning the biologic drug Enbrel, used to treat moderate to severe rheumatoid arthritis.

The Dangers of Upper Payment Limits

Dandaraw-Seritt's Op-Ed outlines the dangers associated with UPLs, which, while intended to make drugs more affordable, may inadvertently restrict access to life-saving treatments. The PDAB set an upper payment limit for Enbrel based on the Medicare Part D maximum fair price (MFP), which is set to take effect in January 2026. The ramifications of this decision could be profound, especially for patients who rely on consistent access to their medications.

Patients, healthcare providers, and other stakeholders had previously alerted the Colorado government about the risks associated with such limitations. Their concerns were grounded in the potential for increased out-of-pocket expenses as plans adjust reimbursements based on the imposed limits. Dandaraw-Seritt notes that despite being informed about these risks, the PDAB proceeded with a decision that seems politically motivated rather than rooted in patient care.

Impact on Patient Access

The Colorado PDAB's decision to tie Enbrel's pricing to the MFP was framed as a measure to steer pricing down. However, critics argue that it does little to alleviate the financial burden on patients, who typically pay a minimal copayment for the medication. Mike Eging, the Executive Director of the Rare Access Action Project (RAAP), stated that this approach may lead insurers to switch patients to alternative treatments, which could lack the desired efficacy and come with their own risks.

Moreover, many patients facing rare diseases already deal with barriers to care and treatment access. The PDAB’s reliance on a politically-driven reimbursement model neglects the unique challenges these patients encounter daily. By prioritizing a one-size-fits-all policy, legislators risk overlooking the nuances necessary for effective healthcare solutions.

The Call for Compassionate Policy

Dandaraw-Seritt's organization, Advocates for Compassionate Therapy Now, was founded with the aim of connecting and educating patients on their treatment options while fostering support within the community. Their work, lauded by various advocates, underscores the importance of centering patient needs in policy decisions, rather than letting politics dictate lifesaving drug accessibility.

In response to the limitations imposed by Colorado’s PDAB, RAAP urges lawmakers to reconsider their approach, particularly regarding upper payment limits that could impact the most vulnerable. The organization emphasizes that while financial responsibility discussions are essential, they should not come at the expense of patient health and access to medications.

Conclusion

The ongoing debates surrounding drug affordability highlight a critical intersection between politics and healthcare. The Colorado PDAB's recent actions serve as a stark reminder of the potential dangers inherent in policy formulations that prioritize economic considerations over patient access to care. Dandaraw-Seritt’s message, supported by RAAP, calls for compassionate leadership and a commitment to ensuring that all patients can receive the treatments they need without financial barriers. As these discussions continue to unfold, advocates remain steadfast in their pursuit of equitable healthcare access for all individuals battling rare diseases and chronic conditions.