A Colorado Court Ruling Doesn’t End the Conversation About Drug Prices

By ALDP Co-founders Michael Glassner and Jason Young

This week, a federal court temporarily blocked Colorado from implementing a plan to lower what patients and health plans would pay for Enbrel, a biologic medicine used to treat rheumatoid arthritis, psoriasis, and several other autoimmune diseases.

The ruling is important, but it is also important to understand what it does – and what it does not.

Colorado’s approach relied on what state law calls an Upper Payment Limit, or UPL – a limit on what many health plans and other purchasers within the state could pay for a particular drug. The court has not issued a final decision on whether Colorado’s law is constitutional. It simply paused implementation of the state’s payment limit while litigation continues. 

There is an important difference between a legal setback for one policy approach and the much broader movement toward greater transparency and accountability in prescription drug pricing.

The affordability problem hasn’t gone away.

Enbrel illustrates why these conversations are happening across the country.

The drug’s list price exceeds $100,000 per year. Colorado found that commercial health plans actually paid about $53,000 per patient in 2023. Medicare has now negotiated a Maximum Fair Price of roughly $28,000 annually, and Colorado’s proposed payment limit closely mirrored that federal benchmark. That payment limit will not take effect for now because of the court’s ruling.

Think about what different Coloradans will experience. At least for the time being, Colorado’s seniors will benefit from the federally negotiated price. But working-age Coloradans are exposed to substantially higher costs for the very same medicine.

Whether one agrees or disagrees with Colorado’s legal approach, that disparity raises an important question of fairness.

Why should two patients living in the same community, taking the same medicine, face dramatically different prices simply because they have different insurance coverage?

That question did not disappear with this week’s ruling.

One lawsuit does not define every state approach.

It is also important to recognize that not every Prescription Drug Affordability Board works the same way.

The term “Prescription Drug Affordability Board” now encompasses at least three distinct models:

1. Some boards focus on transparency – collecting and publishing information that helps policymakers and the public understand what drives drug costs.
2. Others, like Colorado’s, conduct independent drug-specific affordability reviews and establish their own payment limits based on that analysis.
3. And a newer model would use Medicare’s own federally negotiated Maximum Fair Prices as the default benchmark for state payment limits. Minnesota has already codified this approach. Vermont and Oregon have both estimated that extending Medicare’s negotiated prices to their commercial markets would have saved tens of millions of dollars for patients and employers, with a significant share of those savings coming from Enbrel alone.

The legal questions raised by this week’s ruling would apply differently to each of these models. A state that independently reviews a drug and sets its own price faces different legal terrain than one that adopts a price the federal government has already negotiated. Courts can and must continue to work through these distinctions.

Just weeks ago, Louisiana enacted SB 401, creating a transparency-focused Prescription Drug Affordability Board that will identify high-cost medicines and gather information about pricing, research and development investments, public funding, and other factors that influence costs. Rather than setting prices, Louisiana’s board will provide a clearer picture of how drug prices are established and why they continue to rise.

Oregon’s transparency-focused board recently prevailed before the Ninth Circuit, allowing its work to continue.

These examples underscore a key point: “Prescription Drug Affordability Board” is not a single policy. Because the burden of high drug prices falls on patients, taxpayers, employers, and small business, states are testing different ideas, and courts are evaluating them on their own terms. That is exactly how our federal system is supposed to work.

Accountability is bigger than any one case.

At Americans for Lower Drug Prices, we have long believed that effective policymaking begins with facts.

Before legislators decide whether additional action is appropriate, they should understand how prescription drug prices are established, how they change over time, and how those prices affect patients, employers, taxpayers, and public programs.

That principle remains unchanged.

Americans continue to pay substantially more for many brand-name prescription drugs than patients in other developed countries. Employers continue to struggle with rising health care costs. State Medicaid programs continue to face difficult budget decisions. And millions of uninsured and underinsured Americans continue to face list prices they just can’t afford.

Those realities deserve thoughtful attention regardless of how any individual lawsuit is resolved.

In many ways, the Enbrel case shows how much the conversation has already evolved. More than ever, there is growing recognition that prescription drug pricing should not be a black box beyond public examination.

Effective movements learn from and adapt as new information emerges. That is what we are doing today, and it’s the strongest sign that our movement for accountability is maturing.

The legal questions deserve careful consideration. So do the patients who continue to struggle to afford the medicines they need.

ALDP’s work continues. Onward.