State Round-up Part 1: States Are Moving Forward on Drug Affordability
By ALDP Co-Founders Michael Glassner and Jason Young
The new year has brought momentum in the state-level fight for prescription drug affordability. Last week, Virginia’s Senate Commerce and Labor Committee advanced legislation to create a Prescription Drug Affordability Board – showing states aren’t waiting for Washington to act on rising drug costs.
Virginia joins a growing list of states moving forward on drug affordability this legislative session. Hawaii introduced PDAB legislation in January. Maine Governor Janet Mills signed a bill strengthening its existing board, expanding its authority to protect patients. And in Maryland, the state’s PDAB has progressed from its initial rulemaking phase to identifying its first drugs for cost review (Jardiance and Farxiga) – a critical step from planning to action.
This state-level progress matters for three reasons.
First, states are where patients and taxpayers experience high drug prices. When a manufacturer sets an unsustainable price, state Medicaid programs, state employee health plans, and residents and small businesses bear the cost. States have both the motivation and authority to act.
Second, states move faster than Congress. While federal policy debates stretch across election cycles, state legislatures meet annually, respond to constituent pressure, and implement solutions in months rather than years.
The manufacturer of Enbrel – a medication for autoimmune diseases like rheumatoid arthritis – increased its price by 1,582% since FDA approval. In response, Colorado’s Prescription Drug Affordability Board capped Enbrel’s price in February 2024. That was historic. Medicare’s negotiated price for Enbrel took effect only this Jan. 1 – nearly two years after Colorado’s action, and only after decades of advocacy to secure negotiation authority State action deliver results while federal processes work on longer timelines.
Third, state solutions address problems federal policy doesn’t fully solve. Medicare’s new negotiation authority achieved a 67% price reduction for Enbrel for seniors – a big win. But this January, Enbrel’s manufacturer raised the drug’s list price by 5%, outpacing inflation. State affordability boards can set upper payment limits that protect taxpayers and all residents, not just seniors. When Colorado acts, it protects Coloradans. When more states act, more patients get relief.
The contrast is instructive.
States have long served as what Supreme Court Justice Louis Brandeis called “laboratories of democracy,” or testing grounds for different approaches to solving shared problems. PDABs are one important tool. Last year, California became the 29th state to cap insulin prices. This year, Oklahoma is considering similar legislation.
Meanwhile, other states are taking a different path restricting pharmacy ownership in ways that could reduce access to pharmacies, particularly in rural areas, and raise patients’ transportation and time costs. We’re watching these bills closely, because policies that close pharmacies without making drugs more affordable leave patients worse off. We believe our country needs every type of pharmacy serving patients today – independent retail, chain retail, specialty, and mail-order pharmacies. Closing down entire categories of pharmacies doesn’t solve the affordability problem; it creates access problems while leaving manufacturer pricing power untouched. We’ll cover this in Part 2 of our state round-up this week.
For patients struggling with prescription costs, state action isn’t abstract policy. It can be the difference between affording treatment and going without.
The laboratory of democracy is working. States are testing solutions, learning from each other, and moving forward. That’s what patients need – and in Part 2, we’ll examine why some states are moving in the wrong direction.
If you want to learn about the status of a Prescription Drug Affordability Board in your state, click here.