On October 3rd, Colorado’s Prescription Drug Affordability Board’s (PDAB) unanimously voted to set an Upper Payment Limit (UPL) on the expensive prescription medication Enbrel. This first-in-the-nation decision will help ensure that lifesaving medications are affordable for Coloradans.
With this innovative, precedent-setting action, Colorado is the first state in the country to set an Upper Payment Limit for a specific medication and other states are anticipated to follow. Colorado now leads the nation in the effort to keep money in the pockets of hardworking families by having a state board evaluate expensive medications and determine if the cost of those medications should be lowered to save money for hardworking Coloradans.
“This decision is a victory for hardworking Colorado families who have been stretched thin by the high cost of prescription medications,” said Laura “Pinky” Reinsch with Centennial State Prosperity. “By setting a fair upper payment limit on Enbrel, the PDAB is making sure Coloradans can keep more of their hard-earned money for groceries, housing, and other essentials. Families shouldn’t have to choose between their health and their financial security, and this action brings us closer to a Colorado where they never have to.”
The Prescription Drug Affordability Board set Enbrel’s Upper Payment Limit at $600 per 50mg/1ML unit ($30,356 per year). In 2023, the average insurance plan paid $53,049 for Enbrel. According to a recent report from Colorado’s PDAB, Enbrel costs Coloradans and their health plans over $83 million a year, with the average Coloradan paying $4,638 out of pocket per year. Of those surveyed in the report, 71% reported that the cost of Enbrel has made it difficult to access.
Medications don’t work if people can’t afford them. By limiting medication costs, Colorado patients can actually get the medicine their doctors prescribe and care for themselves and their families. When hardworking Coloradans can’t afford their medication, patients risk their conditions worsening and needing more serious medical interventions in the future, which drives up the cost of health care.