Colorado Becomes First State to Limit Price of a Specific Drug

By Marissa Ventrelli | Colorado Politics

Colorado became the first state in the nation to set a price cap on a specific medication last week, following a unanimous decision by the Prescription Drug Affordability Review Board to limit the cost of a drug used to treat inflammatory conditions.

On Oct. 3, the board voted to set an Upper Payment Limit, or UPL, of $600 per 50mg unit of Enbrel, an injectable medication used to treat conditions like rheumatoid arthritis, ankylosing spondylitis, and plaque psoriasis. That comes out to about $30,000 a year, more than $20,000 less than the average insurance plan paid for the drug per person in 2023, according to the Colorado Consumer Health Initiative.

“This decision is a victory for hardworking Colorado families who have been stretched thin by the high cost of prescription medications,” said Pinky Reinsch of 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.”

Pharmaceutical Research and Manufacturers of America, a trade organization that has opposed upper payment limits, said the board failed to address the “operational and compliance charges” hospitals and insurers will face as a result.

“Instead of fixing the root causes of patient affordability concerns, the board has rushed into a reckless experiment,” said Reid Porter, a PhRMA spokesperson. “Colorado’s decision to set an Upper Payment Limit by copying the federal government’s so-called ‘maximum fair price’ model fails to address the real drivers of what patients pay out-of-pocket. Instead, Colorado is risking patient access and jeopardizing the development of new medicines – similar to how Medicare beneficiaries are facing fewer options, more treatment denials and higher costs under the Inflation Reduction Act. Mimicking this flawed model will not safeguard patient access and affordability from these abusive practices by middlemen.”

According to a health initiative poll, 51% of Coloradans report being concerned about affording prescription medication. From 2014 to 2024, prescription drug prices increased by nearly 40%, according to a report by GoodRx.

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