Executive Summary

On February 16, 2024, the Colorado Prescription Drug Affordability Board (PDAB) held a meeting to vote on whether Enbrel and Genvoya are unaffordable (link). Notably, the Board voted unanimously that Enbrel is unaffordable.

ADVI Angle

Summary

The Board voted unanimously (4-0) that “the use of Enbrel, consistent with the labeling approved by the FDA or with standard medical practice, is unaffordable for Colorado consumers,” meaning that the PDAB can move forward with setting an Upper Payment Limit (UPL) for the drug.
This is the first time a PDAB with UPL authority has deemed a selected product unaffordable. On February 23, 2024, the CO PDAB will vote on whether to subject Enbrel to a UPL. If they choose to do so, they will then move forward with determining what the UPL will be set at.
If implemented, the UPL will govern what purchasers can pay and state-regulated payers can reimburse for prescriptions dispensed or administered to individuals in the state. The UPL would be optional for self-insured health plans regulated under the Employee Retirement Income Security Act of 1974 (ERISA).
In contrast, the Board voted unanimously (4-0) that “the use of Genvoya, consistent with the labeling approved by the FDA or with standard medical practice, is not unaffordable for Colorado consumers,” meaning that the PDAB cannot move forward with setting a UPL for the drug.
Notably, Board members stated that available patient assistance programs for patients using Genvoya helped make the drug “not unaffordable”. At its December 2023 meeting, the PDAB also used availability of patient assistance programs as one of the reasons it voted that Trikafta is “not unaffordable”.

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