Several states have established Prescription Drug Affordability Boards (PDABs), which are independent, state-level boards that review prescription drug costs, and in some states, have authority to impose upper payment limits (UPLs) on medicines deemed “unaffordable.”[1]
UPLs introduce significant risks to the biopharmaceutical innovation ecosystem. By capping reimbursement rates, PDABs impose government price controls at the state level, creating uncertainty for manufacturers and investors that can discourage investment in high-risk research areas, delay launches, and ultimately reduce patient access to groundbreaking therapies. UPLs are also predicted to cause greater utilization management and/or placement of selected drugs onto different formulary tiers, which would detrimentally affect patient access.[2]
Patients, clinicians, and manufacturers alike have emphasized the risk that UPLs will reduce access to medicines without guaranteeing meaningful savings for patients.[3] Approximately 86 percent of patients have expressed concern that UPLs will create artificial administrative barriers to accessing their preferred treatment options, particularly given an observed PDAB prioritization of cost savings over clinical necessity.[4] Physicians have further expressed concern regarding a lack of PDAB engagement with medical professionals, which may result in pricing decisions that unintentionally entrench health disparities among underserved populations.[5]
State PDABs have faced legal challenges arguing that their actions are unconstitutional, inconsistent with federal law, or violate state law. Amgen has sued the Colorado PDAB in federal court in Colorado, challenging the selection and imposition of a UPL on its drug, Enbrel.[6] The UPL was set by the Colorado PDAB at $600 per unit on October 3, 2025 and will enter effect on January 1, 2027.[7] The UPL was specifically chosen to be just slightly higher than the Inflation Reduction Act Medicare Drug Negotiation Price for Enbrel, which is $583.59.[8] Other states with UPL authority include Minnesota, Maryland, and Washington.
[1] H. Rogers, “State Regulation of Prescription Drug Prices; Prescription Drug Affordability Boards and Related Litigation,” Congressional Research Service LSB11221 (Sept. 4, 2024).
[2] J. Patterson et al., “Unanswered questions and unintended consequences of state Prescription Drug Affordability Boards,” Health Affairs (June 5, 2024).
[3] B. Brent, “Prescription Drug Affordability Boards: a flawed approach to equity and access,” Health Affairs (Sept. 21, 2025).
[4] Id.
[5] Id.
[6] Amgen v. Colorado Prescription Drug Affordability Review Board, 1:24-cv-810 (D. Colo.).
[7] Amgen v. Mizner, 1:25-cv-3452 (D. Colo.), Complaint (Dkt. 1) at 28.
[8] Id.