Colorado sets first-in-the-nation price ceiling on a prescription drug

Colorado became the first state in the country Friday to set a maximum price that insurers and patients can pay for a prescription medication a move that s likely to face lawsuits The state s Prescription Drug Affordability Board voted to set a maximum price of for milligrams of the arthritis drug Enbrel Adults typically take that dose weekly for an annual maximum price of about Kids with juvenile arthritis take about half that amount putting their maximum at roughly As of insurance companies in Colorado paid an average of about a year for each customer using Enbrel Patients paid about annually out of pocket on average for the medication The drug treats six autoimmune conditions which involve the immune system attacking joints skin and other tissues The board set its price based on Medicare s maximum fair price of about which is the price the federal Centers for Medicare and Medicaid Services offered as part of price negotiations By law CMS has to consider the cost of producing the drug whether the manufacturer has recouped its financing to develop the medication how much federal patronage it received for maturation and sales information among other factors Last year the board voted to deem Enbrel unaffordable setting up a months-long process of determining whether it should set a price ceiling and if so how low it should be The board revealed the drug s wholesale price had increased more than since it debuted in and about over the previous five years Amgen which makes Enbrel sued the state following the board s decision last year A federal judge threw out the lawsuit in March finding the company hadn t proven it would suffer any harm Amgen would have to show that the maximum the state will allow insurers to pay is low enough that the wholesalers the drugmaker sells to would need to pay less Judge Nina Wang ruled Now that the state has set a price Amgen could sue again and argue that the price is too low Related Articles A multitude of of Colorado s federal civilian workers in limbo amid shutdown but constituents lands are open Autism therapy providers sue Colorado s Medicaid agency over prior authorization As Trump punts on therapeutic debt battle over victim protections moves to states Pfizer agrees to lower prescription drug costs for Medicaid in a deal with Trump Family sues Denver s Eating Recovery Center for allegedly ignoring suicidal thoughts Rae Wall of Denver recounted the board Friday that a price ceiling would ease stress on her family and others with chronic illnesses I m all too familiar with what it is like to struggle to afford lifesaving drugs having to decide whether or not I spend my grocery budget for the entire month on a refill she announced The Pharmaceutical Research and Manufacturers of America called the upper payment limit a reckless experiment that wouldn t address the drivers of high costs for patients Colorado is risking sufferer access and jeopardizing the progress of new medicines similar to how Medicare beneficiaries are facing fewer options more remedy denials and higher costs under the Inflation Reduction Act spokesman Reid Porter announced Mimicking this flawed model will not safeguard case access and affordability from these abusive practices by middlemen While drug companies have raised concerns about access no one knows if they would indeed cut off sales to one state particularly if the maximum price is still higher than the cost to produce the medication That cost information is proprietary so the inhabitants can t compare it to the upper payment limit What an individual pays for medications depends on their insurance plan A few plans require a flat copay and people with that type of coverage likely won t see any change in their out-of-pocket costs Others require their customers to pay a percentage of the cost of their medication In those cases patients could see their costs go down Sign up for our weekly newsletter to get wellbeing news sent straight to your inbox