MEDIA RELEASE
Oct. 3, 2025
Consumer advocates praise Prescription Drug Affordability Board’s decision to set first-in-nation Upper Payment Limit on the expensive drug Enbrel
DENVER – A group of consumer advocates celebrated the Colorado Prescription Drug Affordability Board’s (PDAB) unanimous decision to set an Upper Payment Limit (UPL) on Enbrel. This first-in-the-nation decision will help ensure that lifesaving medications are affordable for Coloradans.
The UPL was set at $600 per 50mg/1ML unit (approximately $30,356 per year); the average insurance plan paid $53,049 for Enbrel per person in 2023. This UPL represents the maximum annual price insurers or patients can pay for Enbrel in Colorado and was set at the same level as the Maximum Fair Price (MFP) that has been negotiated at the federal level with manufacturers for use in Medicare Part D.
Colorado is the first state in the country to set an Upper Payment Limit for a specific medication. This is an innovative, precedent-setting action that other states can and should follow. Colorado is leading the nation in the effort to keep money in the pockets of hardworking families by utilizing a new tool to reduce costs for consumers.
Over half of Coloradans reported being worried about being able to afford their prescription drugs in 2024. That’s why Colorado created a PDAB in 2021 to evaluate the affordability of the most expensive prescription drugs and, if unaffordable for consumers, set an upper payment limit to ensure Coloradans can afford them.
Enbrel was deemed “unaffordable” by the board in 2024. According to their previous report, over $83 million was spent on Enbrel by patients and insurers in Colorado in 2023. Of those surveyed in the report, 71% reported that the cost of Enbrel has made it difficult to access.
Statements from supporting organizations:
“Affordability is a primary barrier to access,” said Sophia Hennessy, Lead Policy Research Coordinator of the Colorado Consumer Health Initiative. “The PDAB is working hard to save Coloradans money on the highest cost prescription drugs. This groundbreaking upper payment limit on Enbrel has the potential to save $32 million from drug spending. We’re thrilled with the Board’s decision today that helps ensure more patients can afford their vital medications.”
“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,” said Rae Wall, a Denver resident. “Living with chronic illness is a full-time job. Spending hours on the phone with patient assistance programs, pharmacies, and arguing with insurance to justify coverage. I brace myself every time I walk into a pharmacy, just in case a new prescribed medication is too expensive for me to take. That’s why setting an Upper Payment Limit on Enbrel is so important, it will ease the financial burden for families like mine.”
“Over the past decades, taxpayers have contributed billions of dollars to drug development,” said Bethany Pray of the Colorado Center on Law and Policy. “Enbrel’s manufacturer relied on that public investment, but established a pricing scheme that puts the drug out of reach for many Coloradans, and raises the costs of our health insurance premiums. Thanks to the careful, deliberate work of our Prescription Drug Affordability Board, Coloradans will pay less and take a first step toward reaping the benefit of those decades of investment.”
“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.”
“Runaway prescription drug prices are crushing small businesses like mine, driving health premiums higher every year and forcing us into impossible choices that hurt both employers and employees,” said Masaru Torito, Owner of Kokoro Restaurant and member of the Small Business for America’s Future Advisory Council. “Colorado’s Prescription Drug Affordability Board is a lifeline. By limiting what we can pay for high cost drugs, they are taking meaningful action to reduce health care costs. This work sends a clear message: Colorado is stepping up to protect small businesses and families from skyrocketing prescription drug prices.”
“We all know health care prices are rising faster than paychecks. We also know treating medical conditions early reduces costs in the long run,” said Mark Longshore, Executive Director of the Colorado Nurses Association. “Pricing medications beyond the reach of consumers – even those who have health insurance – will lead to higher healthcare costs when people choose to spend money on their housing or food rather than on their medication, kicking – and increasing – the costs down the road. Setting a reasonable upper payment limit for Enbrel and other high-cost medications will reduce health insurance premiums, increase patient compliance, and lead to lower health care costs.”
“This is a great victory for patients in Colorado, because what good are medications to patients if we can’t afford to access them? Affordable drugs save lives,” said Laura Packard, founder of Voices of Health Care Action.
“Capping prescription drug costs is a win for small businesses. Our research found 60% of small businesses that offer health coverage to their employees reported that the cost of prescription drug copays has increased in recent years,” said Hunter Nelson, Colorado Director of Small Business Majority. “The rising cost of medications along with ballooning insurance premiums and other medical expenses have forced many entrepreneurs to make changes to their healthcare offerings including increasing employee contributions to health plans, shifting to an insurance plan offering more limited coverage and cutting other employee benefits. No small business owner wants to make these choices in part because it’s bad for themselves and their employees — but also because it’s bad for their business. While larger companies can more easily absorb costs and continue to offer strong employee benefits, small businesses often can’t, causing them to miss out on top talent. Given the link between healthcare costs and small business success, Colorado must continue to do everything it can to help reduce healthcare expenses for small firms.”
“High drug prices hit young people from marginalized communities the hardest, forcing too many to forgo the care they need,” said Melanie Kesner, Rocky Mountain Regional Director of Young Invincibles. “By setting an upper payment limit on Enbrel, Colorado is proving that policy can be a powerful tool for equity. Young adults have been clear: health care is only meaningful if it’s accessible and affordable. This decision reflects that truth and moves us closer to a Colorado where every young person can live with dignity and health.”
“Doctors are grateful to the Colorado Prescription Drug Affordability Board for working to ensure our patients can afford the prescription drugs they need to live and thrive,” said Dr. Kyle Leggott, family medicine physician in the Denver metro area and a member of the Committee to Protect Health Care. “Enbrel is a vital medication for patients with arthritis and other debilitating autoimmune conditions, but it only works if patients can afford it. Colorado is leading the way and putting patients first.”
Colorado Consumer Health Initiative is a nonpartisan, nonprofit, membership-based group advocating for equitable access to high-quality, affordable health care. CCHI serves Coloradans whose access to health care and financial security are compromised by structural barriers, affordability, poor benefits, or unfair business practices of the health care industry.
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