FOR IMMEDIATE RELEASE
DATE: July 9, 2024
CONTACT: Priya Telang, (720) 443-6435, ptelang@cohealthinitiative.org
Coalition of Health Care, Consumer Advocacy Groups, Send Letter to Lawmakers Celebrating PDAB Achievement of Key Milestones
Colorado’s First in the Nation PDAB has Finished Review of First Set of Medications, Making Significant Strides to Reduce Costs . Coalition is Urging the Board to set an Upper Payment Limit for Stelara and Cosentyx
DENVER, CO – Last week, a large, diverse coalition of Colorado health care and consumer advocacy groups sent a letter to lawmakers and The Prescription Drug Affordability Board (PDAB) celebrating the passage of key milestones in the Board’s work to reduce the costs of prescription medications for patients. The state’s first-in-the-nation PDAB has finished its statutorily-required affordability review of the first set of five medications – three of which were deemed unaffordable for Colorado families.
In the letter, coalition partners wrote, “Reaching this nation-leading milestone comes at a time when the skyrocketing price of prescription medications is driving up costs for Colorado patients and families. In fact, 1-in-3 Coloradans struggle to afford the prescription medicine they need to stay healthy. The PDAB is our state’s only tool to reign in out-of-control drug costs and its creation was supported by a bipartisan 71% of Coloradans. Coloradans agree: prescription drugs don’t work if people cannot afford them.”
Of the eligible drugs subject to review, the Board selected an initial set of five: Trikafta, Enbrel, Genvoya, Stelara, and Cosentyx. After much deliberation and public, patient, and provider input, it was determined that the costs of Enbrel, Stelara, and Cosentyx were out of reach for Coloradans. These drugs are essential for patients suffering from debilitating diseases, such as rheumatoid arthritis, plaque psoriasis, cystic fibrosis, and HIV. The coalition supports the board’s decision to set an upper payment limit (UPL) for Stelara and Cosentyx.
The letter also congratulated the PDAB for a robust, fair, and thorough affordability review process and for continuing to operate effectively and impartially despite coordinated and well-funded attempts by Big PhRMA to derail the affordability review process. This included threats to pull out of the Colorado market or severely limit access to medications, despite the industry raking in astronomical profits. For example, in 2023 alone, Stelara raked in nearly $11 billion for Johnson & Johnson after it raised the price for a single syringe by $653. Cosentyx brought in $5 billion for Novartis, which raised the price of the drug 7.6% in 2023 in addition to a 7% hike in 2020.
Colorado’s PDAB, was established in 2021 in Senate Bill 175. The PDAB has the authority to review prescription drug costs and evaluate their impact on Coloradans through affordability reviews. There are four steps in conducting affordability reviews including the identification of eligible drugs, selection of drugs for affordability reviews, conducting the affordability reviews on selected drugs, and determining if the selected drugs are unaffordable for Colorado patients. The Board may then recommend ways to alleviate those costs and may elect to set an upper payment limit for the medication. A total of fifteen factors are ultimately considered by the Board when making a decision, including the voices of manufacturers, providers, patients, and advocacy groups to submit information and provide testimony at every decision making point throughout the process.
The Board met last week to adopt final affordability reports and voted in favor of setting a UPL for Stelara and Cosentyx, the board voted to pursue an upper payment limit for Enbrel in February.
Full Text of the Letter Below:
To Lawmakers and Members of the Board,
On behalf of a diverse coalition of stakeholders, we want to acknowledge and celebrate key process milestones in reducing barriers to accessing medications that dramatically improve the lives of Coloradans. We deeply appreciate the Board’s commitment to a transparent process with opportunities for meaningful engagement. We appreciate your consideration as the Board continues its work, specifically related to ensuring Cosentyx and Stelara can be made more accessible and affordable through the initiation of an Upper Payment Limit process.
A robust, fair, and thorough affordability review process. The PDAB has the authority to review prescription drug costs and evaluate their impact on Coloradans through affordability reviews of prescription drugs. There are four steps in conducting affordability reviews: (1) identification of eligible drugs, (2) selection of drugs for affordability reviews, (3) conducting affordability reviews on selected drugs, and (4) determining if use of the selected drugs are unaffordable for Colorado consumers. The Board may then recommend ways to address those costs and may set an upper payment limit for certain prescription drugs. A total of fifteen factors are ultimately considered by the Board when making a decision, including the voices of manufacturers, providers, patients, and advocacy groups to submit information and provide testimony at every decision making point throughout the process.
Review of first set of medications complete. Colorado’s Prescription Drug Affordability Board (PDAB), established under Senate Bill 21-175, concluded its statutorily-required affordability review of the first set of five medications – three of which were deemed unaffordable for Coloradans. Reaching this nation-leading milestone comes at a time when the skyrocketing price of prescription medications is driving up costs for Colorado patients and families. In fact, 1-in-3 Coloradans struggle to afford the prescription medicine they need to stay healthy. The PDAB is our state’s only tool to reign in out-of-control drug costs and its creation was supported by a bipartisan 71% of Coloradans. Coloradans agree: prescription drugs don’t work if people cannot afford them.
Three of five medications deemed unaffordable. Of the eligible drugs subject to review, the Board selected an initial set of five: Trikafta, Enbrel, Genvoya, Stelara, and Cosentyx. After much deliberation, it was determined that the costs of Enbrel, Stelara, and Cosentyx were out of reach for Coloradans. These drugs are essential for patients suffering from debilitating diseases, such as rheumatoid arthritis, plaque psoriasis, cystic fibrosis, and HIV. Trikafta and Genvoya were deemed not unaffordable.
Evidence of PhRMA’s price-gouging tactics. The PDAB refused to let the pharmaceutical industry put profits over patients. Stelara raked in nearly $11 billion – yes, billion with a “b” – for Johnson & Johnson in 2023, after it raised the price for a single syringe by $653. Cosentyx brought in $5 billion for Novartis, which raised the price of the drug 7.6% in 2023 in addition to a 7% hike in 2020. The CEOs of Johnson & Johnson and Novartis are also among the most lavishly paid in the corporate world: J&J CEO Joaquin Duato was paid $28.4 million in 2023, while his counterpart at Novartis, Vas Narasimhan, got a 21% pay raise, bumping his wages to $15.3 million in 2023.
Overcoming industry opposition to PDAB. Despite coordinated and well-funded attempts by Big PhRMA to derail the affordability review process, including threats to pull out of the Colorado market or severely limit access to medications and research/development, advocates mobilized consumer groups, patients, and providers to protect the PDAB and its ability to bring down the high-cost of certain medications.
What’s next. There is more work to be done. This July, the Board will be meeting to adopt final affordability reports, hold a key vote on setting an upper payment limit (UPL), and set a UPL timeline. We believe that the board has an obligation to use their authority to meaningfully lower prescription drug costs for drugs found unaffordable and urge board members to initiate UPL processes for Stelara and Cosentyx. In the meantime, a broad coalition of organizations fighting to make prescription drugs more affordable for Coloradans is celebrating the progress and promise of the PDAB.
Signed,
Mannat Singh, Executive Director, Colorado Consumer Health Initiative
Austin Blumenfeld, Executive Director, Centennial State Prosperity
Laura Packard, Founder, Health Care Voices
Melanie Kesner, Rocky Mountain Regional Director, Young Invincibles
Miles Baker, Chief of Staff, Committee to Protect Health Care
Bethany Pray, Deputy Director, Colorado Center on Law & Policy