Resources for Effective PDAB Implementation
In partnership with NASHP, PORTAL has developed the following publications to offer information and considerations relevant to state PDABs conducting affordability reviews and setting upper payment limits.
June 29, 2023
Most PDABs are tasked with conducting affordability reviews. How PDABs define the meaning of a “drug” for the purposes of selecting candidates for these assessments has important consequences for determining which and how many drugs will be considered for affordability reviews.
February 26, 2024
Several state laws require PDABs to identify therapeutic alternatives for drugs that a PDAB selects for affordability review. This memo outlines a methodology for using medical professional associations’ clinical guidelines to identify appropriate therapeutic alternatives for selected drugs, including suggestions for overcoming challenges encountered through use of this methodology.
September 11, 2023
PDAB affordability reviews may consider a drug’s affordability from several angles, including affordability to patients, affordability to the state health care system, and affordability relative to other comparable treatments. This white paper outlines key considerations for PDABs conducting affordability reviews that may inform each of these perspectives and contribute to a holistic assessment of a drug as affordable or unaffordable. This paper discusses factors including affordability definitions, drug regulatory and evidentiary information, drug price and spending metrics, therapeutic alternatives, comparative effectiveness, economic evaluation, patient costs and access, and market dynamics.
February 27, 2024
Some PDABs have authority to set upper payment limits for drugs that they find to be unaffordable to state consumers or the state health system following an affordability review. An upper payment limit (UPL) sets a maximum rate at which a drug can be purchased in the state. States’ enabling PDAB statutes offer some guidance on factors that PDABs must consider while developing UPLs and additionally determine the applicability of a UPL in each state, but PDABs with UPL authority are also tasked with crafting specific processes for UPL development and implementation. This white paper describes three potential strategies that a PDAB may employ to arrive at a UPL: reference pricing, net price, and budgetary thresholds.
NASHP PDAB Resources for States
NASHP has published a variety of resources that detail enacted PDAB laws, track PDAB legislation, and discuss ongoing PDAB implementation.
This chart offers an overview and comparison of state affordability review legislation in the seven states that have passed legislation to create a state prescription drug affordability board as of January 2024. PDAB statutes vary between states in their scope, UPL authority, and staffing allocations.
NASHP tracks legislation to lower prescription drug costs, including PDAB legislation. To see which states have PDAB bills, select “Affordability Review” in the dropdown category menu and browse the state map and accompanying table.
November 15, 2021
February 12, 2021
NASHP Model PDAB Legislation
NASHP has developed model legislation to establish a state PDAB to conduct affordability reviews of certain high–cost drugs, and to set upper payment limits for unaffordable drugs.
August 2022
This bill offers model language for state legislators pursuing the establishment of a prescription drug affordability board.
August 2022
This Q&A blog discusses the details of NASHP’s model PDAB legislation. The blog explains a PDAB’s structure, funding, purpose, and process, as established by the legislation.
August 2022
This white paper by Rachel Sachs, JD, MPH, discusses the prescription drug affordability board model, including legal challenges states may face in developing and implementing PDABs and opportunities for states to design their boards to avoid legal concerns.
PDAB State Resources
Each state office charged with PDAB implementation publishes a website that details the board’s membership, meeting schedule, and implementation timeline. PDAB meeting materials and recordings are publicly available, as are any reports published by the board. Below are state PDAB websites, regulations, and all reports published by state boards as of February 2024.
- Colorado SB 21-175/Chapter 240, enacted June 16, 2021
- CO HB 23-1255, enacted May 10, 2023
- Colorado Prescription Drug Affordability Board Website
- Adopted Board Policies
- Adopted Rules
- Affordability Review Reports
- Division of Insurance: Colorado 2023 Eligible Drug Dashboard and Resource List
- Maine LD 1499/Chapter 471, enacted June 24, 2019
- ME LD 120 (2021), enacted July 7, 2021
- Maine Prescription Drug Affordability Board Website
- Report of the Maine Prescription Drug Affordability Annual Report: Recommendations to Reduce Prescription Drug Spending
- 2021 Report, published March 2, 2022
- 2022 Report, published January 23, 2023
- Maryland HB 768/Chapter 692, enacted May 25, 2019
- Maryland HB 1100/Chapter 425, enacted May 8, 2020
- Maryland HB 279/SB 202, enacted April 11, 2023
- Maryland HB 200/SB 181, enacted April 24, 2023
- Maryland Prescription Drug Affordability Board Website
- Regulations, last updated July 17, 2023
- Study of the Operation of the Generics Drug Market, published June 1, 2022
- 2022 Annual Cost Review Report, published December 31, 2022
- 2023 Annual Cost Review Report, published December 31, 2023
- New Hampshire HB 1280/Chapter 13, enacted July 16, 2020
- New Hampshire Prescription Drug Affordability Board Website
- Adopted Rules, effective December 2022
- Prescription Drug Affordability Board Annual Report
- 2021 Report, published November 1, 2021
- 2022 Report, published November 1, 2022
- 2023 Report, published November 1, 2023
- 2024 PDAB Goals and Strategies
- Oregon SB 844/Chapter 598, enacted July 19, 2021
- Oregon SB 192, enacted August 3, 2023
- Oregon Prescription Drug Affordability Board Website
- Final Rule: Selecting Prescription Drugs for Affordability Review, filed July 28, 2023
- 2023 Generic Drug Reportfor the Oregon Legislature, published June 2023
- 2022 Report for the Oregon Legislature, published December 2022 published December 2022
- 2023 Report for the Oregon Legislature, published December 2023
- Washington SB 5532, enacted March 24, 2022
- Washington Prescription Drug Affordability Website
- Annual Report 2023, published December 15, 2023