State Prescription Drug Affordability Boards Now Cover 7.8 Million Lives in Medicaid and Commercial Markets

Eight states have established Prescription Drug Affordability Review Boards (PDABs) to control drug costs, with four states (CO, MD, MN, WA) authorized to set Upper Price Limits that typically apply to both Medicaid and state-regulated commercial plans. Colorado became the first state to implement a UPL in October 2025, setting a $600 per-unit cap on Enbrel aligned with federal negotiated pricing. For Medicaid managed care plans operating in these states, PDABs represent a new layer of price regulation affecting pharmacy benefits and potentially reimbursement structures for approximately 7.8 million covered lives.

Managed Care · Pharmacy · Finance

This is outside commentary from Avalere, not part of Medicaid Monitor's independently scored news coverage.

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