In a landmark move that could reshape pharmaceutical pricing nationwide, Colorado has become the first state to impose a price ceiling on a prescription drug, targeting the costly autoimmune treatment Enbrel. The decision, handed down by the state’s Prescription Drug Affordability Board (PDAB), sets a maximum payment of $600 per 50-milligram dose, a dramatic reduction from the previous annual cost of over $53,000 per patient.

A Bold Step Toward Drug Affordability

The PDAB, established in 2021 to evaluate the affordability of high-cost medications, deemed Enbrel “unaffordable” in early 2024. The injectable biologic, manufactured by Amgen, is commonly prescribed for rheumatoid arthritis and other autoimmune conditions. Since its release in 1998, Enbrel’s wholesale price has surged more than 1,500%, prompting widespread concern among patients, insurers, and consumer advocates.

Under the new cap, Colorado insurers and patients will pay no more than $31,200 annually for the drug—a figure aligned with the federal Medicare program’s Maximum Fair Price (MFP) set to take effect in January.

Impact on Patients and Pharmacies

For many Coloradans, the price cap represents a lifeline. In 2023 alone, patients paid an average of $4,600 out of pocket, with some spending nearly $10,000 annually. Combined with insurer contributions, the state shelled out over $83 million on Enbrel that year.

“This is groundbreaking,” said Priya Telang of the Colorado Consumer Health Initiative. “It’s a bipartisan issue. Everyone struggles with the cost of prescription drugs. This is just the start of many consumer savings”.

However, not all stakeholders are celebrating. Independent pharmacies, already operating on thin margins, warn that the cap could force them to dispense Enbrel at a loss. “Taking a loss on a quarter of your scripts is not a business,” said Ali DiLorenzo, lead technician at Wheat Ridge Professional Pharmacy.

Legal Challenges and National Implications

Amgen has pushed back, filing a federal lawsuit to block the PDAB’s authority. Though a judge dismissed the case in March 2024, the company is appealing, and further litigation is expected.

Despite legal hurdles, Colorado’s move is being hailed as a model for other states. By setting an Upper Payment Limit (UPL), the state has created a precedent that could inspire similar actions across the country. Advocates estimate the cap could save Colorado consumers and insurers over $32 million annually.

What’s Next?

The PDAB is currently reviewing other high-cost drugs, including Cosentyx and Stelara, for potential price caps. As the pharmaceutical industry watches closely, Colorado’s bold experiment in drug affordability may mark the beginning of a broader reckoning with unchecked medication costs.

For The Rocky Mountain Dispatch, this story underscores a growing tension between public health priorities and pharmaceutical profit models—one that Colorado is now confronting head-on.