Prescription Drug Affordability Boards (PDAB)
Prescription Drug Affordability Boards (PDAB) have been formed in several states. PDABs are the wrong approach to effectively lower patient costs for prescription medications and could ultimately cause more harm by creating added barriers between patients and their medically necessary treatment. Chronic Care Policy Alliance believes PDABs are ineffective in identifying and solving the actual problems patients with chronic conditions face in affordability.
The PDAB model provides a board of unelected officials with the authority to review prescription drug costs and set Upper Payment Limits (UPLs) for medications. Contrary to the claims of PDAB supporters, UPLs do not directly lower patient out-of-pocket costs and will have little impact on overall patient costs. Setting UPLs for medications might endanger patient accessibility or limit appropriate reimbursement for the physicians who administer them. Additionally, UPLs will create a new incentive structure for payers that could compromise patient access to the selected medications. This is due to increased utilization management or reshuffling of formularies. Insurers and PBMs could place medications subject to UPLs on higher formulary tiers or implement other utilization management tactics to steer patients away from these drugs. This could lead to higher out-of-pocket costs for patients who could face higher copay or coinsurance rates to retain access to that medication or be forced to switch to a more expensive medication which results in higher profits for their PBM. This is called nonmedical switching which causes unnecessary complications for patients.
We strongly urge a focus on patient-reported issues and address the causes of their affordability and access challenges – including prior authorization, alternative funding programs, and PBM reform. This along with direct patient participation in the discussion could lead to lowered prices.
To learn more, please visit our Blog on PDABs HERE, or the EACH/PIC Coalition website HERE.