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Understanding Prescription Drug Affordability Boards: A Guide for Patients

In an attempt to lower healthcare costs, many states have introduced Prescription Drug Affordability Boards (PDABs). These boards are tasked with examining whether prescription medications are “affordable” within their respective states and exploring ways to lower spending. But what exactly are PDABs, and how do they impact patients, particularly those with chronic diseases?

How do PDABs work?

Each state seems to be slightly different, but generally, PDABs identify a select number of medications each year for detailed review. Depending on the state, PDABs may report their findings to the legislature or set an upper payment limit (UPL) for medications deemed unaffordable. However, these limits only affect what states and insurers pay for medications, not the out-of-pocket costs for patients.

These boards typically cost states between $500,000 to over $1 million annually, depending on their structure and tasks. Comprised of 4-10 appointed members with expertise in healthcare-related fields, including pharmacists, doctors, and economists, PDABs are often supported by professional staff who handle logistics and stakeholder engagement.

Implications for Patients

While the intent behind PDABs is to reduce overall spending on medications, the direct benefits for patients remain uncertain. Since PDABs can only influence prices within commercial, state, and Medicaid programs and not federal programs like Medicare, the impact on patient out-of-pocket costs is limited. Additionally, setting UPLs could lead to unintended consequences such as changes in insurance formularies, increased utilization management, and potential financial losses for providers administering the drugs. These changes could create more barriers for patients seeking access to their preferred medications.

Patient Involvement and Advocacy

PDAB’s effectiveness in benefiting patients directly remains to be seen, which is why patient voices are crucial in the discussion about drug affordability. By engaging with PDABs and advocating for policies that prioritize patient affordability and access, patients and advocacy groups can inform decisions that impact their care. Active involvement and persistent advocacy are essential to ensure that health policies truly reflect the needs and experiences of those they are designed to help.

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