Drug pricing and affordability continue to be key issues at both the state and federal levels as new legislation is considered and implementation of legislation that has already passed is underway. 

This past week, CBSA’s President & CEO Elyse Blazevich represented the Colorado life sciences community in Washington, D.C. at the 2023 We Work For Health Healthcare Summit, where she discussed issues that impact health innovation and patient access to life-changing and life-saving medicines with the Colorado Congressional Delegation, policy leaders, and life sciences leaders from across the country. The summit featured panels on 340B, PBMs, and the impacts of the Inflation Reduction Act. 

In her meetings with the Colorado Congressional Delegation, Elyse emphasized CBSA’s perspectives on issues vital to our community. Those issues included: 

• Support for the broadening bipartisan discussion on pharmacy benefit manager (PBM) reforms, such as the Patients Before Middlemen (PBM) Act, the Protecting Patients Against PBM Abuses Act, the Delinking Revenue from Unfair Gouging (DRUG) Act, and the Help Ensure Lower Patient (HELP) Act. 

•  Concerns about drug pricing controls which could chill investment in next-generation treatments for patients in need, such as the “reasonable pricing” clause in the Senate HELP Committee’s draft of the 2023 Reauthorization of the Pandemic and All-Hazards Preparedness Act (PAHPA), the Strengthening Medicare and Reducing Taxpayer (SMART) Prices Act, and Colorado’s implementation of a Prescription Drug Affordability Board (PDAB).

We’ve included more information below about a few of those issues: the PBM Act, the PAHPA “reasonable pricing” clause, and a PDAB implementation update. 

PBM Act 

CBSA’s support for PBM reforms is outlined in this letter that CBSA sent to Senator Michael Bennet and Senator John Hickenlooper. CBSA encouraged the Senators to cosponsor the Patients Before Middlemen (PBM) Act (S.1967), which was introduced by Senate Finance Chairman Ron Wyden (D-OR), Senate Finance Ranking Member Mike Crapo (R-ID) and U.S. Senators Bob Menendez (D-NJ), Marsha Blackburn (R-TN), Jon Tester (D-MT), and Roger Marshall (R-KS). 

This bipartisan legislation will help fix a broken system and make medications more affordable for patients. The PBM Act would eliminate one of the most egregious flaws in the U.S. prescription drug pricing system: the ability of PBMs to favor higher-priced drugs. This bill would de-link PBM revenues from drug prices for Medicare Part D beneficiaries. The fees PBMs receive could no longer be connected to the price of a drug or any discounts and rebates. The legislation would also require PBMs to refund any dollars collected in excess of their legitimate service fees to taxpayers. 

PAHPA 

CBSA’s concerns with the “reasonable pricing” clause in the Senate HELP Committee’s draft of the 2023 Reauthorization of PAHPA are outlined in this letter that CBSA sent to Senator John Hickenlooper. Specifically, we are opposed to Sections 601 and 602 in the Chairman’s proposal. These sections require all Biomedical Advanced Research and Development Authority (BARDA) and Centers for Disease Control (CDC)-supported products be sold to the Federal Government or in the U.S. commercial market at the lowest price among G7 countries and at a “reasonable price.” If enacted, these provisions would effectively shut down private sector investment and the type of public-private partnerships that are vital to the development of life-saving medical countermeasures (MCMs). This is especially true for many MCMs that have a limited commercial market or no commercial market and rely on these partnerships. 

PDAB Implementation Update 

In Colorado, implementation of the Prescription Drug Affordability Board (PDAB or Board) established in 2021 by SB21-175 (and modified in 2023 by HB23-1225), which is working to select drugs for an affordability review in order to set an upper payment limit on certain drugs, continues to ramp up.  

CBSA has been closely monitoring all PDAB meetings and Prescription Drug Affordability Advisory Council (PDAAC or Advisory Council) meetings. CBSA has also been reviewing the Colorado PDAB 2023 Eligible Drug Dashboard and working with members to identify data discrepancies and calculation errors evident in the dashboard, which can be submitted to PDAB staff using the Dashboard Inquiry Form. 

The PDAAC met most recently on July 13^th.  The primary objectives of the meeting were: (1) to fulfill the PDAAC’s statutory requirement of providing input to the Board on drug selection, and (2) to respond to the Board’s request to rank the top 20 recommended drugs out of the PDAB’s list of the top 50 prioritized drugs. 

While approaches and specific drugs were discussed, a recommended list of 20 drugs was not reached. The Advisory Council directed staff to find additional time for the PDAAC members to continue their discussion in a meeting open to the public and vote on finalized recommendations before the next PDAB meeting on August 4^th. CBSA will continue to engage throughout each step of the PDAB process.