With PDABs becoming increasingly popular throughout the country, HealthHIV is advocating for the crucial needs of patients amid rapid policy change, and critical conversations happening on this subject.
HealthHIV seeks to:
- Protect access to lifesaving medications
- Push forward and uplift initiatives to ensure equitable medication uptake
- Preserve critical public health efforts
- Promote the patient voice in all healthcare policy discussions
What is a Prescription Drug Affordability Board?
A Prescription Drug Affordability Board (PDAB) is an oversight entity established by states to evaluate and manage the costs of prescription drugs. Its primary objective is to ensure drug affordability for consumers while balancing state healthcare budgets. PDABs conduct “affordability reviews” of drug prices and spending, and develop strategies to control costs.
A key tool in their arsenal is the implementation of Upper Payment Limits (UPLs), which set maximum price caps that state programs will pay for certain medications.
What’s at stake for patients?
- Affordability, from a patient perspective, means access to essential medications and treatments without facing financial hardship, ensuring equitable healthcare access and robust patient protections.
- Patients may face limited access to specific medications if manufacturers do not lower their prices to meet UPLs, potentially affecting their ability to obtain essential treatments.
What’s at stake for providers?
- For providers, it involves delivering quality care without being constrained by cost considerations.
- Providers may need to consider alternative medications for their patients based on UPLs and affordability, potentially altering treatment plans and impacting patient care.
What’s at stake for payers?
- Payers work to strike a balance between controlling expenses and safeguarding patients’ equitable access to necessary healthcare services.
- Payers must navigate changes in drug pricing strategies and formulary designs due to UPLs, potentially affecting which drugs are covered and how costs are shared with patients.
Latest Resources
Prescription Drug Affordability Boards (PDABs) and Upper Payment Limits (UPLs) Impact on Patients, Drug Pricing, and Innovation
This HealthHIV Advocacy paper explores the function of Prescription Drug Affordability Boards (PDABs) in managing prescription drug costs, considering perspectives of patients, providers, and payers to ensure equitable access to vital medications while controlling healthcare expenses.
Considerations and Implications of PDABs and Their Impact on 340Bs
Prescription Drug Affordability Boards (PDABs) are designed to help reduce the costs of prescription medications in 11 states where they currently exist (legislation pending in 13 more states).
PDAB: Balancing the Scale
The Role of PDABs in Drug Pricing and Healthcare Stakeholder Impacts
PDAB Action Steps for Patients
Patients looking to contribute to the conversation about drug affordability and Upper Payment Limits (UPLs) can start here.
PDAB Action Center
This info, along with our (coming soon!) Social Media Sample Posts, PDAB Letter Template, PDAB Policy Resources, and Submitted State Comments and Coalition Letters, offers a straightforward way to help inform your thoughts and concerns, share your experiences, and actively participate in shaping policies that directly impact patient care and access. We will be posting all of these documents and items to this Resource Center soon.
Action Steps for Patients
Patients looking to contribute to the conversation about drug affordability and Upper Payment Limits (UPLs) can start here. Click to download.
- With momentum provided by the 2022 Inflation Reduction Act, close to a dozen states have implemented—or are considering implementing—Prescription Drug Affordability Boards (PDABs) in order to tackle drug costs. Learn more here: https://healthhiv.org/pdab/
- Prescription Drug Affordability Boards (PDABs) introduce a new and complex dynamic in the ongoing efforts of public and private entities to negotiate drug prices and reimbursement rates. Read #HealthHIV’s latest advocacy paper on PDABs here: https://healthhiv.org/resource/prescription-drug-affordability-boards-pdabs-and-upper-payment-limits-upls-impact-on-patients-drug-pricing-and-innovation/
- Prescription Drug Affordability Boards (PDABs) must balance system-wide financial concerns with the actual impact on patients’ out-of-pocket costs. Explore #HealthHIV’s PDAB Resource Center to learn more about this: https://healthhiv.org/pdab/
- Overall, PDABs’ approach must balance broader—system-wide—financial concerns with the actual impact on patients’ out-of-pocket costs, but does not always do so.
- The evidence regarding the effectiveness of PDABs in reducing list prices or reimbursement rates is also still emerging, and it remains to be seen whether and how these reductions will actually translate into real-world direct savings to patients.
- Existing evidence does suggest, however, that the impact of PDABs on reducing patient out-of-pocket costs and enhancing access to medication remains complex, and varies from state-to-state.
- While PDABs are meant to analyze statewide drug pricing and recommend strategies to lower patient spending, their effectiveness largely depends on factors like the existence of cost-offsetting patient assistance programs, and better access to both real-world and claims data.
- PDABs must work with patients and stakeholders across various disease states and conditions—whether rare, orphan, or communicable—to serve the dual goals of both preserving and improving medication access, and containing costs.
- Only with these dual goals—and this broader context—as PDABs’ north star will the needs of patients truly be put first.
PDABs by State
Learning from Other States: States like Minnesota may look to the experiences of others, such as Colorado, Oregon, and Maryland, to learn from their approaches, challenges, and successes. This can help tailor policies to address their healthcare systems’ and patient populations’ specific needs and circumstances.
Additional state-specific information will be added at a later date.
