Capping Colorado’s prescription costs will backfire | Denver Gazette
If only there were a magic wand to tame the high cost of living in our inflationary economy. Instead, there are politicians — who merely pretend to possess such superhuman power. And their attempts to wield it inevitably backfire, sooner or later.
Thus, our sense of impending doom after news that another high-priced prescription drug was officially declared “unaffordable” by Colorado’s groundbreaking Prescription Drug Affordability Review Board. The finding last Friday paves the way for the drug board to set an upper price limit that could be charged for the drug in our state.
The board’s action no doubt is popular among the politicians who conjured up the board a few years ago, as well as with the advocacy groups that regularly joust with the pharmaceutical industry. Plenty of rank-and-file Coloradans might welcome the move, as well.
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They’re hard pressed by rising out-of-pocket expenses for essential prescription drugs, over and above what their health plans are willing to cover. And a lot of seniors on fixed incomes — pinched by high prices for life-saving drugs on which they depend — must be applauding the move.
Too bad it won’t work — just like all the other crowd-pleasing but shortsighted attempts at government-imposed price controls.
As reported Monday in The Gazette by the Colorado Chamber of Commerce’s Sum & Substance news service, the board’s action was directed at Stelara, a medication that treats anti-inflammatory diseases affecting joints and bowels. It was developed and is manufactured by pharmaceutical giant Johnson & Johnson, and demand for it has been on the rise.
The number of Coloradans prescribed the drug has risen 250% since 2018. As demand has risen, so has the drug’s price. The average out-of-pocket cost to state residents shot up from $2,584 in 2018 to $7,365 in 2022.
So, the board took a step toward providing Stelara patients purported relief.
Never mind that the board acknowledged the drug is a victim of its success — its efficacy driving demand. Or that there are similar drugs in the prescription market to which at least some of those who are priced out of Stelara could turn.
Drug board members also recognized during their deliberations that the drugmaker offers significant help through its patient assistance program to bring down costs for patients.
And even if the out-of-pocket expenses to consumers are high, health plans appear to be covering the lion’s share of the costs. As The Sum & Substance reported, Stelara is covered by 7 of the 10 health-insurance carriers regulated by the state at a cost that averages $154,401 annually per patient; all but the $7,365 in out-of-pocket costs is paid by health plans.
The relief — assuming the board pushes ahead with a price cap — is likely to be fleeting. This is the second time the board has gone down this path. The board previously ruled autoimmune-disease drug Enbrel to be unaffordable and began the subsequent process of setting a price limit when the drugmaker sued the state over the drug board’s basic constitutionality.
Litigation aside, the bigger hurdle to any lasting success for the board’s action is basic market forces. Experts who know the pharmaceutical market well told The Sum & Substance the decision could prompt Johnson & Johnson to discontinue selling Stelara in Colorado even as it remains available to residents in other states.
A representative of the Colorado BioScience Association said, “Government price controls won’t lower costs for patients and risk serious, unintended consequences, including limiting patient and prescriber choice and reducing investments in new medicines.”
It’s simple economics. Just ask an economist. Evidently, the members of the state’s drug board, didn’t.
Denver Gazette Editorial Board

