Colorado officials will soon make momentous decisions that could have unintended consequences for some of the state’s most vulnerable residents.

The decisions, due from the Prescription Drug Affordability Board, is whether certain medications, including popular treatments for Crohn’s Disease, Psoriasis and Psoriatic Arthritis, are affordable. If the board decides they aren’t, it can vote to impose an upper payment limit, thereby prohibiting insurance plans from paying more than the set price.

Unfortunately, this is a one-sided approach to the problem of patient affordability. If Colorado policymakers looked at the system holistically, they would see the biggest driver of high out-of-pocket costs for patients is the nexus of middlemen, including insurers and their pharmacy benefit managers, who profit off rebates from drug makers and high patient co-pays and coinsurance.

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Real reform would target abuses in these areas. PDAB’s tunnel-vision approach is unlikely to reduce costs to patients at the pharmacy counter and could make it impossible for Coloradans to obtain medications they need. That’s because many pharmacies and hospitals will struggle to source medicines subject to the PDAB price controls.

Suppose, for example, the board sets a price that’s lower than a pharmacy or hospital’s cost of acquisition. Perhaps some successful pharmacies and hospitals in affluent areas will continue to supply the drug at a loss, in the expectation they can make up the revenue on other medicines. But providers who are currently just scraping by in poor rural or urban areas may decide they have no choice but to stop carrying the medication and send patients elsewhere.

Ample research has demonstrated when availability worsens, patient behavior changes.

Many patients live in areas where home delivery is insecure. Some will find they must travel farther to find a pharmacy that stocks their medicine. The additional transportation burden might be merely inconvenient for the state’s better-off patients. But for patients in marginalized groups, the difference could be decisive.

Consider Black and Hispanic patients are already significantly more likely to live in “pharmacy deserts.” Compared to White patients, Black patients are also likelier to travel more than five miles from home to reach their nearest health care facility.

These differences matter. Transportation issues will entail an increase in prescription “non-adherence” — when patients don’t take their medications as prescribed.

Delay or interruption in treatment for chronic conditions can cause flare-ups and speed progression of the disease with little to no chance of regression. In the long run, patients will end up spending more on health care than they would’ve otherwise.

State lawmakers had good intentions when they created the board. But the truth is a national effort on the narrow question of drug prices is already underway in Washington D.C. at the Centers for Medicare and Medicaid Services. The 2022 Inflation Reduction Act gave officials the power to negotiate prices with drug makers on an expanding list of medications for federal programs. State-by-state efforts to impose similar price controls will likely create further confusion and uncertainty about availability.

A far more effective way to increase drug affordability for patients, in Washington and in Colorado, would be to rein in the middlemen in the drug supply chain connecting drug-makers to patients. Paper-pushers suck billions out of the system while adding little value and providing no out-of-pocket relief for patients.

Patients continue to raise these concerns and others with the board. It’s not too late to adjust this misguided approach. Let’s hope the five unelected members of the Colorado PDAB are receptive to the feedback from thousands of patients most likely affected by their decisions, and consider all factors contributing to patient affordability challenges.

Kristi Kibler is the chief executive officer of Lupus Colorado, which was established in 1972 for the purpose of providing support, education and training to everyone affected by lupus.