By Sophia Hennessy

The pharmaceutical industry is one of the most opaque industries in the country. Drugs are arbitrarily priced, profits are maximized, industry players point fingers at each other to deflect blame and patients suffer at the expense of corporate greed.

In 2024, more than half of Coloradans reported being worried about being able to afford their prescription drugs. Our legislators have taken several steps to improve affordability and patient access to prescription drugs, but the Prescription Drug Affordability Board (PDAB) is the only tool the state has that evaluates and addresses the root causes of skyrocketing drug prices.

Last year, the Board ruled Enbrel, Cosentyx and Stelara as “unaffordable” for Colorado consumers. This year, they have the opportunity to set an upper payment limit (UPL) on all three drugs and bring savings to Colorado consumers. The board is currently working through the upper payment limit process for Enbrel, which is expected to be announced on Friday.

In Colorado, Enbrel patients with commercial insurance spent more than $6.7 million out of pocket, and our commercial insurers paid $76 million. A combined $83 million was spent just on Enbrel in our state.

Taking into account the average Enbrel patient is paying $4,638 out of pocket for a year’s supply, but may be paying up to $9,990 out of pocket, it’s understandable why the board needs to pursue an upper payment limit. Coloradans cannot afford to pay thousands of dollars out of pocket for a life-changing drug.

The board is considering setting the UPL at Enbrel’s CMS Max Fair Price (MFP), which was negotiated as a fair price for Medicare Part D. If Colorado sets Enbrel’s Upper Payment Limit at the Medicare negotiated rate, Colorado could see more than $32.8 million in savings. Millions of dollars could be saved in Colorado’s health insurance market, for our state employee health plan and in consumer out-of-pocket costs.

According to AHIP, more than 24% of all commercial health plan premiums go toward prescription drug costs. The effect of an upper payment limit will be far-reaching; not only will it have an effect on patients’ out-of-pocket costs, but it should also effect consumer health insurance premiums. 

At the same time, Big Pharma has worked hard to prevent the critical work of the board. They have threatened to pull out of the state, they have been running a major astroturfing campaign through third-party organizations, they have claimed they won’t be able to research and develop new drugs and they have sued the state of Colorado.

This is propaganda. They are not telling the truth. Big Pharma routinely spends more on direct-to-consumer ads than on the research and development of new drugs. Last year, Big Pharma spent $31 million lobbying in Washington and spent $13 million lobbying in the first quarter of 2025 alone. The price hikes of hundreds of common medications consistently rise faster than the rate of inflation.

They are not worried about funding research and development of new drugs; they’re trying to protect their profits.

Big Pharma is one of the only players in the health care industry that has been allowed to operate unchecked. They have been allowed to set prices in the United States that are more than 2.5 times higher than in other countries, especially for name-brand drugs. 

Families are struggling to afford their everyday necessities, and we must use every tool available to reduce health care spending for Colorado families. Our state budget is tight, and recent changes at the federal level are projected to increase premiums on the Colorado state marketplace by up to 38% in 2026. The PDAB can save our state health plans money and shield consumers from bearing the full weight of these projected premium increases. 

We have been paying too much for prescription drugs for far too long. Colorado’s PDAB is paving the way in setting the first upper payment limit in the country, ensuring Colorado patients can afford their drugs. We hope they pursue upper payment limits for Cosentyx and Stelara in the coming months, so Colorado can capture more savings.

No family should avoid filling their prescription because of the cost, and the state’s Prescription Drug Affordability Board is a crucial part of reducing health care costs for Coloradans.

Sophia Hennessy is the policy and research coordinator at the Colorado Consumer Health Initiative, a nonprofit that works to ensure all Coloradans have access to affordable and high-quality health care. She resides in Denver.