Colorado became the first state in the nation to set a price cap on a specific medication last week, following a unanimous decision by the Prescription Drug Affordability Review Board to cap the cost of a drug used to treat inflammatory conditions.

On Oct. 3, the board voted to set an upper payment limit (UPL) of $600 per 50mg unit of Enbrel, an injectable medication used to treat conditions like rheumatoid arthritis, ankylosing spondylitis, and plaque psoriasis.

“This decision is a victory for hardworking Colorado families who have been stretched thin by the high cost of prescription medications,” said Pinky Reinsch of Centennial State Prosperity. “By setting a fair upper payment limit on Enbrel, the PDAB is making sure Coloradans can keep more of their hard-earned money for groceries, housing, and other essentials. Families shouldn’t have to choose between their health and their financial security, and this action brings us closer to a Colorado where they never have to.”

Pharmaceutical Research and Manufacturers of America, a trade organization that has opposed upper payment limits, said the board failed to address the “operational and compliance charges” hospitals and insurers will face as a result.

“Instead of fixing the root causes of patient affordability concerns, the board has rushed into a reckless experiment,” said Reid Porter, a PhRMA spokesperson. “Colorado’s decision to set an Upper Payment Limit by copying the federal government’s so-called ‘maximum fair price’ model fails to address the real drivers of what patients pay out-of-pocket.”

“Instead, Colorado is risking patient access and jeopardizing the development of new medicines – similar to how Medicare beneficiaries are facing fewer options, more treatment denials and higher costs under the Inflation Reduction Act. Mimicking this flawed model will not safeguard patient access and affordability from these abusive practices by middlemen,” Reid said.

According to a poll from the Colorado Consumer Health Initiative, 51% of Coloradans report being worried about affording prescription medication. From 2014 to 2024, prescription drug prices increased by nearly 40%, according to a report by GoodRx.

The new price cap on Enbrel comes out to about $30,000 a year, $20,000 less than the average insurance plan paid for the drug per person in 2023, according to the Colorado Consumer Health Initiative.

Established by legislation in 2021, the Prescription Drug Affordability Review Board was created to assess the affordability of the most expensive prescription medications. Last year, the board identified three medications— Enbrel, Stelara, and Cosentyx — as unaffordable. Enbrel is the first of those to receive an upper payment limit following the board’s decision not to impose a price cap on the cystic fibrosis treatment Trikafta.

Critics of the board have argued that implementing price limits on drugs hampers research, as pharmaceutical companies may no longer find it financially viable, given the significant cost of developing news drugs.

In the case of Trikafta, which the FDA described as a breakthrough therapy to treat patients who have the most common cystic fibrosis mutation, patients and their families had feared that placing a ceiling on the price of Trikafta and other expensive drugs would, in the short term, hinder access and, in the long term, discourage investment in drug research.

“We shouldn’t, as a society, as the United States, say, ‘Hey, your disease is too expensive, so we’re gonna let you die. We’re gonna sacrifice these 400 people in CO in the name of affordability,’” Jen Reinhardt, whose daughter has cystic fibrosis, said at a committee hearing in the legislature last year. “We need someone to stand up and protect people with rare diseases. A genetic therapy for a sole condition isn’t the same as something that treats millions of people where the pharmaceutical companies are gauging people. Until we have access protections, please stop doing this to us, it’s not helpful.”

Enbrel’s high cost is due to the fact that it’s a biologic medication, meaning it is produced using living cells in a specialized facility, according to the Seattle Times. In addition, careful storage and transportation is required due to the drug’s sensitivity to temperature. Furthermore, a 2021 Supreme Court ruling prevented lower-cost biosimilar versions of Enbrel from entering the U.S. market until 2029, effectively allowing its manufacturer, Amgen, to hold a monopoly.

Meanwhile, the Colorado Consumer Health said patients and insurers spent more than $83 million on the drug in 2023, and 71% of patients who take Enbrel said its cost has made accessibility difficult.

Rae Wall, a Denver resident who lives with a chronic illness, said she often has to spend her entire grocery budget for the month on her prescription medication.

“Living with chronic illness is a full-time job,” she said. “Spending hours on the phone with patient assistance programs, pharmacies, and arguing with insurance to justify coverage. I brace myself every time I walk into a pharmacy, just in case a new prescribed medication is too expensive for me to take. That’s why setting an Upper Payment Limit on Enbrel is so important, it will ease the financial burden for families like mine.”

The Prescription Drug Affordability Review Board will be held on Nov. 4 at 10 a.m.