State prescription drug affordability boards

On Jan. 1, 2027, Colorado was set to become the first state to enforce a cap on what buyers inside its borders pay for a prescription drug. Its Prescription Drug Affordability Review Board had adopted a rule⁶ setting an upper payment limit of $600 per 50-milligram unit of etanercept, an injected biologic for rheumatoid arthritis and other autoimmune conditions. On July 1, 2026, a federal judge in Denver blocked the cap from taking effect, The Colorado Sun reported⁷, finding it was likely preempted by federal patent law.

The ruling hit the only state that had actually set such a limit, under an idea that started in Maryland in 2019. A prescription drug affordability board, or PDAB, is a state body that reviews whether particular drugs are affordable and, in some states, can set an upper payment limit (UPL), a maximum that purchasers in the state may pay or reimburse. At least 10 states had active boards as of August 2025, according to a January 2026 Congressional Research Service legal sidebar¹.

This explainer covers how the boards work alongside other state tools such as price transparency laws, which states have them and what powers they hold, where the Colorado case stands, and why generics appear in these laws even though few generics come near their price triggers.

How a board picks drugs to review

Maryland's law, House Bill 768, was enacted May 25, 2019⁹, according to the National Academy for State Health Policy (NASHP), which tracks the boards. The enacted text⁴ tells the board to identify drugs that cross set price triggers and then decide whether a full cost review is warranted. Colorado's 2021 law, Senate Bill 21-175⁵, uses a similar structure for its affordability reviews.

Both laws adjust the dollar amounts for inflation each year. WAC means wholesale acquisition cost, the manufacturer's list price to wholesalers. Both laws also let the board look at other drugs that create affordability problems.

Once a drug is chosen, a board gathers pricing and spending data, takes public testimony and decides whether the drug is unaffordable to the state's health system or its patients. Board and stakeholder council meetings are open to the public in Maryland, where the next board meeting is scheduled for Nov. 16, 2026, according to the board's site³.

Which states have boards, and what they can do

Boards differ most in whether they can set prices. CRS describes two groups. In Maine, Massachusetts and New Hampshire, boards can review drugs and recommend policy but cannot directly control a price. In at least five states (Colorado, Maryland, Minnesota, Oregon and Washington), the law gives the board UPL authority, though the details vary. The table below draws on CRS, NASHP's list of enacted laws and board reports, and the boards' own sites.

Who must honor a UPL is the other big difference. Colorado's law says a limit applies to all purchases and payer reimbursements for a drug dispensed or administered in the state, though the state later clarified that it does not apply to wholesalers, Medicare or self-funded employer plans governed by federal ERISA law, CRS notes. Minnesota's law exempts Medicare and ERISA plans. Maryland's applies only to state and local government purchasers.

Maryland's board voted to apply UPLs to empagliflozin and an injectable semaglutide product for diabetes, two drugs that also carry Medicare negotiated prices. No Maryland UPL was active yet, the board's UPL page² said in November 2026. State and local government entities may begin applying the limits on Jan. 1, 2027, and must apply all active UPLs after Jan. 1, 2028. In Washington, board staff told members in July 2026 that the state's UPL rules would not take effect until about the end of July 2027.

Where the Colorado case stands

Colorado's board found etanercept unaffordable in 2024 and voted unanimously in October 2025 to set the $600 limit, scheduled to take effect Jan. 1, 2027. CRS reported that the board found the drug's WAC had risen 1,582.24 percent since FDA approval in 1998, and that the limit is similar to Medicare's negotiated price for the drug, which CMS set at $2,355 for a 30-day supply¹⁰ starting in 2026. The Colorado Sun put the cap at about $31,000 a year, against a wholesale cost of about $96,000 per patient per year.

The drug's manufacturer has sued twice. Its first suit, filed in March 2024 before any limit existed, was dismissed on March 28, 2025, for lack of jurisdiction. It sued again on Oct. 30, 2025, arguing that the limit is preempted by federal patent law and violates the dormant Commerce Clause. Granting the preliminary injunction, Chief Judge Daniel D. Domenico wrote that under binding Federal Circuit precedent, caps on the price of patented drugs are preempted by federal law. The precedent was a Federal Circuit ruling against an earlier District of Columbia law on patented drug prices.

On July 24, 2026, the board voted to let the state attorney general appeal, Colorado Politics reported⁸. The board had also been studying limits for ustekinumab and secukinumab, two other autoimmune biologics; the Sun noted that ustekinumab is now off-patent while secukinumab is still patent-protected.

Where generics fit

Generic drugs are written into both the Maryland and Colorado triggers, but only for outliers: a generic must have a list price of $100 or more for a month's supply and a 200 percent increase over its average for the prior year. That is the profile of the old-generic price jumps of 2013 to 2015, covered in our piece on the generic price spikes, and the same outliers are the target of separate state price-gouging laws. Maryland's 2019 law also ordered a study of the generic drug market, which the board published on June 1, 2022, according to NASHP.

GxRadar's own data show how far most common generics sit from those triggers. In October 2026, 30 tablets or capsules of every one of the 47 generics on our price tracker cost pharmacies less than $9 at the national average acquisition cost, based on CMS NADAC data¹¹. Thirty 500 mg metformin tablets came to about 44 cents. NADAC is a measure of pharmacy cost, not the list price the laws use, but the gap is large. The generics most likely to draw a board's attention are older drugs with one or two makers, the market we describe in why some generics have only one maker.

For how state boards relate to federal policy, see our explainer on the Inflation Reduction Act and generics; for how prices move when competitors arrive, see why generic prices fall as competitors enter.

What to watch

Three dates stand out. Maryland's board meets Nov. 16, 2026. Maryland's first UPLs become available to state and local purchasers on Jan. 1, 2027, the same day Colorado's etanercept cap was meant to start before the injunction. And the state's appeal will test whether a state can cap what in-state buyers pay for a patented drug, a question CRS flagged for Congress in January.