Colorado’s Board of Regents voted unanimously Friday to consider setting maximum prices for drugs to treat autoimmune diseases, pushing the state into uncharted territory and potentially confronting the drug’s makers. The gender was set.
Colorado’s Prescription Drug Affordability Commission has voted that the injectable drug Enbrel is unaffordable for patients in the state. The use of this drug can cost patients and insurance companies more than $46,000 per year.
The board also considered Genvoya, a combination drug for HIV, but decided the drug was affordable because of patient assistance programs.
The vote will allow the board to consider setting a maximum price for Enbrel when it meets again next week in Colorado, making it the first time any state has taken such action on a prescription drug. Friday’s meeting did not discuss what level drug price caps would be set at.
Enbrel is approved for multiple diseases in which the immune system attacks the body’s tissues, including four types of arthritis and the most common skin condition, psoriasis.
Hope Stoner, policy manager for the Colorado Consumer Health Initiative, said the vote was an important step toward lowering drug costs.
“Patients who rely on Enbrel, and frankly all patients, must be able to afford the medicine they need,” she said in a statement. “We support the board’s decision today and hope to establish payment caps so that patients receive financial relief alongside physical relief.”
Drug companies whose products are no longer before the board are warning that Colorado patients could no longer be able to buy their drugs if the state sets a price cap, but consumer advocates say They claim that this is a bluff to protect profits.
According to the state’s all-payer claims database, Enbrel costs more than $46,000 per patient per year, with patients covered by commercial insurance or Medicare Advantage averaging $2,295 in 2022. becomes. At least 3,400 people in the state were found to be using Enbrel that year, according to the database.
The Prescription Drug Affordability Commission’s mission is to determine whether drugs are affordable for patients, not for the system as a whole. The board ruled in December that the $200,000-a-year cystic fibrosis drug was affordable because the assistance program covered most of patients’ out-of-pocket costs.
A small survey found that most respondents who took Enbrel reported having at least one problem related to the cost of the drug. Eight of the 38 Coloradans surveyed said costs pushed them into medical debt, and 20 said they needed to cut other expenses. Nine people reported skipping doses of Enbrel or extending the time between doses to save money.
Amy Gutierrez, a board member and pharmacist, said she is concerned about the number of patients reporting affordability issues.
“This is a very high percentage of people who have to choose between paying rent and food and getting medicine and transportation,” she says.
Amgen, Enbrel’s maker, said in a letter to the board that patients could lose access to the drug if the state sets a lower price. But Brett Johnson, who spoke on behalf of Amgen at the board meeting, highlighted concerns in Friday’s remarks about Process and the perception that Enbrel is being treated differently than the cystic fibrosis drug Trikafta.
“About half of[Enbrel’s]patients who pay less than $100 said they had no trouble affording the drug,” he said.
Tiffany Westrick-Robertson, who spoke on behalf of the International Autoimmune and Autoinflammatory Arthritis Foundation, also spoke about the board’s commitment to increasing patient engagement and why some say affordability is an issue. expressed concern that not enough efforts were being made to clarify the issue.
“I’m very, very concerned,” she said.
Enbrel’s price has been rising since the late 1990s. According to the board’s draft affordability report.. Prices per patient in 2022 will be about $13,000 higher than in 2018, and the average patient co-payments will rise about $600 in that time.
Enbrel’s list price increased 1,582% from November 1998 to January 2024, excluding rebates paid to intermediaries. Pharmaceutical companies say rebates are one of the main reasons patients pay more for drugs, and so do insurers’ decisions about rebate amounts. The cost of taking over.
Still, board member Kathy Hershberger said raising list prices that much is a step too far.
“What[the increase]should be is up for debate, but it shouldn’t be 1,500%,” she said.
Genvoya’s per-patient costs also increased, increasing by more than $8,000 over four years to $32,196 in 2022. According to the board’s report on the drug. The co-payment allocated to patients was $2,616 in 2022, but directors say the government’s HIV patient program helps cover costs for people with incomes up to five times the federal poverty line. said Dr. Gail Mizner.
“This particular drug … patients are taking it because the program is robust,” she said.
All 22 people who responded to the Genvoya survey said their monthly drug costs were less than $100. However, four people reported having to cut costs in other areas of their lives to afford their medications.
The number of people using Genvoya in Colorado was cut in half from 2018 to 2022 as other drugs became available. Board member and pharmacist Justin Vandenberg said utilization trends suggest it may not be a major financial challenge for the state in the future.
“It looks like you’re probably catching this on the backend,” he said.
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