Many policymakers are looking for ways to reduce drug spending. Federal policymakers aren’t the only ones considering the issue. In recent years, state Prescription Drug Affordability Boards (PDABs) have been formed to reduce drug prices. A paper by Barthold et al. (2026) describe what PDABs are:
By April 2025, 12 states had enacted legislation to create Prescription Drug Affordability Boards (PDABs).5 Although specific legislative directives vary across states, the goal of all PDABs is to increase drug affordability for consumers while balancing state health care budgets. The primary functions are to identify high-cost drugs, review affordability, recommend policies to state legislatures, and potentially set upper payment limits (UPLs) for certain drugs.
The paper also describes the Washing State PDAB methodology used to identify drugs for review, as follows:
Branded drugs are eligible for affordability review if their wholesale acquisition cost (WAC) was at least $60,000 or their price increased above certain thresholds. Biosimilar products are eligible if their price is not at least 15% lower than the reference biological product. Generic drugs are eligible if their WAC per 30-day supply was at least $100 and increased at least 200% over a 12-month period. Eligible drugs were ranked according to 4 criteria with the following weights: total out-of-pocket cost (0.35), total cost (0.33), average out-of-pocket cost among users (0.19), and total number of users (0.13).
Based on this approach, the Washington PDAB identified 290 drug products. Of these, 4 drugs were selected for review: Cabometyx (cabozantineb), Enbrel (etanercept), Humira (adalimumab), and
Xtandi (enzalutamide).
Although the paper does not focus on how the PDAB affected drug costs, the article is interesting in the context of how the drugs were selected. You can read the full article here.
