DENVER, Colo. — Colorado has become the first state in the nation to implement a prescription drug price cap, targeting Enbrel, an expensive injectable medication used to treat several autoimmune conditions.
On Friday, the Colorado's Prescription Drug Affordability Review Board (PDAB) set the cap at $600 for a 50-milligram dose of Enbrel, which adults typically take weekly. Over the course of a year, this amounts to $31,200 — significantly less than what insurance companies and patients have been paying.
According to 2023 data from the Board, insurance companies paid approximately $53,000 annually for each customer using Enbrel, while patients paid about $4,600 out of pocket each year.
Since the drug was introduced in 1998, its wholesale price has increased more than 1,500%.
The cap comes after PDAB deemed the drug Enbrel "unaffordable" in February 2024.
PDAB was established by the state in 2021 to review prescription drug prices and determine whether certain drugs are unaffordable for Colorado consumers.
"This is groundbreaking," said Priya Telang, communications manager at the Colorado Consumer Health Initiative.
Telang emphasized the bipartisan nature of healthcare affordability concerns.
"It's a bipartisan issue," she told Denver7. "Everyone has issues accessing and affording health care in general, but particularly for prescription drugs. This is just the start of so many consumer savings."
However, the price cap has raised concerns among local pharmacies about potential financial impacts.
Ali DiLorenzo, lead technician at Wheat Ridge Professional Pharmacy, explained the financial burden these expensive medications place on pharmacies.
"It is a very expensive med. It's over $7,000," DiLorenzo said, referring to the monthly cost. "Insurance companies don't really reimburse you."
DiLorenzo expressed concern about how the price cap might affect independent pharmacies that are already operating on thin margins.
"Taking a loss on a quarter of your scripts is not a business," DiLorenzo said.
After PDAB deemed the drug Enbrel "unaffordable," the pharmaceutical company, Amgen, which makes the drug, filed a federal lawsuit to stop the board from pursuing a price cap.
A federal judge dismissed the case in March 2024, saying Amgen did not have enough to prove this would cause the company harm. Amgen is appealing.
Now that the price cap has been officially set, more litigation is anticipated.
