States Expand Prescription Drug Affordability Boards to Combat Rising Costs

Eleven states have established Prescription Drug Affordability Boards (PDABs) to address prescription drug costs, with four states authorizing upper payment limits (UPLs) though none implemented yet. Virginia's governor vetoed PDAB legislation for the second consecutive year, while Maryland expanded UPL authority. Colorado's PDAB survived a constitutional challenge from a drug manufacturer, with the court dismissing the case in March 2025.

The ruling is significant as it maintains the viability of PDABs and UPLs as a policy solution for states to address prescription drug costs. PDABs in Colorado, Maryland, Minnesota, and Washington have UPL authority, and as they move through the process of implementing UPLs, other states will be monitoring the impact and whether it is an effective approach to lower prices for consumers.

Legislation we’re watching this month, including Certificate of Need in Mississippi, facility fees in Oregon, Medicaid reform in Indiana, and more.

Virginia and Utah wrapped up their sessions with significant healthcare legislation. Both states enrolled legislation that stands to have significant influences to the state of healthcare delivery and coverage and public health.

With rising prescription drug costs a concern for consumers, state legislatures have taken an array of actions to contain costs. In recent years the establishment of Prescription Drug Affordability Boards (PDABs) has emerged as a strategy across the country. Eleven states have established a PDAB or a similar drug cost control entity. PDABs in four states (Colorado, Maryland, Minnesota, and Washington) have the authority to set upper payment limits (UPLs) on prescription drugs they determine to be unaffordable after review.