In a first-in-the-nation move, a Colorado panel has voted to limit what health plans in the state will pay for a costly arthritis treatment, a step that may encourage other states to pursue similar strategies to contain spending on prescription medicines.
The landmark vote by the Colorado Prescription Drug Affordability Board creates a so-called upper payment limit for the widely prescribed Enbrel medication, which is a blockbuster treatment sold by Amgen. As a practical matter, the decision establishes a payment ceiling for government agencies and commercial plans that provide health insurance for state residents.
The limit was set at $600 per unit, which is also the current maximum fair price that is set to go into effect in the Medicare program in January. This works out to approximately $30,350 a year per person, compared with roughly $53,000 that the average insurance plan in the state paid per person in 2023, according to state claims database.
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