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Drug Affordability Boards

What are they?

Drug affordability boards, or prescription drug affordability boards (PDAB), are empowered by state legislatures to review the affordability of selected drugs, suggest drug pricing and affordability solutions, and set upper payment limits (UPL). The UPL serves as a cap on the acquisition cost and purchase price as well as reimbursement for a particular drug.

For a more in-depth overview of what drug affordability boards and upper payment limits are click here

Why is it important?

The pharmaceutical supply chain and contractual arrangements providing for the delivery of care are complex. The implementation of a UPL for a provider administered drug has the potential to disrupt access to provider administered drugs by:

  • Making the current reimbursement model for provider administered drugs impermissible
  • Creating an inability for providers to purchase drug products from outside of a state based on the state’s application of a UPL

What is CSRO doing about it?

CSRO is working to ensure that drug affordability board legislation does not disrupt rheumatologists’ ability to care for their patients. CSRO is a member of the Value of Care Coalition, which works to ensure that pricing reform policies continue to allow for access to innovative treatments while reducing patient out-of-pocket costs.

What can YOU do about it?

Visit our Legislative Map Tool to read about current step therapy laws or legislation in your state. You can send letters in support of pending legislation and find educational materials.

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