Here’s What’s Happening With States’ Efforts to Set Payment Limits for Drugs
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Feb 27, 2025
While the federal government has already set negotiated prices for the first round of drugs subject to the Medicare Drug Price Negotiation Program, states that have the authority to set upper payment limits (UPLs) for medications are inching toward doing so — despite a variety of complications.
On the state level, the authority to set UPLs for select drugs is wielded by prescription drug affordability boards (PDABs), which states across the country have created in recent years amid mounting frustration over rising drug costs. Not all PDABs are authorized to set UPLs, but among the five boards that do, Colorado and Maryland are the furthest along in the process.
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