Many policymakers are looking for ways to reduce drug spending. Federal policymakers are not the only ones looking at the issue. In recent years, state Prescription Drug Affordability Boards (PDABs) have formed to reduce drug prices. A paper by Barthold et al. (2026) describes the what PDABs are:
As of April 2025, 12 states had enacted legislation to form Prescription Drug Affordability Boards (PDABs).5 Although the specific legislative directives vary across states, all PDABs aim to increase drug affordability for consumers while balancing state health care budgets. The primary functions are to identify high-cost drugs, conduct affordability reviews, recommend policies to state legislatures, and potentially set upper payment limits (UPLs) for certain drugs.
The paper also describes the methodology Washing State PDAB used to identify drugs for their review, as follows:
Branded drugs are eligible for affordability review if their wholesale acquisition cost (WAC) was at least $60,000 or their price increased above certain thresholds. Biosimilar products are eligible if their price was not at least 15% lower than the reference biologic product. Generic drugs are eligible if their WAC was at least $100 per 30-day supply and increased by at least 200% in a 12-month period. Eligible drugs were ranked according to 4 criteria with the following weights: total out-of-pocket costs (0.35), total costs (0.33), mean out-of-pocket costs among users (0.19), and total number of users (0.13).
Based on this approach, the Washginton PDAB identified 290 drug products. Of these, 4 drugs were selected for review: Cabometyx (cabozantinib), Enbrel (etanercept), Humira (adalimumab), and
Xtandi (enzalutamide).
While the paper does not focus on how PDAB’s impacted drug cost, the article is interesting in terms of how drugs were selected. You can read the full article here.
