Colorado Sued by Amgen Over PDAB Price Cap on Enbrel

November 13, 2025

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Amgen, the manufacturer of Enbrel (a rheumatoid arthritis and ankylosing spondylitis treatment), filed a lawsuit against the Colorado Prescription Drug Affordability Review Board (PDAB) after the board determined Enbrel to be “unaffordable” and established an upper payment limit (UPL) of $600 per 50mg unit of the drug. In the suit, Amgen claims the UPL, which imposes price caps on the sale or purchase of Enbrel beginning Jan. 1, 2027, is unconstitutional and jeopardizes patient access to the drug.

Amgen previously sued the PDAB when the board was first considering a UPL, but the lawsuit was dismissed by a federal judge on the grounds that the company had not demonstrated it would likely suffer harm from the Board’s actions. The case is scheduled for a preliminary hearing in Jan. 2026. Colorado is the first state to set a UPL through a PDAB.

legislation

Virginia and Hawaii Introduce PDAB Legislation

The Virginia Senate introduced a bill to establish a Prescription Drug Affordability Board (PDAB) to review drugs with a wholesale acquisition cost (WAC) of $60,000 or more per year or a WAC increase of $3,000 or more in any 12-month period. For drugs deemed to cause an affordability challenge, the legislation authorizes the PDAB to […]
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February 12, 2026

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Solutions

AHIP Shares Update on Plan Progress to Simplify Prior Authorization

AHIP shared progress on the voluntary, multi-year commitments made by AHIP, BCBSA, and leading health plans (including Cigna Healthcare) to streamline and simplify prior authorization. Health plans serving nearly 270 million Americans are participating in this initiative. The 2026 commitments took effect on Jan. 1 and include: reducing the scope of claims subject to prior […]
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February 12, 2026

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legislation

DOL Issues Proposed Rule on Improving Transparency into PBM Fees

Pursuant to President Trump’s Executive Order “Lowering Drug Prices by Once Again Putting Americans First,” the Department of Labor’s (DOL’s) Employee Benefits Security Administration (EBSA) issued a proposed rule that would require providers of PBM services and affiliated entities of brokerage and consulting services to disclose direct and indirect compensation to their self-funded ERISA fiduciary […]
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February 12, 2026

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