Extend And Modify Prescription Drug Affordability Board

In 2021, the general assembly enacted SB 21-175, which created the prescription drug affordability board (board) in the division of insurance (division) and an affordability review process whereby the board may review costs associated with, and establish upper payment limits for, certain prescription drugs. The bill makes certain changes concerning the board.

Section 1 defines "board activity", and section 2 states that only board members, and not staff members or contractors of the division, are required to recuse themselves from any board activity or vote where they have a conflict of interest.Section 3 allows the chair of the board to cancel or postpone a board meeting for good cause.Section 4 makes certain changes to the procedure by which the board identifies prescription drugs that may be subjected to an affordability review, which changes take effect January 1, 2025. Section 4 also requires the board to report on its public web page certain information regarding its considerations.Section 5 removes language prohibiting the board from establishing an upper payment limit for more than 12 prescription drugs within a specified period.Section 6 establishes that an upper payment limit for a prescription drug is not a final agency action that is subject to judicial review until the board promulgates a rule establishing the upper payment limit.Sections 6 and 7 remove certain language describing an appeals process for appealing decisions of the board.Sections 8 and 9 extend the repeal and associated sunset review of the board from September 1, 2026, to September 1, 2031.Section 10 establishes that a denial of a request for benefits for a prescription drug that is unavailable in the state because a manufacturer has withdrawn the prescription drug from sale or distribution within the state is an "adverse determination" for which an individual may request an independent external review.

(Note: Italicized words indicate new material added to the original summary; dashes through words indicate deletions from the original summary.)

(Note: This summary applies to the reengrossed version of this bill as introduced in the second house.)