As states authorize and implement Prescription Drug Affordability Boards, health care stakeholders have raised concerns about both their decision-making processes and the potential negative consequences of those decisions. PDABs are inherently state-based organizations, and their board members are creating policy that impacts their state residents. Reasonable people might assume these policymakers live in the states they regulate, but reporting from Colorado indicates that’s not the case.
The Colorado Sun reports that 2 of the 5 members of the Colorado Prescription Drug Affordability Board don’t actually live in Colorado.
PDAB members are typically appointed to multi-year terms by the governor or state legislative leaders. In some states, like Colorado, PDAB members have been reappointed to new terms with little public discussion. Unlike members of the state legislature or statewide officeholders up for regular elections, there’s no mechanism for state residents impacted by PDAB decisions to directly remove PDAB members. And what if board members move out of state? In Colorado, they remain on the board.
Health care stakeholders continue to point out that PDAB decisions are likely to increase patient costs and decrease patient access. Out-of-state PDAB members are entirely insulated from the consequences of the regulations they implement. How can PDABs ensure accountability when members aren’t affected by their own decisions?
The new reporting also notes that “patient-advocacy organizations have questioned whether the board’s work will actually end up hurting the people who rely on the medicines the board is trying to make more affordable.”
Because health care regulation affects patient access and provider capacity, accountability matters. A recent survey found that 100% of specialist physicians interviewed expressed concern that PDAB decisions would create administrative burdens reducing their time for patient care. These are not merely hypothetical risks, they are concerns from those on the front lines.
Effective policymaking requires skin in the game. When regulators are shielded from their own decisions — with consequences including higher out-of-pocket costs, reduced pharmacy access, and delayed treatments — they lack an essential perspective. State residents deserve to know those making decisions about their health care live with those same decisions, particularly when PDABs across the country have yet to save patients a single dollar.
While the Colorado statute doesn’t require PDAB members to live in-state, the lack of personal exposure raises new concerns.