In recent years, several states have established Prescription Drug Affordability Boards (PDABs) to address the escalating costs of medications. These boards are tasked with reviewing drug prices and, in some cases, have the authority to implement upper payment limits (UPLs) to cap the maximum amount that can be paid for specific drugs within their jurisdictions. As of April 2026, Colorado, Maryland, Minnesota, and Washington have granted their PDABs the authority to impose UPLs. The upcoming months are poised to be pivotal in determining the effectiveness and future direction of these boards.
PDABs are composed of appointed members representing various stakeholders in the drug supply chain, including patients, clinicians, pharmacists, insurers, and pharmacy benefit managers. Notably, most PDABs exclude representatives from the pharmaceutical industry to avoid potential conflicts of interest. The primary function of these boards is to conduct affordability reviews of select medications, considering factors such as the drug’s cost, market competition, and price increases. Based on these reviews, PDABs can recommend pricing solutions to the legislature or, in states with UPL authority, set price ceilings for certain drugs. ([csro.info](https://csro.info/advocacy/our-issues/drug-affordability-boards/prescription-drug-affordability-boards-what-you-should-know?utm_source=openai))
Implementing UPLs is a contentious aspect of PDABs’ authority. UPLs establish a maximum price for all purchases, sales, and reimbursements of a specific drug within the state. This cap typically applies to manufacturers, pharmacists, and providers but often excludes health plans and pharmacy benefit managers. The goal is to make medications more affordable for consumers; however, concerns have been raised about potential unintended consequences. For instance, if providers cannot procure drugs at or below the UPL, they may face financial losses, leading to reduced availability of certain medications and limited patient access. ([csro.info](https://csro.info/advocacy/our-issues/drug-affordability-boards/prescription-drug-affordability-boards-what-you-should-know?utm_source=openai))
Legal challenges further complicate the landscape for PDABs. In Colorado, a manufacturer has contested the state’s authority to impose UPLs, arguing that such limits conflict with federal authority and violate due process. This lawsuit underscores the delicate balance states must maintain between regulating drug prices and adhering to federal laws. ([multistate.us](https://www.multistate.us/insider/2026/2/25/prescription-drug-affordability-boards-face-legal-challenges-as-states-tackle-drug-costs?utm_source=openai))
Additionally, the effectiveness of PDABs in achieving their intended goals remains under scrutiny. While these boards aim to reduce prescription drug costs and increase access, some patient advocacy groups and provider organizations question whether they are truly accomplishing these objectives. The concern is that, despite the establishment of PDABs, patients may not experience significant relief from high medication costs. ([csro.info](https://csro.info/advocacy/our-issues/drug-affordability-boards/prescription-drug-affordability-boards-what-you-should-know?utm_source=openai))
As the implementation of UPLs progresses, the coming months will be critical in assessing the impact of PDABs on drug affordability and access. Stakeholders, including policymakers, healthcare providers, and patient advocacy groups, will closely monitor these developments to determine the viability and effectiveness of PDABs as a tool for controlling prescription drug costs.