Terry Wilcox, the co-founder and Chief Mission Officer of Patients Rising, criticized the unelected and unaccountable Colorado Prescription Drug Affordability Board for imposing the nation’s first price control, or “Upper Payment Limit,” on a popular autoimmune medication that is used to manage rheumatoid arthritis, psoriatic arthritis, and other serious autoimmune conditions.
“Healthcare decision should be made by patients working with our doctors — not an unelected and unaccountable group of political appointees.”
“Colorado’s Prescription Drug Affordability Board is jeopardizing the health and well-being of patients living with rheumatoid arthritis, psoriatic arthritis, and other serious autoimmune conditions. This government price control experiment limits patients’ access to a critical medication.
There’s no guarantee that this UPL experiment will save patients a single penny at the pharmacy counter.
Throughout this process, patient voices were ignored. The data was flawed. The science was questionable. The decision was predetermined.
Government bureaucrats now stand between Colorado patients and their doctors. That’s not healthcare reform; that’s healthcare rationing in action.”
Background: Colorado PDAB Imposes Price Control
The unelected Colorado Prescription Drug Affordability Board (PDAB) voted on October 3, 2025, to establish an upper payment limit (UPL) for a popular autoimmune medication that is used to manage rheumatoid arthritis, psoriatic arthritis, and other serious autoimmune conditions.
The decision by the unelected Colorado PDAB imposes the nation’s first price control and effectively blocks patient access to care
action makes Colorado the first state in the nation to cap the price for a specific prescription medication. The UPL is effective starting January 1, 2027.
Despite its name, an Upper Payment Limit doesn’t cap what patients pay at the pharmacy. Instead, it limits what insurers and the state can reimburse for a medication. The Colorado board has no authority to control patient out-of-pocket costs, and there’s no guarantee any savings will reach patients.
Health plan executives surveyed by Avalere Health reported that 77% believe Upper Payment Limits will disrupt patient access through changes in coverage, drug tiering, and increased cost-sharing. Half of surveyed insurers said they would likely impose stricter utilization management tactics, including prior authorizations and step therapy requirements.
VIDEO: PDABs Bad Policy