Stop the Minnesota Prescription Drug Affordability Board

This Minnesota Legislation Could Reward Insurersand Hurt Patients

An ill-conceived plan in Minnesota could threaten patients’ access to critical medicines by giving greedy insurance companies more freedom to deny coverage to those in need.

That plan is to implement a so-called “Prescription Drug Affordability Board” (PDAB), which sounds great but could have a terrible downstream effect. Advocates and patients must do what we can to fight this legislation and call on Minnesota lawmakers to reject this proposal. 

Why The Minnesota Legislature’s PDAB
Is a Windfall For Insurers

Empowering The Expansion of Coverage Denials From Insurers

Many patients have experienced appealing time and time again to their insurance companies for the coverage they need in seeking treatment, but a PDAB in Minnesota could make that experience a whole lot worse.

By imposing an “upper payment limit” (UPL) on certain medicines, payers seeking reimbursement cannot bill above the mandated price. At first impression, this seems well-intended, but by imposing these mandates, insurers could have the ability to deny coverage based on the board’s rulings since the policy doesn’t require health plans to use the UPL to set the price a patient would have to pay. There’s plenty of reason to believe that costs at the pharmacy counter wouldn’t even be lowered as a result.

Insurance companies already have wide discretion to deny coverage for treatments they supposedly deem not “medically necessary.” Data from a Kaiser Family Foundation study shows that about 1 in 7 claims for treatments are already rejected by insurance companies as it is. Do Minnesota lawmakers want to support billion-dollar insurance companies denying coverage to chronically ill patients? This legislation does not assure us that insurers won’t use the PDAB as a tool to deem a drug as too expensive to cover. Even more concerning is that members of this board could be the very insurance company executives that have proven time and again to deny medically essential treatments to benefit their bottom line.

This Cannot Stand

If implemented, patients with cancer, rare diseases, chronic illnesses, and other health problems could have fewer drugs and treatments to choose from, ultimately compromising their health.

A PDAB is also a boon to insurance companies, and the benefits simply don’t stack up for patients seeking the help they deserve. The Minnesota legislature must remove the prescription drug affordability board and it’s upper payment limit from all pending legislation. Patients must always be the prime benefactors of any health policy introduced in this country, not the insurance companies that have failed us time and again.


Patients Rising Now is urging the Minnesota legislature to vote NO on this prescription drug affordability board, and so should you!