{"id":2348,"date":"2026-07-07T12:04:23","date_gmt":"2026-07-07T12:04:23","guid":{"rendered":"https:\/\/coloradospringsmoverss.com\/?p=2348"},"modified":"2026-07-07T12:04:23","modified_gmt":"2026-07-07T12:04:23","slug":"colorado-cant-cap-price-of-arthritis-drug-enbrel-federal-judge-rules","status":"publish","type":"post","link":"https:\/\/coloradospringsmoverss.com\/?p=2348","title":{"rendered":"Colorado can\u2019t cap price of arthritis drug Enbrel, federal judge rules"},"content":{"rendered":"
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Colorado can\u2019t cap the price of arthritis medication Enbrel while a lawsuit challenging the state\u2019s drug affordability board\u2019s action plays out, a federal judge ruled last week.<\/p>\n

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In 2024, the Colorado Prescription Drug Affordability Review Board declared Enbrel unaffordable, and last year it set an \u201cupper payment limit\u201d of about $31,000 per year. Amgen, which owns Enbrel, sued the state in November, seeking to block the price ceiling.<\/p>\n

Enbrel partially suppresses the immune system, reducing damage from rheumatoid arthritis and five other diseases where the body attacks its own tissues. As of 2023, insurance companies in Colorado paid about $53,000 annually for each patient using Enbrel, with patients\u2019 out-of-pocket costs averaging $4,600.<\/p>\n

The board also determined that two other drugs that treat autoimmune diseases, Cosentyx and Stelara, were unaffordable. It found that the cystic fibrosis drug Trikafta and the HIV drug Genvoya were affordable despite their high prices because of patient assistance programs.<\/p>\n

U.S. District Court Judge Daniel Domenico issued a preliminary injunction Wednesday preventing the state from putting the ceiling in place while the lawsuit continues. Before a plaintiff or defendant can get a preliminary injunction, they have to show that they\u2019re likely to succeed as the case plays out and that they\u2019d suffer clear harm if the court doesn\u2019t stop the other party from doing something.<\/p>\n

Colorado could appeal the injunction, but the state attorney general\u2019s office hasn\u2019t said if it plans to do that. Colorado Division of Insurance spokeswoman Genna Morton also declined to comment, but said the division is reviewing the judge\u2019s order.<\/p>\n

Domenico set aside the question of whether Enbrel\u2019s price was appropriate. Federal patent law prevents states from limiting the prices companies can charge, and any price ceiling would be inherently harmful to the seller, he said.<\/p>\n

If the state wants to help residents afford Enbrel, it could offer subsidies or attempt to negotiate prices, as Medicare has done under the Inflation Reduction Act, Domenico said.<\/p>\n

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\u201cBut one way it cannot do so under the binding precedent of the federal circuit, is by capping the price of a patented drug,\u201d he wrote.<\/p>\n

An upper payment limit means that Medicare, Medicaid and state-regulated private insurance plans couldn\u2019t pay more than a certain amount for their Colorado plan members, presumably putting pressure to cut the price further up the supply chain. Other types of private insurance could decide whether to adopt the limit.<\/p>\n

Drugmakers pulling out of Colorado because of a price ceiling would have to give six months\u2019 notice or pay a $500,000 fine. Pharmaceutical supply chains are complicated, and no one knows if a company would truly deem it worthwhile to leave a market entirely rather than sell at a lower price.<\/p>\n

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Adam Fox, deputy director of the Colorado Consumer Health Initiative, described the ruling as a \u201cstep backward\u201d for affordability in the state.<\/p>\n

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\u201cDrugs don\u2019t work if people cannot afford them and this is yet another example of pharmaceutical companies throwing their weight around to keep their prices high and squeeze all the money they can from consumers,\u201d he said in a statement. \u201cIt is disappointing this preliminary injunction has been granted, but it will not be the last word in this court case.\u201d<\/p>\n

The Pharmaceutical Research and Manufacturers of America trade group has pushed back against the concept of upper price limits, arguing that states would do better to target insurance companies and pharmacy benefit managers \u2014 the middlemen who determine which medications are easiest to access and what patients pay for them under their insurance plans.<\/p>\n

\u201cState bureaucrats promise savings through government price-setting policies like upper payment limits \u2014 but more often deliver more bureaucracy, higher administrative costs and disruptive supply chain impacts, with no clear evidence that patients will pay less,\u201d senior director of public affairs Reid Porter said in a blog post.<\/p>\n

Ultimately, no one knows what will happen if a price ceiling survives court challenges. Ten other states have created review boards, though Colorado\u2019s is furthest into the process.<\/p>\n

Amgen sued when the board first declared Enbrel unaffordable in 2024, but a judge threw out that lawsuit because it hadn\u2019t yet shown harm from the board\u2019s actions.<\/p>\n

Enbrel\u2019s original patent expired in 2018, but Amgen filed for more than 100 additional patents after buying the drug from its original developer. Generic alternatives won\u2019t hit the market until at least 2029.<\/p>\n

A estimated that the cost of Enbrel needed to drop roughly by half for it to be cost-effective for rheumatoid arthritis. At the time, the drug cost about $40,000 per year. (The review didn\u2019t consider other autoimmune conditions treated with Enbrel, which could have different cost-effectiveness thresholds.)<\/p>\n

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Colorado can\u2019t cap the price of arthritis medication Enbrel while a lawsuit challenging the state\u2019s drug affordability board\u2019s action plays out, a federal judge ruled last week.<\/p>\n","protected":false},"author":1,"featured_media":2347,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[17,4],"tags":[],"class_list":["post-2348","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-health","category-news"],"yoast_head":"\nColorado can\u2019t cap price of arthritis drug Enbrel, federal judge rules - Colorado Springs Moverss<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/coloradospringsmoverss.com\/?p=2348\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Colorado can\u2019t cap price of arthritis drug Enbrel, federal judge rules - 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