Health Care & Wellness
PDAB Implementation Challenges Slow State Drug Cost Efforts
June 8, 2026 | Mary Kate Barnauskas
Prescription Drug Affordability Boards have proven far more complex to stand up than many lawmakers anticipated, with states spending years just building out the staff, rules, and processes needed to function. States like Washington and Minnesota enacted their PDABs in 2022 and 2023, respectively, but have yet to complete a single affordability review, largely due to the time required to develop regulatory frameworks and hire staff. Colorado finalized its first upper payment limit in October 2025, but the limit won't take effect until January 2027, and the process has faced litigation along the way. No PDAB upper payment limit has taken effect yet, which means the broader debate over whether these boards can actually lower state prescription drug costs remains unresolved. States considering new PDABs are watching existing ones closely, and the operational track record so far has already shaped outcomes in places like Virginia, where a PDAB bill was vetoed, and New Hampshire, where its board was repealed.
