Following the establishment of the first Upper Payment Limit (UPL) in October 2025, Colorado is poised to continue setting UPLs for additional drugs deemed “unaffordable.” Maryland is expected to do the same.
The effectiveness and impact of the UPL implementation for Enbrel will have a strong influence on how Maryland and other states proceed with their UPL processes. Closely watched aspects of the implementation are likely to be the efficiency of refund payments to pharmacies (when pharmacy acquisition costs exceed the UPL), the value of monitoring reports on cost-sharing savings, and the outcome of Amgen’s second pending lawsuit against the Colorado PDAB.
CRA’s Life Sciences consultants, Chris Nüesch and Laura Jenkins, provide an overview of these factors and examine potential next steps for Colorado and other state PDABs as they continue their affordability review process and look for opportunities to set UPLs for other drugs.
