In early October, an obscure state board in Colorado did what no government in the U.S. has ever done, setting a limit on how much insurers and patients could pay for a widely used prescription drug.
The price cap is the most far-reaching act by any of the roughly dozen state prescription drug affordability boards, or “PDABs,” created in recent years amid mounting frustration over the rising cost of prescriptions.
Meanwhile, Oregon’s PDAB is lagging.
The board has yet to complete one of its central functions: flagging nine drugs and one insulin product for risk of being excessively expensive. And its vice-chair, Amy Burns, called for it to disband during its October meeting because of its lack of accomplishments.
“We’ve been doing this for three plus years,” said Burns, who is also head of pharmacy services at southern Oregon-based insurer AllCare Health. “We’ve really come up with nothing that’s actually been enacted.”
While the board is pressing ahead with drug affordability reviews, its members now say a quirk in Oregon’s public meetings law — that transparency advocates say keeps governments from making decisions behind closed doors — is preventing them from accessing sensitive data they need to do their work.
The board’s slow progress highlights how the opaque pharmaceutical pricing system — which relies on rebates and complex negotiations — can hinder policymakers’ efforts to address the rising costs of drugs. Advocates who backed the board’s creation in 2021 are now frustrated by its lack of action.
“If people can’t afford their prescriptions, that’s a major problem,” said John Mullin, board president of the Oregon Coalition for Affordable Prescriptions. “That’s why it’s important to do (affordability determinations), so that we can hone in on potential action.”
More than half of Oregonians say they are worried about the cost of prescription drugs and over a quarter reported rationing medications, according to a 2024 survey by health care research nonprofit Altarum.
The board’s unfinished work — listing expensive prescriptions that could burden patients and health care systems — has meant lawmakers have less direction to guide policy decisions on pharmaceuticals, according to Mullin, whose group includes insurers and labor unions.
Shelley Bailey, chair of Oregon PDAB and co-owner of Central Drugs pharmacy, defended the board’s work in an interview with Street Roots, saying it’s still relatively new.
While the board has yet to identify specific drugs that pose potential affordability problems, she pointed out that it has produced research on generics and has continued its reviews of medications, which offer price trends and information on whether less costly options are available.
For example, the board’s review of the anti-psychotic drug Vraylar found that its wholesale acquisition cost has outpaced inflation and costs patients more than alternative medications. Another report compared the cost of Ozempic to other popular weight-loss drugs.
“This is the type of work we need to keep doing,” she said. “It’s just very difficult.”
‘Even the pharmaceutical industry was shaking their heads’
Maryland created the first prescription drug affordability board in 2019 following years of outrage-provoking headlines over medication prices. Those included “pharma bro” Martin Shkreli’s 5,000% hike of a lifesaving antiparasitic and Mylan’s steep increase in the price of life-saving EpiPens that cost just dollars to make.
The idea behind the board was that it would prevent future Martin Shkrelis by watching drug prices and scrutinizing those that spiked, said William Padula, assistant professor of pharmaceutical and health economics at the University of Southern California.
“The purpose of the PDAB was to stop bad actors that even the pharmaceutical industry was shaking their heads about,” said Padula, who advised Maryland lawmakers.
Padula said that while the approach of each state board will differ, the lack of a common methodology or data source to evaluate drug prices means they will struggle as they become established.
“They don’t have a validator to tell them they are doing this the right way,” he added.
Oregon lawmakers passed a bill in 2021 creating the board (the same year Colorado created its board). It began operating the following year with the requirement that it annually report on at least nine drugs and one insulin product that “may create affordability challenges” for patients and health care systems.
After two years setting up, the board voted in 2024 to halt its first affordability reviews because its members wanted to improve its criteria and wait for better data. Then in August, the board again delayed its work.
The board plans to vote on which drugs to designate as potentially unaffordable in January, Bailey said.
As it wrestled over reviews, the board faced a steady drumbeat of criticism from drugmakers and their trade group, the Pharmaceutical Research and Manufacturers of America, or “PhRMA,” who claim state PDABs are misguided and ignore the role of middlemen drug chain companies called pharmacy benefit managers in driving up drug prices. PhRMA did not respond to a request for comment.
PhRMA directors Dharia McGrew and Alexandra Hussey wrote a letter to the Oregon PDAB earlier this month, reiterating their concerns about the “lack of clarity surrounding the data” the board intended to use in its affordability reviews. They also reiterated that drug manufacturers often provide significant rebates, discounts and other price concessions in negotiations with insurers and middlemen companies that they said aren’t passed on to consumers.
Manufacturers’ price concessions play an important role in shaping costs in the drug supply chain. That includes how much money or “net pricing” drugmakers actually see after negotiations, as well as how much health insurers end up paying for medications and how much consumers pay in premiums.
But the public doesn’t get details about final prices, because information on drugmakers’ rebates and other concessions is proprietary.
Board calls press access ‘biggest impediment’
The board has access to extensive data on insurance claims and from regulators. But Bailey, the board’s chair, said the “biggest impediment” facing the board’s work on affordability reviews is not being able to see drugmakers’ net pricing or concessions.
The holdup, she said, is an unusual provision in Oregon’s public meeting law that allows members of the press to observe executive sessions of state boards and commissions. These sessions are otherwise closed to the public to allow officials to discuss sensitive matters like litigation, personnel and trade secrets.
Journalists are not allowed to report what happens during executive sessions. But even the idea of a reporter being present for discussions about closely guarded drug price negotiations has both PhRMA and Oregon PDAB members worried.
In January, PhRMA representatives wrote in a letter that members of the press are not bound by the board’s confidentiality policies and “there exists a substantial risk that confidential, proprietary, or trade secret information may be disclosed during executive session to persons who are not entitled to receive it and who may publish or otherwise misuse it.”
Bailey said drugmakers keep rebate and discount details secret because they lead to insurers paying different prices for the same drug. She also pointed out that of the four states that have PDABs with the ability to set price caps, none allow press into executive sessions.
John Murray, an eastern Oregon-based pharmacist and board member, said during its September meeting that questions over what is a media outlet “opens a whole can of worms.”
“If I was a manufacturer and I had rebate information and trade secret information that could be used against me by my competitor or somebody else, I would be hesitant to display that in executive session not knowing who the media outlets were or trusting that they are going to follow the law,” he said.
Other board members expressed similar hesitation and suggested having journalists sign confidentiality agreements or asking lawmakers for an exemption to the law.
Oregon Public Meetings Law does not include penalties for journalists who disclose information revealed in executive session.
But Brent Walth, a veteran journalist and associate professor of journalism at the University of Oregon, said he can’t recall a reporter violating it.
“As a journalist, you don’t want to be accused of being unethical,” he said.
Walth said giving reporters access to these meetings has worked well for over 50 years through a balance of “applying law and applying trust” that he said has deterred officials from abusing executive sessions to make consequential decisions behind closed doors.
State panels are limited in the policies they can adopt around press access to executive sessions. For example, they can’t limit attendance to one reporter from each type of news medium or require advanced notice. However, a presiding officer of a panel can direct journalists not to record an executive session.
The law includes some exceptions including for labor negotiations or a student’s medical records.
Walth said that while he understands the concerns of Oregon PDAB, he said they should try to solve the issue using existing state laws. Creating exemptions for one industry or special interest will cause others to start seeking them as well, he said.
“And the ability of journalists to watchdog our public officials will be eroded and potentially lost,” he said.
Next stop, price caps?
Despite its rocky start, Bailey said the board will complete its work on affordability reviews.
Charlie Fisher, director of the Oregon State Public Interest Research Group, said “2026 is going to be a good year for Oregon PDAB.”
Earlier this year, lawmakers passed a bill intended to reduce the board’s workload by requiring it to designate a maximum of nine drugs and one insulin product as potentially unaffordable. The new law goes into effect next year. Fisher said that will allow the board to focus its work on fewer drugs and produce more in-depth reviews.
Four state PDABs have varying authority to set price caps, or “upper payment limits,” on excessively expensive drugs. Colorado’s price cap on Enbrel, which treats rheumatoid arthritis, survived a lawsuit from Amgen, the drug’s manufacturer, but has since been appealed.
Oregon’s board has not embraced price caps out of concerns of provoking backlash. But Fisher said it should be the board’s goal.
“It really gets at the actual cost to consumers and the state,” he said.
But Padula, the health economics professor, said there is no guarantee that price caps will mean lower costs for consumers after drugmakers and insurance companies negotiate.
“You need another set of laws to make sure that the patient benefits,” he added.
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This article appears in November 5, 2025.