1. What is a PDAB?

A Prescription Drug Affordability Board (PDAB) is a state-level body created by legislation to review high-cost prescription drugs, determine which are "unaffordable" to consumers, and — depending on the state — set binding price caps known as Upper Payment Limits (UPLs). States have established PDABs because federal law imposes almost no ceiling on what a manufacturer may charge, leaving price intervention largely to the states.

As of July 2026, nine states have active PDAB statutes, though their powers vary considerably; only four can cap a drug's price — and on July 1, 2026 a federal court blocked the first cap ever adopted.

2. How state PDABs formed

Maryland established the first PDAB in 2019. Additional states followed between 2021 and 2024 — most as review-and-recommend boards, four with full UPL authority. Two early boards, New Hampshire and Ohio, were repealed in 2025. The first binding price caps were adopted in 2025–2026, each with a delayed effective date. The nine boards active today, in order of creation:

Boards that were repealed

New Hampshire — enacted 2020 (HB 1280, RSA 126-BB), repealed 7/1/2025; no reviews completed.
Ohio — enacted 2019 (HB 166, ORC § 125.95), advisory-only and dormant since 2021, repealed 7/1/2025.

How UPL authority gets granted

UPL authority is conferred by state legislation: the legislature must enact a statute that expressly grants the board power to set price caps. All four UPL states acquired it the same way — built into the enabling statute at the outset: Maryland (2019), Colorado (2021), Washington (2022), and Minnesota (2023). Statutory citations appear with each board below.

The alternative route — a review-only board amending its statute to add cap authority after the fact — remains untested; no state has completed it. Maine is the furthest along: LD 697 (enacted January 7, 2026) directs its board to recommend UPL authority, which follow-up legislation could grant in 2027. Maine therefore remains a review/report board, and the number of UPL states stands at four.

Why the numbers stay small

Enactment is rarely the obstacle; the politics are. Two distinct thresholds account for the totals — why only nine states have established a PDAB, and why only four hold cap authority:

1. Establishing any PDAB requires a Democratic trifecta willing to legislate on drug pricing. All nine PDAB states are Democratic trifectas; no Republican-led state has enacted one. Even supportive states stall: Virginia's bill has been vetoed three years running — twice by Gov. Youngkin (R, 2024–25) and again by Gov. Spanberger (D) in May 2026.
2. Adding UPL cap authority clears a higher threshold. PhRMA, BIO, and state pharmacy associations oppose binding price caps most forcefully; only four of the nine boards hold that power, and none has added it since 2023.

3. Board authority and profiles

The nine active boards divide into two groups by the authority they hold — those that can cap a price, and those limited to review or reporting:

• PDAB + UPL — reviews a drug, declares it unaffordable, and sets a binding Upper Payment Limit on what carriers, pharmacies, and providers pay. Four boards: Colorado, Maryland, Minnesota, Washington.
• PDAB only — reviews and/or reports on drug prices but cannot set a binding cap. Five boards: New York, Oregon, Maine, Massachusetts (review/report) and New Jersey (transparency only).

PDAB + UPL authority

How a UPL gets adopted

Granting authority is a one-time legislative act; setting an individual cap is a separate, repeatable process the board conducts itself:

1. The board selects a drug and conducts an affordability review against statutory cost thresholds.
2. The board adopts the UPL administratively, through rulemaking rather than new legislation. In Maryland, the board's UPL action plan must first be approved by the Legislative Policy Committee; Colorado and other states set caps through standard agency rulemaking.
3. A delayed effective date applies. All three UPLs adopted to date (CO–Enbrel, MD–Jardiance, MD–Ozempic) take effect January 1, 2027; none is yet binding on payers.
4. Litigation can stop it before it starts. The delay between adoption and effect is exactly the window in which a manufacturer sues. Colorado's Enbrel cap was enjoined on July 1, 2026 — six months before it would have bound anyone.

What a UPL actually reaches

Once a cap takes effect, federal law limits its reach. A UPL cannot apply to Medicare beneficiaries (governed by federal Part D) or directly bind Medicaid (governed by federal Medicaid rules). It is also open to two distinct preemption attacks: the IRA theory, that federal Medicare drug-price negotiation already occupies the field; and the patent theory, that capping the price of a patented drug conflicts with the exclusivity federal patent law confers. Colorado's Amgen II suit pleaded the first and won on the second.

A UPL does reach state-employee health plans, commercial insurance sold in the state, and pharmacy and provider purchases — roughly 30–40% of a drug's volume in the state. Significant, but not comprehensive.

PDAB only

These boards can review and recommend but cannot set a price cap, which does not render them inconsequential. Oregon took up Keytruda at its July 15, 2026 review; no determination has been published yet. Absent UPL authority, no binding cap follows even if the board declares the drug unaffordable; the determination nonetheless carries weight. An unaffordability finding becomes a reference point other states cite, increases pressure on the Oregon legislature to grant UPL authority in a future session, and establishes methodology precedent applicable in Colorado, Maryland, and Washington.

4. Where things stand, 2025–2026

Current counts

The first price caps

No UPL is yet operationally in effect — all carry delayed effective dates — and the first one adopted has now been blocked in court:

• Oct 2025 — Colorado, Enbrel. First UPL in the nation ($600 per 50mg, roughly $31,000 a year against a current cost near $58,000); was to take effect Jan 1, 2027. Preliminarily enjoined July 1, 2026 and not currently enforceable.
• Apr 2026 — Maryland, Jardiance. Second UPL (~$204 per 30-day supply, set at the Medicare Maximum Fair Price); effective Jan 1, 2027.
• May 18, 2026 — Maryland, Ozempic. Third UPL ($274 per 30-day supply, also at MFP, state/local government plans); effective Jan 1, 2027.

The pattern that matters is the sequencing. Adoption is not the milestone it appeared to be nine months ago; the effective date is, and nothing has reached one yet. A cap adopted in October 2025 was still unenforceable in July 2026, and is now blocked indefinitely.

Legislation in flight

5. State-by-state summary

All nine active PDAB states have Democratic trifectas — a Democratic governor and Democratic control of both legislative chambers.

Sources

• NASHP PDAB Toolkit — nashp.org
• NASPA PDAB resource — naspa.us
• Multistate Insider — 2025 PDAB roundup — multistate.us
• Partnership for Safe Medicines — PDAB activity blog — safemedicines.org
• Colorado DOI PDAB page — doi.colorado.gov
• Maryland PDAB — pdab.maryland.gov
• Oregon PDAB — dfr.oregon.gov/pdab
• Washington PDAB (HCA) — hca.wa.gov
• Minnesota PDAB — mn.gov/commerce
• Maine PDAB — maine.gov/oahc
• Massachusetts HPC drug pricing — masshpc.gov
• New York DFS Drug Accountability — dfs.ny.gov
• New Jersey PDAC — njconsumeraffairs.gov
• Colorado Hospital Association — PDAB tracker — cha.com
• Congressional Research Service — PDAB litigation overview — congress.gov
• Colorado Sun — Enbrel UPL preliminary injunction, July 2026 — coloradosun.com
• Multistate Insider — PDAB implementation hurdles, June 2026 — multistate.us
• Capitol News Illinois — SB 3496 House passage — capitolnewsillinois.com
• Maryland Matters — Ozempic UPL vote, May 2026 — marylandmatters.org