Lower cost of medications in Illinois by creating prescription drug affordability board

I first met Tracey when she was admitted to the hospital for incessant diarrhea and dehydration from an inflammatory bowel disease flareup.

As I pieced together her story from her chart, I learned she’d been battling Crohn’s disease for years, a journey initially marked by repeated emergency room visits, hospital stays and rounds of steroids.

Starting a biologic medication had been transformative; on paper, it had wiped her chart clean of any further hospitalizations. Outpatient notes celebrated her ability to regain control over her life, return to work and enjoy simple pleasures that her disease had once taken from her.

But as we spoke, I understood why she was back now. Her insurance had changed — she’d lost coverage for the biologic that had kept her stable, and at over $5,000 a month out of pocket, the medication was simply out of reach.

As a doctor, it’s frustrating when we have solutions for patients, but they can’t afford them. That’s why I support the creation of a Prescription Drug Affordability Board, also known as PDAB, in Illinois.

A PDAB could make a significant difference for patients like Tracey. PDABs have independent panels of experts who analyze the prices of expensive drugs and, when necessary, can establish upper payment limits for specific medications or negotiate with drug manufacturers, making them more affordable for patients.

By reviewing cost data and considering the health impact of each medication, PDABs ensure the most critical and costly treatments remain within reach for people who need them most.

The idea behind PDABs is not new nor is it radical. Maryland led the way establishing the first PDAB in 2019, and since then, many states have followed, including Colorado, Maine, Minnesota, New Hampshire, Oregon and Washington. Illinois has yet to take this step, leaving residents vulnerable to rising drug prices with little recourse.

The need for such a measure is urgent. Without a PDAB, Illinois patients must endure the uncertainties of an unregulated pricing landscape where drug costs are dictated by market dynamics and, increasingly, corporate profit margins.

For patients relying on expensive treatments for chronic conditions like inflammatory bowel disease, this can be devastating. Illinois has a chance to provide much-needed stability by adopting a PDAB that would help keep essential drugs affordable and accessible.

Some critics argue that PDABs could dampen pharmaceutical innovation by setting upper payment limits, potentially reducing the revenue companies reinvest in research. Yet, this concern appears unfounded and seemingly suggests these companies are merely getting by with limited resources left to allocate toward research and development.

In fact, a report from the U.S. House Committee on Oversight and Reform revealed that from 2016 to 2020, the 14 largest drug companies spent $577 billion on stock buybacks and dividends — $56 billion more than on research and development. Further, pharmaceutical industry engagement in the PDAB dialogue, hinting that research would be one of the first areas to face cuts, subtly raises questions about these companies' priorities.

In reality, pharmaceutical companies enjoy some of the highest profit margins across nearly all industries. The PDAB model doesn’t stymie innovation. Instead, it adds a measure of fairness to ensure life-saving drugs remain accessible to those who need them.

Illinois, with its diverse population and strong medical infrastructure, has an opportunity to show leadership. By establishing a PDAB, Illinois could join other states in providing patients with greater security over the cost of their health care, reducing the financial strain that often accompanies chronic health conditions.

For individuals like Tracey, a PDAB could mean the difference between managing her disease effectively and facing the debilitating hardships of untreated symptoms.

As Illinoisans, we should demand our state take action to address the rising cost of prescription drugs. A PDAB would be a critical step toward ensuring all residents, regardless of income, have access to the medications they need.

Rebecca Yao, M.D., is a gastroenterology fellow in Chicago.

The views and opinions expressed by contributors are their own and do not necessarily reflect those of the Chicago Sun-Times or any of its affiliates.

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