• Colorado: The Colorado Prescription Drug Affordability Board (PDAB) voted to limit how much health plans in the state will pay for certain costly drugs, making it the first state to implement a cap on prescription drug prices. The first drug affected by the price cap is Amgen's arthritis medication Enbrel. In 2023, the average insurance plan in Colorado paid around $53,000 per person for the treatment. The price was capped at $600 per unit, which is the current maximum fair price set to go into effect in Medicare in January and roughly equal to $30,350 a year per person. "Affordability is a primary barrier to access," said Sophia Hennessy, lead policy research coordinator at the Colorado Consumer Health Initiative. "The PDAB is working hard to save Coloradans money on the highest cost prescription drugs. This groundbreaking upper payment limit on Enbrel has the potential to save $32 million from drug spending." However, Amgen has pushed back on the decision, saying PDAB acted "unlawfully" and that its actions "will create new access barriers for patients without improving affordability at the pharmacy counter." (Silverman, STAT+, 10/3)
• Pennsylvania: Highmark Health has appointed Karen Hanlon as its new president, effective immediately. As she takes on new duties as president, Hanlon will also retain her current position as the organization's COO. According to Modern Healthcare, Hanlon originally joined the system's insurance subsidiary, Highmark Inc., in 1997, and has held several leadership roles at the organization over the years, including CFO and treasurer of Highmark Health. Hanlon succeeds David Holmberg as Highmark's president. Holmberg is currently Highmark's CEO and board chair of Highmark Inc. "Karen is an exceptional leader with a deep understanding of both our organization and the health care industry," Holmberg said. "… As our industry continues to weather many challenges and we remain focused on delivering the best health experiences for those we serve, I look forward to this next step in Karen's leadership journey at Highmark Health and to our continuing work together to meet that objective." (DeSilva, Modern Healthcare, 10/8; Minemyer, Fierce Healthcare, 10/8)
• Washington: Costco will soon sell monthly supplies of Novo Nordisk's GLP-1 drugs Ozempic and Wegovy for $499 to members without insurance. According to Novo, the GLP-1 drugs will be sold at over 500 Costco pharmacies in the United States. The $499 out-of-pocket price is around half the list price of Ozempic and roughly two-thirds less than the list price of Wegovy. Currently, Novo offers monthly supplies of Ozempic and Wegovy for the same price on its direct-to-consumer website, as do CVS and Walmart. Costco executive members and those with Costco Citibank credit cards will also get an additional 2% discount, along with cash back rewards, when buying either of the drugs with a prescription. "We continue to find new ways to make access to our medicines more convenient, meeting people where they are," a Novo spokesperson said. (Venkat, The Hill, 10/3; Hassan, New York Times, 10/5)

Host Abby Burns invites Advisory Board experts Chloe Bakst, Aaron Hill, and Amanda Okaka to discuss the drivers behind rising drug costs and why traditional cost-saving strategies are falling short. They provide actionable guidance on how purchasers and plans can modernize their approach to utilization management and make moves toward integrating pharmacy and medical benefits in order to manage total cost of care — in other words, move toward value.