Opinion: Will Minnesota’s PDAB help—or harm—access to HIV medications?
Minnesota’s new Prescription Drug Affordability Board (PDAB) can set upper payment limits (UPLs) on high-cost drugs, but advocates warn caps could disrupt access—especially for people living with HIV who rely on ADAP, 340B, and wraparound services. Patient voices say affordability must not come at the expense of availability.
For the more than 11,000 Minnesotans living with or affected by HIV, access to affordable medications isn’t a luxury — it’s a matter of life and death. Across Minnesota, vulnerable populations who are living with HIV and other chronic conditions rely on government programs and solutions to afford and access their medications.
But one such “solution” Minnesota has implemented to control drug costs won’t have the intended impact for patients like me.
In recent years, numerous states have established Prescription Drug Affordability Boards (PDABs) to review and regulate the prices of certain medications. In 2024, Minnesota became the 11th state to establish a PDAB, granting a board of appointed individuals the authority to review the cost of medications and set upper payment limits (UPLs) on certain medications the board deems to be unaffordable.
Minnesota’s PDAB may be a well-intentioned attempt to lower costs, but good intentions don’t always lead to good outcomes for patients. Many of the Minnesota PDAB board members do not reflect the lived and diverse experiences of people who are impacted by the high cost of prescription drugs. This could be detrimental for already vulnerable patient communities and the long-standing initiatives that provide support to them.
Government programs such as the AIDS Drug Assistance Program (ADAP) and 340B Drug Pricing Program already negotiate significant drug discounts to serve vulnerable populations in Minnesota and around the country. Imposing artificial caps on reimbursement rates for certain drugs through a UPL at the state level could cause a negative ripple effect that upends the supply chain and stakeholders within it, including pharmacies, drugmakers, and patients who rely on these medications.
Colorado and Maryland, both of which implemented PDABs, serve as cautionary tales. Prescription drugs that are subject to a UPL in these states have the potential to become less available, which could leave patients scrambling to find alternative treatments for their condition. For people who rely on a daily HIV regimen, have cancer, or an autoimmune condition that requires consistent medication with no generic alternative, the consequences can be dire.
Limiting access through UPLs also cuts off critical services these programs help fund, including culturally competent care, community-based outreach, mental health support, and wraparound services that disproportionately benefit LGBTQIA2S+ individuals, communities of color, and others harmed by our fragmented healthcare system.
That’s why intentional patient engagement with PDABs is so important. In a recent opinion, the executive director of the Minnesota PDAB praised the newly established board, citing polling that highlights affordability challenges and promising to address those issues through the establishment of UPLs.
However, as a new board with limited outputs, more time is needed to understand how the PDAB will benefit Minnesotans who rely on prescription drugs. While affordability is a critical concern, it must be addressed without compromising access.
New research from the Partnership to Fight Chronic Disease (PFCD) reveals that 77% of health plan payers believe UPLs will disrupt patient access to medications. UPLs set a limit on the amount a provider, who is responsible for storing and administering the medication, can reimburse for that treatment. When faced with lower reimbursement rates, providers may be forced to prescribe a different, often less effective medication.
As someone who has lived with HIV for 13 years and manages other chronic conditions, I know firsthand how life-altering a diagnosis can be, and how damaging it is when systems and insurance structures fail the people they claim to serve. It was through that mistreatment and barriers with access to care that I found my voice as an advocate.
Patients and those who care for them should stand ready to participate in this process. Attend meetings of the Minnesota PDAB. Ask questions. Speak up. Because policies made without community input often do more harm than good.
PDAB members, especially those who represent or work directly with communities in their daily roles, have a responsibility to educate the public, advocate on their behalf, ensure that decisions truly benefit patients who rely on prescription medications. PDABs must also ensure that patients, providers, and caregiver representatives who experience the real-world impact of treatments are represented on PDABs, not just in an advisory capacity.
If PDABs fail to fulfill their intended purpose of making medications more affordable for patients, they can be repealed, just as New Hampshire’s PDAB was.
Patrick Ingram is a Minnesotan, a board member of the Community Access National Network (CANN), an advocate for patients with HIV and other chronic diseases, and a co-chair of the MN African American State Health Advisory Council.