Amid rising prescription drug costs, several states are independently implementing measures to alleviate the financial burden on consumers. Unable to directly control drug prices, these states are instead targeting pharmacy benefit managers (PBMs) — the intermediaries who broker deals between drug manufacturers, insurance companies, and pharmacies.

Some states are exploring the establishment of drug affordability review boards to scrutinize pricing structures, while others have already enacted legislation aimed at enhancing transparency requirements for both manufacturers and PBMs.

These initiatives have garnered praise from advocates who argue that the federal government has been sluggish in its efforts to compel drug companies and insurers to reduce costs. However, critics warn that such measures might lead to pharmacy closures and stifle the development of new medications.

The move has drawn support from advocates who say the federal government is too slow when it comes to getting drug companies and insurers to lower costs and criticism from those who say lowering prices will lead to pharmacies closing and fewer drugs being developed.

Some laws require PBMs to pass discounts on to consumers or be more transparent in drug purchasing, others have review boards for prices, and others put copay caps on critical drugs like insulin.

At least 31 states have enacted nearly 70 laws to lower drug costs, according to the National Academy for State Health Policy.

In California, the state capped insulin costs for state-regulated plans and will offer a generic version for $11 a pen, while Maryland is allowing its drug affordability review board to lower prices for all plans, not just state employees, and Colorado has capped the price of the popular rheumatoid arthritis drug Enbrel.

Colorado is the first state to cap the price for all consumers when it comes to Enbrel, a drug used by nearly 2,600 Coloradans. Beginning in 2027, new insurers will pay no more than $31,000 a year for the drug, a decrease from the average insurance payment of $53,049 in 2023.

Other states have passed laws requiring PBMs to pass discounts on to consumers, instead of pocketing the difference between what they pay and what they charge insurers.

PBMs are dominated by three companies: CVS Health, Cigna and United Health Group. That has given those groups market power. Those companies that say they have lowered costs have pushed back against laws to limit prices.

So have drug companies. Amgen Inc., the maker of Enbrel, sued Colorado over the drug review board, saying it would cause economic harm to the company. A federal judge dismissed the lawsuit.