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Colorado officials will soon make far-reaching decisions that could have unintended consequences for some of the state’s most vulnerable residents.

The decision, expected from the Prescription Drug Affordability Board, concerns whether certain drugs, including popular treatments for Crohn’s disease, psoriasis and psoriatic arthritis, are affordable. If the panel decides they are not, it can set a cap on payment, preventing insurance plans from paying more than the set price.

Unfortunately, this is a one-sided approach to the problem of patient financial opportunity. If Colorado policymakers took a holistic view of the system, they would recognize that the biggest driver of high out-of-pocket costs for patients is the interconnectedness of middlemen, including insurers and their pharmacy benefit managers, who profit from drug manufacturer rebates and high patient copayments and deductibles.

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Real reform would address abuses in these areas. The PDAB’s narrow-minded approach is unlikely to lower costs for patients at the pharmacy counter and could make it impossible for Coloradans to get the medications they need, as many pharmacies and hospitals will struggle to obtain drugs subject to PDAB price controls.

For example, suppose the board sets a price that is below what a pharmacy or hospital can afford to buy the drug. Perhaps some successful pharmacies and hospitals in affluent areas will continue to sell the drug at a loss, expecting to recoup the revenue from other drugs. But providers currently struggling to make ends meet in poor rural or urban areas may decide they have no choice but to discontinue the drug and send patients elsewhere.

Extensive research has shown that patient behavior changes when availability decreases.

Many patients live in areas where home delivery is not available, and some must travel further to find a pharmacy that stocks their medications. For the state’s wealthier patients, the extra transportation may be merely inconvenient. But for patients from marginalized communities, the difference can be critical.

Consider that black and Hispanic patients are already significantly more likely to live in “pharmacy deserts.” Compared to white patients, black patients are also more likely to have to travel more than five miles from home to reach the nearest health facility.

These differences matter. Transportation problems lead to an increase in prescription non-adherence – when patients do not take their medications as prescribed.

Delaying or interrupting treatment for chronic diseases can lead to flare-ups and accelerate disease progression without the possibility of reversal. In the long run, patients will spend more on their health care than they otherwise would have.

State lawmakers had good intentions when they created the panel. In fact, a national initiative on the narrow issue of drug prices is already underway in Washington, D.C., at the Centers for Medicare and Medicaid Services. The Inflation Reduction Act of 2022 gave officials the authority to negotiate with drugmakers over the prices of a growing list of drugs for federal programs. Efforts by individual states to impose similar price controls will likely create further confusion and uncertainty about availability.

A far more effective way to increase drug affordability for patients in Washington and Colorado would be to keep the middlemen in the drug supply chain between manufacturers and patients in check. Bureaucrats are sucking billions out of the system without adding any real value and without providing any relief for patients on their copayments.

Patients continue to raise these and other concerns before the panel. It is not too late to change this misguided approach. Let us hope that the five unelected members of the Colorado PDAB are receptive to feedback from the thousands of patients most likely affected by their decisions and consider all the factors that contribute to patient affordability issues.

Kristi Kibler is the CEO of Lupus Colorado, founded in 1972 to provide support, education and training to all those affected by lupus.