The Prescription Drug Affordability Board (PDAB) & The Data Mart
In June 2021, Colorado passed SB21-75 and became the first state in the country to allow a nonpartisan board to review high-cost drugs and possibly set payment limits for those they determine to be unaffordable. Overseen by the Colorado Division of Insurance (DOI), the bill names the Colorado All Payer Claims Database (CO APCD) as a primary source of information, as requested by the payers and pharmacy benefit managers.
CIVHC has been collecting information on prescription drug rebates from payers since 2018 and has continued to expand the data gathered over the years. As administrator of the CO APCD, CIVHC maintains the Data Submission Guide (DSG), which helps payers understand what data elements must be submitted and in what format. Each year, it is updated to add new data that will bring new insight to the CO APCD or clarify submission guidelines.
The table below shows the nine data elements legislated to be collected and reported on from the CO APCD under the banner of the PDAB. The elements listed in dark grey were already feasible for CIVHC to report on based on current data being collected in the CO APCD. However, those in green could not be derived from current CO APCD data and were included in DSG 13 as a separate annual file submission that payers report to CIVHC outside of their monthly submissions.
As CIVHC collected and verified the first PDAB annual data files in the fall of 2022, the intake team worked closely with payers to familiarize them with the new processes and identify parts of the legislated reporting that need further definition. CIVHC incorporated suggestions from payers on what submitted data fields needed clarification or correction into DSG 14, which went into effect in 2023.
Data Mart
The DOI and the PDAB are not only breaking ground nationally by lowering prescription drug prices, they are also helping CIVHC test the Data Mart - a new way of providing access to non-public CO APCD data. The Data Mart marks a substantial change in how this information is delivered, with users securely logging directly into the CO APCD data enclave. Once the requested data is loaded, users can build basic data aggregations, visualizations, and develop geographic analyses within the specialized CO APCD environment. CIVHC partnered with legal, compliance, and privacy/security advisors throughout development to determine the necessary parameters that would ensure patient privacy and compliance with federal laws. Since the Data Mart has been operational, CIVHC’s testers have expressed that it has been helpful and has increased their ability to use CO APCD data. CIVHC is looking into expanding the viability of the Data Mart model in the future.
The DOI used the data they received through the Data Mart to create this dashboard, which explores the drugs that are eligible for review by the PDAB and the criteria used for selection. You can learn more about the dashboard and the PDAB by watching this recent webinar - Curbing Prescription Drug Costs in Colorado.