Prescription Drugs Under Review by CMS and State PDABs
| Brand Name | Non-Brand Name | Diseases/Conditions Treated | CMS | Colorado PDAB | Maryland PDAB | Oregon PDAB | Washington PDAB |
|---|---|---|---|---|---|---|---|
| Ajovy | fremanezumab-vfrm | Migraine headaches | Selected for 2025; Found affordable | ||||
| Anoro Ellipta | umeclidinium/vilanterol | Chronic obstructive pulmonary disease | Selected for 2026 negotiation | ||||
| Austedo; Austedo XR | deutetrabenazine | Chorea in Huntington’s disease, tardive dyskinesia | Selected for 2025 negotiation | ||||
| Basaglar | insulin glargine-yfgn | Diabetes | Selected for 2025; Found affordable | ||||
| Biktarvy | bictegravir/emtricitabine/tenofovir alafenamide | Human immunodeficiency virus type 1 infection | Selected for 2026 negotiation | ||||
| Botox | onabotulinumtoxinA | Cervical dystonia, chronic migraine, detrusor hyperactivity, overactive bladder, severe axillary hyperhidrosis, spastic disorders | Selected for 2026 negotiation | ||||
| Breo Ellipta | fluticasone furoate, vilanterol | Asthma, COPD | Selected for 2025 negotiation | ||||
| Cabometyx | cabozantinib | Advanced kidney cancer, neuroendocrine tumors, liver cancer, differentiated thyroid cancer | Selected for 2025 review | ||||
| Calquence | acalabrutinib | Chronic lymphocytic leukemia/small lymphocytic lymphoma, mantle cell lymphoma | Selected for 2025 negotiation | ||||
| Cimzia | certolizumab pegol | Crohn’s disease; Plaque psoriasis; Psoriatic arthritis; Rheumatoid arthritis |
Selected for 2026 negotiation | ||||
| Cosentyx | lxekizumab | Ankylosing spondylitis, enthesitis-related arthritis, non-radiographic axial spondyloarthritis, plaque psoriasis, psoriatic arthritis | Selected for 2026 Negotiation | Reviewed in 2024 and found unaffordable. Selected for 2025 UPL review. | Selected for 2025; Creates affordability challenges | ||
| Creon | pancrelipase (lipase-protease-amylase) | Treatment of exocrine pancreatic insufficiency due to cystic fibrosis or other conditions | Selected for 2025; Found affordable | ||||
| Dupixent | dupilumab | Asthma and nasal polyps which result in chronic sinusitis, eczema (atopic dermatitis), eosinophilic esophagitis, prurigo nodularis | Selected for 2025 review | ||||
| Eliquis | apixaban | Blood clots | Selected for 2023-24 negotiation | Selected for 2025; Found affordable | |||
| Emgality | galcanezumab | Migraine headaches | Selected for 2025; Found affordable | ||||
| Enbrel | etanercept | Psoriasis, psoriatic arthritis/tumor necrosis factor (TNF), rheumatoid arthritis | Selected for 2023-24 negotiation | Reviewed in 2024 and found unaffordable. UPL set in 2025. | Selected for 2025 review | ||
| Entresto | sacubitril/valsartan | Heart failure | Selected for 2023-24 negotiation | Selected for 2025; Found affordable | |||
| Entyvio | vedolizumab | Crohn’s disease; Ulcerative colitis | Selected for 2026 negotiation | ||||
| Erleada | apalutamide | Prostate cancer | Selected for 2026 negotiation | ||||
| Farxiga | dapagliflozin | Chronic kidney disease, diabetes, heart failure | Selected for 2023-24 negotiation | Selected for 2025 review | |||
| Fiasp | insulin | Diabetes | Selected for 2023-24 negotiation | ||||
| Generic | insulin glargine-yfgn | Diabetes | Selected for 2025; Found affordable | ||||
| Genvoya | elvitegravir,cobicistat, emtricitabine, tenofovir alafenamide | HIV | Reviewed in 2024 and found NOT unaffordable | ||||
| Humira | adalimumab | Rheumatoid arthritis, ankylosing spondylitis, axial spondyloarthritis without radiographic evidence of AS, chronic plaque psoriasis, psoriatic arthritis, Crohn’s disease, ulcerative colitis, hidradenitis suppurativa, panuveitis, active polyarticular juvenile idiopathic arthritis | Selected for 2025 review | ||||
| Humulin R U-500 (Concentrated) |
insulin regular | Diabetes | Selected for 2026 review | ||||
| Humulin R U-500 KwikPen | insulin regular | Diabetes | Selected for 2026 review | ||||
| Ibrance | palbociclib | Breast cancer | Selected for 2025 negotiation | ||||
| Imbruvica | ibrutinib | Blood cancers | Selected for 2023-24 negotiation | ||||
| Janumet, Janumet XR | sitagliptin,metformin | Type 2 diabetes | Selected for 2025 negotiation | ||||
| Januvia | sitagliptin | Diabetes | Selected for 2023-24 negotiation | ||||
| Jardiance | eepagliflozin | Diabetes, heart failure | Selected for 2023-24 negotiation | Reviewed in 2025 and found to pose affordability challenge | Selected for 2026 review; Selected for 2025 review, found affordable | ||
| Keytruda | pembrolizumab | Cancer | Selected for 2026 review | ||||
| Kisqali | ribociclib | Breast cancer | Selected for 2026 negotiation | ||||
| Lantus | insulin glargine-yfgn | Diabetes | Selected for 2025; Found affordable | ||||
| Lantus SolorStar | insulin glargine | Diabetes | Selected for 2025; Creates affordability challenges | ||||
| Lenvima | lenvatinib | Thyroid cancer; Endometrial cancer; Liver cancer; Kidney cancer |
Selected for 2026 negotiation | ||||
| Linzess | linaclotide | Chronic idiopathic constipation, irritable bowel syndrome with constipation | Selected for 2025 negotiation | ||||
| Mounjaro | tirzepatide | Diabetes | Selected for 2026 review; Selected for 2025 review, found affordable | ||||
| NovoLog | insulin | Diabetes | Selected for 2023-24 negotiation | ||||
| Nurtec | rimegepant, rimegepant sulfate | Migraine headaches | Selected for 2025; Found affordable | ||||
| Ocrevus | ocrelizumab | Multiple sclerosis | Selected for 2026 review | ||||
| Ofev | nintedanib | Idiopathic pulmonary fibrosis | Selected for 2025 negotiation | ||||
| Orencia | abatacept | Psoriatic arthritis; Rheumatoid arthritis | Selected for 2026 negotiation | ||||
| Otezla | apremilast | Oral ulcers in Behçet’s Disease, plaque psoriasis, psoriatic arthritis | Selected for 2025 negotiation | ||||
| Ozempic | semaglutide | Type 2 diabetes, type 2 diabetes and cardiovascular disease, obesity/overweight and cardiovascular disease | Selected for 2025 negotiation | Reviewed in 2025 and found to pose affordability challenge | Selected for 2026 review; Selected for 2025 review, found affordable | ||
| Pomalyst | pomalidomide | Kaposi sarcoma, multiple myeloma | Selected for 2025 negotiation | ||||
| Rexulti | brexpiprazole | Major depressive disorder; Schizophrenia; Agitation associated with dementia due to Alzheimer’s disease |
Selected for 2026 negotiation | ||||
| Rybelsus | semaglutide | Type 2 diabetes, type 2 diabetes and cardiovascular disease, obesity/overweight and cardiovascular disease | Selected for 2025 negotiation | Selected for 2025; Found affordable | |||
| Semglee | insulin glargine-yfgn | Diabetes | Selected for 2025; Found affordable | ||||
| Skyrizi | risankizumab | Crohn’s disease, plaque psoriasis, psoriatic arthritis | Selected for 2025 review | Selected for 2026 review | |||
| Stelara | ustekinumab | Crohn’s disease, plaque psoriasis, psoriatic arthritis, ulcerative colitis | Selected for 2023-24 negotiation | Reviewed in 2024 and found unaffordable. Selected for 2025 UPL review. | |||
| Toujeo Max SolorStar | insulin glargine-yfgn | Diabetes | Selected for 2025; Found affordable | ||||
| Toujeo SolorStar | insulin glargine-yfgn | Diabetes | Selected for 2025; Found affordable | ||||
| Tradjenta | linagliptin | Type 2 diabetes | Selected for 2026 renegotiation; Selected for 2025 negotiation | ||||
| Trelegy Ellipta | fluticasone furoate, vilanterol | Asthma, COPD | Selected for 2025 negotiation | Selected for 2025; Found affordable | |||
| Tremfya | guselkumab | Immune conditions; plaque psoriasis, psoriatic arthritis, ulcerative colitis | Selected for 2026 review | ||||
| Trikafta | eeexacaftor, tezacaftor, ivacaftor | Cystic fibrosis | Reviewed in 2023 and found NOT unaffordable | ||||
| Trulicity | dulaglutide | Glycemic control in type 2 diabetes mellitus, reduce the risk of major adverse cardiovascular events in type 2 diabetes mellitus | Reviewed in 2025 and found to pose affordability challenge | Selected for 2025; Creates affordability challenges | |||
| Ubrelvy | ubrogepant | Migraine headaches | Selected for 2025; Found affordable | ||||
| Verzenio | abemzciclib | Breast cancer | Selected for 2026 negotiation | Selected for 2026 review | |||
| Vraylar | rariprazine | Bipolar I disorder,major depressive disorder, schizophrenia | Selected for 2025 negotiation | Selected for 2025; Creates affordability challenges | |||
| Wegovy | semaglutide | Type 2 diabetes, type 2 diabetes and cardiovascular disease, obesity/overweight and cardiovascular disease | Selected for 2025 negotiation | ||||
| Xarelto | rivaroxaban | Blood clots, coronary or peripheral artery disease | Selected for 2023-24 negotiation | Selected for 2025; Found affordable | |||
| Xeljanz | tofacitinib | Psoriatic arthritis; Rheumatoid arthritis; Ulcerative colitis |
Selected for 2026 negotiation | Selected for 2026 review | |||
| Xifaxan | rifaximin | Hepatic encephalopathy, irritable bowel syndrome with diarrhea | Selected for 2025 negotiation | ||||
| Xolair | omalizumab | Asthma; Chronic spontaneous urticaria | Selected for 2026 negotiation | Selected for 2026 review | |||
| Xtandi | enzalutamide | Prostate cancer | Selected for 2025 negotiation | Selected for 2025 review |