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 |
|---|---|---|---|---|---|---|---|
| Tradjenta | Linagliptin | Type 2 diabetes | Selected for 2026 negotiation | ||||
| Anoro Ellipta | umeclidinium/vilanterol | Chronic obstructive pulmonary disease | Selected for 2026 negotiation | ||||
| Biktarvy | Bictegravir/emtricitabine/tenofovir alafenamide | Human immunodeficiency virus type 1 infection | Selected for 2026 negotiation | ||||
| Entyvio | vedolizumab | Crohn’s disease; Ulcerative colitis | Selected for 2026 negotiation | ||||
| Kisqali | ribociclib | Breast cancer | Selected for 2026 negotiation | ||||
| Cimzia | certolizumab pegol | Crohn’s disease; Plaque psoriasis; Psoriatic arthritis; Rheumatoid arthritis |
Selected for 2026 negotiation | ||||
| Erleada | apalutamide | Prostate cancer | Selected for 2026 negotiation | ||||
| Orencia | abatacept | Psoriatic arthritis; Rheumatoid arthritis | Selected for 2026 negotiation | ||||
| Xolair | omalizumab | Asthma; Chronic spontaneous urticaria | Selected for 2026 negotiation | ||||
| Rexulti | brexpiprazole | Major depressive disorder; Schizophrenia; Agitation associated with dementia due to Alzheimer’s disease |
Selected for 2026 negotiation | ||||
| Xeljanz | tofacitinib | Psoriatic arthritis; Rheumatoid arthritis; Ulcerative colitis |
Selected for 2026 negotiation | ||||
| Lenvima | lenvatinib | Thyroid cancer; Endometrial cancer; Liver cancer; Kidney cancer |
Selected for 2026 negotiation | ||||
| Lantus SolorStar | Insulin Glargine | Diabetes | Selected for 2025; Creates affordability challenges | ||||
| 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 | |||
| Vraylar | Rariprazine | Bipolar I disorder,major depressive disorder, schizophrenia | Selected for 2025 negotiation | Selected for 2025; Creates affordability challenges | |||
| 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 | ||
| Ajovy | Fremanezumab-vfrm | Migraine headaches | Selected for 2025; Found affordable | ||||
| Basaglar | Insulin Glargine-yfgn | Diabetes | Selected for 2025; Found affordable | ||||
| Creon | Pancrelipase (Lipase-Protease-Amylase) | Treatment of exocrine pancreatic insufficiency due to cystic fibrosis or other conditions | Selected for 2025; Found affordable | ||||
| Eliquis | Apixaban | Blood clots | Selected for 2023-24 negotiation | Selected for 2025; Found affordable | |||
| Emgality | Galcanezumab | Migraine headaches | Selected for 2025; Found affordable | ||||
| Entresto | Sacubitril/valsartan | Heart failure | Selected for 2023-24 negotiation | Selected for 2025; Found affordable | |||
| Jardiance | Eepagliflozin | Diabetes, heart failure | Selected for 2023-24 negotiation | Reviewed in 2025 and found to pose affordability challenge | Selected for 2025; Found affordable | ||
| Lantus | Insulin Glargine-yfgn | Diabetes | Selected for 2025; Found affordable | ||||
| Generic | Insulin Glargine-yfgn | Diabetes | Selected for 2025; Found affordable | ||||
| Mounjaro | Tirzepatide | Diabetes | Selected for 2025; Found affordable | ||||
| Nurtec | Rimegepant, Rimegepant sulfate | Migraine headaches | Selected for 2025; Found affordable | ||||
| 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 2025; Found affordable | ||
| 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 | ||||
| Toujeo Max SolorStar | Insulin Glargine-yfgn | Diabetes | Selected for 2025; Found affordable | ||||
| Toujeo SolorStar | Insulin Glargine-yfgn | Diabetes | Selected for 2025; Found affordable | ||||
| Trelegy Ellipta | Fluticasone Furoate, Vilanterol | Asthma, COPD | Selected for 2025 negotiation | Selected for 2025; Found affordable | |||
| Ubrelvy | Ubrogepant | Migraine headaches | Selected for 2025; Found affordable | ||||
| Xarelto | Rivaroxaban | Blood clots, coronary or peripheral artery disease | Selected for 2023-24 negotiation | Selected for 2025; Found affordable | |||
| Botox | OnabotulinumtoxinA | Cervical dystonia, chronic migraine, detrusor hyperactivity, overactive bladder, severe axillary hyperhidrosis, spastic disorders | Selected for 2026 negotiation | ||||
| Verzenio | Abemzciclib | Breast cancer | Selected for 2026 negotiation | ||||
| Austedo; Austedo XR | Deutetrabenazine | Chorea in Huntington’s disease, tardive dyskinesia | Selected for 2025 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 | ||||
| Dupixent | Dupilumab | Asthma and nasal polyps which result in chronic sinusitis, eczema (atopic dermatitis), eosinophilic esophagitis, prurigo nodularis | Selected for 2025 review | ||||
| 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 | ||
| 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 | ||||
| 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 | ||||
| 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 | ||||
| Linzess | Linaclotide | Chronic idiopathic constipation, irritable bowel syndrome with constipation | Selected for 2025 negotiation | ||||
| NovoLog | Insulin | Diabetes | Selected for 2023-24 negotiation | ||||
| Ofev | Nintedanib | Idiopathic pulmonary fibrosis | Selected for 2025 negotiation | ||||
| Otezla | Apremilast | Oral ulcers in Behçet’s Disease, plaque psoriasis, psoriatic arthritis | Selected for 2025 negotiation | ||||
| Pomalyst | Pomalidomide | Kaposi sarcoma, multiple myeloma | Selected for 2025 negotiation | ||||
| Skyrizi | Risankizumab | Crohn’s disease, plaque psoriasis, psoriatic arthritis | Selected for 2025 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. | |||
| Trikafta | Eeexacaftor, Tezacaftor, Ivacaftor | Cystic fibrosis | Reviewed in 2023 and found NOT unaffordable | ||||
| Wegovy | Semaglutide | Type 2 diabetes, type 2 diabetes and cardiovascular disease, obesity/overweight and cardiovascular disease | Selected for 2025 negotiation | ||||
| Xifaxan | Rifaximin | Hepatic encephalopathy, irritable bowel syndrome with diarrhea | Selected for 2025 negotiation | ||||
| Xtandi | Enzalutamide | Prostate cancer | Selected for 2025 negotiation | Selected for 2025 review |