If you live with CRPS, you are likely an expert at navigating pharmacy counters and insurance appeals. But there is a new acronym in the healthcare landscape that might determine whether you can access your medication at all: PDABs.
Combined with a controversial metric called the QALY, these boards are changing the way the value of your life—and your relief—is calculated.
What is a PDAB?
A Prescription Drug Affordability Board (PDAB) is a state-level body created to curb rising drug costs. Think of them as a “watchdog” for medication pricing. They review specific high-cost drugs and, in some cases, can set “upper payment limits” (price caps).
While the goal of making medicine cheaper is noble, the method they use to decide if a drug is “worth it” is where the chronic pain community faces a significant risk.
The QALY: Measuring the “Quality” of Your Life
To decide if a drug is “cost-effective,” many boards rely on a metric called the Quality-Adjusted Life Year (QALY).
- 1.0 QALY represents one year of “perfect health.”
- 0.0 QALY represents death.
If a patient is living with a disability or chronic pain, the QALY system assigns their life a value less than 1.0.
The Problem: When a PDAB uses QALYs to determine if a pain medication is “worth the price,” the math is inherently biased. Because the system views a year of life with chronic pain as “lesser” than a year of life in perfect health, the “value” of a treatment that extends or improves that life is mathematically downgraded.
Why Chronic Pain Patients Should Be Concerned
Restricted Access: If a PDAB decides a drug isn’t “cost-effective” based on QALY math, insurance companies may stop covering it or move it to a “specialty tier” with massive co-pays.
Discrimination by Algorithm: Using QALYs can lead to “value-based” decisions that discriminate against the elderly and those with permanent disabilities. It suggests that a treatment for someone who will never reach “perfect health” isn’t as worth the investment.
Ignoring the “Patient Voice”: Metrics like QALYs often fail to capture the nuances of chronic pain, such as the ability to return to work, attend a child’s graduation, or simply experience a 20% reduction in daily agony.
What Can You Do?
The good news is that several states and federal advocates are fighting to ban the use of QALYs in drug evaluations, arguing that they violate the Americans with Disabilities Act (ADA).
Self-Advocate: If your state has a PDAB, find out when their public comment periods are. As of late 2025, the following states had PDABs: Colorado, Maine, Maryland, Massachusetts, Minnesota, New Hampshire, New Jersey, New York, Ohio, Oregon, and Washington. If your state has a PDAB, you can click here for updates.
Share Your Story: Data points don’t feel pain, but people do. Telling a board how a specific “expensive” medication allowed you to function can humanize the cold math of a QALY.
Support “Quality-Neutral” Metrics: Push for boards to use alternative measures that don’t discount the value of life based on disability status.
Your life is a 1.0, regardless of your pain score. Don’t let a PDAB tell you otherwise.
Lisa Van Allen, MS, PhD is a Pain Psychologist and the Chair of the RSDSA Advisory Board. When she’s not writing for the RSDSA or her own blog, you will find her trying to keep her pups out of the fresh paint on her canvases.