Next week, the Maryland General Assembly’s Legislative Policy Committee will vote on the Maryland Prescription Drug Affordability’s plan for setting upper payment limits with drug companies.
Those limits allow the state to negotiate with companies that are charging exorbitant prices for common drugs for insurance plans run by the state.
The Board finished its final plan on setting upper payment limits after years of work in September. By law, the Legislative Policy Committee must vote on the plan within 45 days of submission.
“We are hopeful that the legislative policy committee will approve it, and once that happens, we are hopeful that the board will use that authority to make high-cost drugs more affordable for state and local governments,” said Vincent DeMarco, president of Maryland Healthcare for All!, a drug affordability group.
The limits will only be implemented for insurance plans provided by state and local governments, however, lawmakers and advocates are currently working on a bill that would give the Board jurisdiction to set limits for private plans as well.
A law authorizing that authority was introduced in the General Assembly this year, but ultimately didn’t make it to the Governor’s desk.
The state established the board in 2019, however its work was pushed off due to funding issues.
“The idea behind these boards is for states to think about what a fair price would be that can increase access to these drugs for patients within the state,” said Rachel Sachs, a professor of health law at Washington University in St. Louis.
DeMarco said with the upper-payment limit structure in effect, the board now can focus on the drugs that need to be negotiated instead of coming up with the proper way to limit price.
In April, the board selected a handful of drugs it thinks fit the criteria of being cost prohibitive to Marylanders who are on state-run health insurance plans.
The drugs include the diabetes and weight loss medication Ozempic, ADHD drug Vyvance and Dupixent, a medication that’s used to treat asthma.
Others selected are Trulicity, Jardiance, Farxiga, Skrizi and Bikarvy.
The drugs were chosen out of hundreds of possible options for their high price and their widespread use.
All of the drugs under consideration meet the board’s definition of being cost prohibitive, meaning they cost more than $30,000 a year or $100 a month for generic versions.