Maryland drug affordability board considers eight drugs for first cost review

The board’s five members voted unanimously to refer the preliminary list to be discussed by the board’s Stakeholder Council, a group of about two dozen people who represent hospitals, nurses, physicians, insurance companies, drug companies, pharmacy benefit managers and other players in the prescription drug market.

That group, which meets April 29, will provide feedback that members of the Prescription Drug Affordability Board will consider when making their final vote to approve the list May 20. Only at that time will the board begin its inaugural cost review process. And there will be ample opportunity for public comment between then and now, said Andrew York, the board’s executive director.

The Prescription Drug Affordability Board, created by the General Assembly in 2019, was the first board in the country to have the power to establish upper payment limits for high-cost prescription drugs. However, the board has not yet exercised that authority – and it will be a while until it does so.

The board is still drafting an action plan for how it will go about creating caps for drug prices. That plan will need to be approved by board members and go before the General Assembly’s Legislative Policy Committee before it can be used.

While lawmakers discussed a bill this session that would have expanded the scope of the Prescription Drug Affordability Board, that bill did not move forward. For now, the board only has authority to establish how much state and local governments are allowed to spend on certain prescription drugs.

The board selected the eight drugs it is considering for a cost review from a list of 2,287 drugs that were eligible under the board’s rules and regulations, York said in a presentation during Monday’s meeting. They include:

All of the drugs are in the top 100 prescription drug products with the highest total patient out-of-pocket costs and the highest gross spending for insurers, according to materials from Monday’s board meeting.

Two of the drugs – Biktarvy and Dupixent – have a wholesale acquisition cost that is more than $30,000, according to the materials. That cost is the manufacturer’s list price for a drug to wholesalers or direct purchasers in the country, which doesn’t include rebates or other price reductions.

Pharmaceutical Research and Manufacturers of America, a powerful trade organization that has aggressively lobbied against allowing Medicare to negotiate drug prices for Medicare recipients, has also strongly opposed the actions of Maryland’s Prescription Drug Affordability Board.

“Above all else, members of this board should prioritize medicine access and affordability for Marylanders – government price setting simply is not the answer,” Stami Williams, a spokesperson for the organization, said in an email on Monday. “After half a decade and millions of dollars to support the board, this process has failed to save patients one cent and their concerns are going unaddressed. Putting decisions that should be between patients and doctors in the hands of unelected bureaucrats is not working.”

A representative of Gilead and others supportive of the company’s HIV drug Biktarvy spoke at Monday’s meeting, raising concern that establishing an upper payment limit for the medication would stymie research and innovation.

Michael Knaapen, government affairs manager of the HIV+Hepatitis Policy Institute – an organization funded by drugmakers including Gilead and AbbVie, according to its website – said focusing on pharmacy benefit manager reform may be a more effective way of lowering out-of-pocket costs for patients. He also noted that a drug’s list price doesn’t tell the whole story of how much it actually costs patients.

“This board’s decision on one medicine could change the pricing landscape in ways that undermine clinical judgment and patient choice in favor of costs unrelated to care,” he said during the public comment period. “As you consider which drugs to select for further review, please be mindful of the complexities involved in HIV and AIDS medication pricing.”

Gerard Anderson, a member of the Prescription Drug Affordability Board and a professor of health policy and management at Johns Hopkins University, said his main concern is lowering out-of-pocket drug spending for Marylanders. He added that he didn’t understand the argument made in written and oral testimony to the board that creating upper payment limits would make drugs less affordable.

“It’s basic laws of supply and demand. If the amount that I pay for bread is less, I’m more likely to purchase bread,” he said. “It seems to me the same principle should apply to pharmaceuticals. Access would improve, especially for the most vulnerable, especially for the low-income individual.”

Even if board members determine that a drug is unaffordable for Marylanders during the cost review, that doesn’t mean it will automatically be subjected to an upper payment limit, York said. Establishing spending caps for state and local governments is just one tool the board has for making drugs more affordable.

As the board conducts its first cost review, it may consider more drugs to review for affordability analysis. Anderson asked Marylanders to contact the board at [email protected] with ideas for other drugs that should be added to the list.

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