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Prescription Drug Affordability Board frustrated by slow progress of cost-reduction efforts

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Prescription Drug Affordability Board frustrated by slow progress of cost-reduction efforts

By Danielle J. Brown
Prescription Drug Affordability Board frustrated by slow progress of cost-reduction efforts
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Prescription Drug Affordability Chair Van T. Mitchell on May 20, 2024. Photo by Danielle J. Brown

Members of Maryland’s Prescription Drug Affordability Board expressed frustration Monday on the slow pace of the so-called “cost review” process to determine if six prescription drugs are unaffordable for workers on state health plans.

While most of the administrative hurdles have been addressed, staff said it could still take months before the board is at a point where it can officially declare whether a half-dozen medications are unaffordable for Marylanders.

“We’ve been at this now for four years … I think it’s important for us to find a timeline and know exactly whether we’re going to hit them or not,” Chair Van T. Mitchell said after the meeting. “They’re (board members) at a point where they want to get it across the finish line.”

The Prescription Drug Affordability Board was created by the General Assembly in 2019. It was slow to get started, after then-Gov. Larry Hogan (R) cut its funding in 2020 amid pandemic-induced economic uncertainty.

Gov. Wes Moore (D) signed separate legislation last year that reaffirms the board’s authority to issue upper payment limits and extends deadlines from the earlier law.

In May, the board selected the first six prescription drugs to analyze and conduct cost reviews on: Ozempic, Trulicity, Farxiga, Jardiance, Skyrizi and Dupixent.

But being selected for review does not mean the board has officially determined a medication is too costly for state employees to afford. The board’s five-member staff still needs to gather additional information for the board to consider before members look into cost-reduction efforts.

Any actual efforts to lower the costs of drugs for state employees are still a ways off.

Andrew York, executive director for the board, said he hoped to have a dossier for the selected drugs by the end of the calendar year, tentatively by the November meeting, to ensure that there is enough time for drug manufacturers and distributors to provide the requested information.

Mitchell urged York to provide more definitive deadlines for the remainder of the year.

“I think in the end, the board would really like to see a more concrete timeline to be completely done — whether it’s the end of October, November, whatever,” Mitchell said. “But I think you owe it to the board in the next couple of weeks to try to get this under a more manageable timeline that you can get to the board.”

The board is still working out policy for setting upper payment limits, a tool that it could use for prescription cost reduction efforts, where the state would set a limit on how much it is willing to pay for certain prescription drugs under the state health care plans.

Any upper payment limit plan created by the board would need to go to the General Assembly’s Legislative Policy Committee for review and approval.

There are only two more regularly scheduled meetings for the board in 2024, one in September and one in November. PDAB typically meets once every two months.

“So, we can’t do anything in this until the Legislature approves us,” board member Gerard Anderson said at Monday’s meeting. “If that’s the case, we are going to wait until the September meeting to start that process, or can we have an interim meeting before that? Because, we’ve been talking about upper payment limits for a year.

“I’m ready to move forward, and I just wonder why we can’t move forward,” he said.

Mitchell agreed that the board might need to schedule at least one additional meeting to ensure that it can complete the cost-review process and get the upper payment plan underway by the end of the year. He also acknowledged that the five staffers have a lot of work to do to collect and analyze the data needed to conduct cost review.

York agreed to provide a clearer timeline for the cost review process and for finalizing the process to implement upper payment limits.

“I think what we heard today was the board wants us to move as quickly as we can,” York said after the meeting. “It sounds like we would love to get to the point where the board is doing their work and making their decisions — deciding whether or not a drug poses affordability challenges as soon as possible.”

Despite the board’s frustration, Mitchell found the Monday meeting productive.

“I actually think today was good. I mean, I think all the staff needed to hear what we said,” Mitchell said after the meeting. “I think we’re making some strides. I think we’re getting there.”