Lawmakers in Annapolis agree that we want to lower the cost of prescription drugs to patients. Finding ways to do that has been challenging. According to a 2023 poll conducted by Morning Consult on behalf of the Pharmaceutical Research and Manufacturers of America, 86% of adults agree that lowering out-of-pocket costs for health care should be a top priority for lawmakers. We don’t need a poll to tell us that people are struggling to pay for their health care, including prescription drugs.
Maryland became the first state in the nation to pass what is called a Prescription Drug Affordability Board or PDAB in 2019. The board was charged with looking at the entire pharmaceutical supply chain, including insurers, manufacturers and the newest but most profitable player, pharmacy benefit managers or PBMs. The goal was to help Maryland state employees and Medicaid recipients afford medicine. The PDAB is given the authority to set prices, or upper payment limits, that can be charged for some drugs. It is important to know that Maryland lawmakers cannot impose laws or rules on the largest users of prescription drugs, Medicare patients.
Gov. Larry Hogan vetoed the bill to establish the PDAB in 2019 after it was passed along party lines with a lengthy debate. The Democrats overrode that veto the following year and set up the nation’s first PDAB in 2020.
The PDAB has been hard at work, spending over $3 million since its inception. Because of the overly complicated nature of pharmaceutical drugs, from research and development to manufacturing, to negotiations between manufacturers and insurance companies, to the middlemen PBMs that never handle actual drugs, to pharmacies and eventually to patients who need these medications, the supply chain is hard to unwind. The board had to push their legislative timeline back because they were behind schedule.
Four years and millions of dollars later, the PDAB has yet to set a single drug price and has not saved the state or patients a single dime, proving there is no easy answer to getting lower patient prices.
Despite a lack of outward progress by the PDAB, a group of activists wants to put even more on their plate by asking the legislature to pass House Bill 340/Senate Bill 388, which would expand the board’s authority to set prices for the entire state (not Medicare), rather than just state employees and Medicaid recipients. They haven’t been able to finish a single cost review yet, so is it really the time to double down on their workload? The executive director of the board, Andrew York, spoke before the Health committee recently, and they are not asking for more responsibility.
A well-paid activist group with lobbyists is pushing to expand the PDAB with a populist message that people want lower-priced medications. If there is one thing we know, there is no simple fix, or lawmakers in D.C. and across the country would have figured out how to get you lower drug prices at the pharmacy counter. In the meantime, well-funded activist groups need something to do, and Big Pharma is an easy target. People see all the commercials on TV and assume drug companies are making too much money. It’s hard to explain to people that pharmacy benefit managers are reaping billions for paperwork and secret price negotiations that are putting small community pharmacies out of business. Most people have never heard of a PBM.
Medicines are expensive, and the drug supply chain is very complex. No one should have to choose between paying to keep the lights on or paying for their medicine. There is hope through a few bills with bipartisan support that may provide you with better access and immediate relief at the pharmacy.
Some bills are being considered in Annapolis that will directly impact patients’ wallets. H.B. 879/S.B. 595 seeks to protect a patient’s right to utilize coupons and discount cards for medications and have them count toward their deductible. When patients are outside their deductible, they are at the most expensive time of their insurance cycle, and it’s when we see patients stop taking their medications. Patients should not be punished for utilizing cost-sharing tools available to them. You may be eligible for cost-savings, check out www.mat.org. Another bill is H.B. 1270/S.B. 1019, which may help patients get relief at the pharmacy counter by ensuring manufacturer rebates are shared with them. Just as a grocery store doesn’t pocket your manufacturer rebate you cut out of the paper or download on your phone, neither should an insurer or PBM pocket the savings meant for your health.
It’s not time to expand PDAB’s workload. There are other policies that put patients before profits. I will continue to work with my colleagues in Annapolis to find ways to lower the cost of medicine for you and your family.
Christopher T. Adams (christopher.adams@house.state.md.us) is a Republican representing District 37B in Caroline, Dorchester, Talbot and Wicomico counties in the Maryland House of Delegates.
