A Publix Super Markets pharmacy manager picks up a prescription in Miami. Photo by Joe Raedle/Getty Images.
At a time when Maryland could accelerate medical innovation to meet global health challenges, our state’s policymakers are taking steps that could curb medical progress and disrupt patient access and care.
The Prescription Drug Affordability Board (PDAB), created in 2019, recently voted to begin the process of imposing Upper Payment Limits (UPLs) on up to six medications that treat heart disease, diabetes, Crohn’s disease and more. A UPL does not reduce a patient’s out-of-pocket costs, such as copays, deductibles, or coinsurance, but instead limits the amount of reimbursement for a drug that providers, pharmacies, and other health care facilities would receive.
The PDAB’s vote came after patient advocates and medical innovators expressed There are serious doubts about the board’s motivations and the lack of transparency in their process.
As a member of the PDAB Stakeholder Advisory Board, I am deeply concerned that establishing UPLs in Maryland will have two unintended consequences. It will harm Maryland’s life sciences ecosystem, which is one of our largest economic engines, and it will do nothing to directly improve patient affordability or access to care.
First, the PDAB’s decisions could have a chilling effect on medical innovation in our state. Maryland’s life sciences ecosystem – consisting of 2,700 companies, 54,000 employees and leading federal and academic research institutions – is developing cures, therapies and treatments that millions of patients depend on.
Arbitrary price controls jeopardize their ability to invest in research and clinical trials to discover breakthroughs in the treatment of cancer and other diseases. Maryland should encourage, not potentially restrict, investment.
Second, PDAB’s flawed process for determining UPLs ignores the actual costs patients pay for medications. By considering only the net cost of a drug, the PDAB does not consider the impact of insurance plans and Pharmacy Benefit Managers (PBMs) on patient costs. Insurance companies and PBMs often receive significant rebates from drug manufacturers, but are not required to share these savings with patients. The PDAB cannot determine the cost of a drug without considering PBMs and insurance company costs.
Furthermore, instituting arbitrary UPLs could limit patients’ access to medications by disrupting supply chains and altering health care plans, resulting in health disparities and loss of access to treatments prescribed by a health care provider, not a quasi- public panel of five people.
Many stakeholders in the healthcare ecosystem have expressed concerns about the unintended consequences of instituting a UPL. Health HIV, an organization that advocates for people living with HIV, warned“Any disruption in access to necessary medicines due to UPLs could lead to an increase in HIV infections and overall healthcare costs.”
These comments and others like them should prompt the PDAB to immediately pause its work and fix these errors. If they do, they won’t be alone.
Recently, Oregon’s Prescription Drug Affordability Board did this delayed its cost review for similar reasons. Their questionnaire of stakeholders found that “more than half of respondents did not believe a UPL would lead to cost savings, with many expressing concerns about lost revenue, reduced patient access and increased patient costs.”
We can improve patient affordability without harming our life sciences workforce or patient access by considering all factors that contribute to out-of-pocket costs. For example, Maryland Share the Savings Act would require carriers and PBMs to share up to 85% of drug rebate savings with patients. The General Assembly should take up this bill in January with a simple question in mind: Why not let patients benefit from it?
The Council’s process has led patients and healthcare providers to question the Council’s commitment. Ninety seconds to testify or submit comments without dialogue shows a lack of interest in patients’ concerns.
The PDAB should enable more feedback from patients, healthcare providers and other stakeholders. They will learn that by potentially limiting access to medications, UPLs can force patients to use alternative medications that do not meet their needs, potentially leading to harm and rising costs elsewhere in the health care continuum. Non-medical switching, a practice banned in several states, will now be codified by a UPL.
PDAB’s misguided focus on drug price controls endangers medical innovation and employment in Maryland, while doing nothing to improve drug affordability or protect Marylanders’ access to medicines.