A Maryland board tasked with constraining prescription drug costs officially named six medications Monday for “cost review,” to determine if the drugs pose affordability challenges for Marylanders on the state’s health care plan.
Drugs treating attention-deficit/hyperactivity disorder and HIV/AIDS did not make the list for now.
The Prescription Drug Affordability Board (PDAB) finalized the selected drugs for review at an in-person meeting that followed years of virtual meetings, a holdover from COVID-era social distancing precautions.
“It’s nice to see our board members and our new employees,” said board Chair Van T. Mitchell from the William Amoss meeting room in the Miller Senate Office Building. “We finally, I think, are moving in the right direction with a lot of momentum.”
Virtual meetings are just one hurdle the board has faced. Created by the General Assembly in 2019, the board was slow to begin operating, due in part to a veto from former Gov. Larry Hogan (R) amid pandemic-induced economic uncertainty in 2020.
Gov. Wes Moore (D) signed legislation in 2023 reaffirming the board’s authority to issue upper payment limits as a potential cost-reduction tool and extended deadlines from the earlier law.
“It’s been taking us a while to get to where we need to,” board member Stephen Rockower, a retired orthopedic surgeon, said after Monday’s meeting.
“Some of it was us getting ourselves organized and getting the funding from the state to be able to do what we needed to do. But now that we’ve done that … we’re making progress,” he added.
After the slow start, Monday’s meeting marks the first time a handful of drugs will officially undergo “cost review,” in which board staff will seek public comments, additional information and data over the next 60 days to determine if Marylanders struggle to afford treatments for diabetes, moderate-to-severe eczema and other diseases treated by the targeted medications.
The board is still months away from potential cost-reduction efforts.
Prescription Drug Affordability Board Executive Director Andrew York on May 20, 2024. Photo by Danielle J. Brown
Andrew York, the board’s executive director, reminded members that selection is not a declaration that a particular medication is unaffordable. It merely gives the board the opportunity to gather more information on out-of-pocket costs for patients, as well as other financial considerations to determine the affordability of a drug.
Four drugs treating Type 2 diabetes were prioritized by the board for cost-review analysis: Ozempic, Trulicity, Farxiga and Jardiance. The latter two are also used to treat heart and kidney disease.
Ozempic is also being used as a weight-loss treatment for certain patients.
Skyrizi, used to treat plaque psoriasis and Crohn’s disease, was also selected for the first round of review. Dupixent, used to treat moderate-to-severe eczema, was selected for cost review as a lower priority, meaning the board will conduct its analysis of Dupixent after the other five drugs.
Initially, there were eight prescription drugs being eyed for review, but two were removed from consideration for now: Biktarvy and Vyvanse.
Biktarvy is a single-pill treatment that manages the symptoms of HIV, or human immunodeficiency virus. PDAB member Gerard Anderson argued that federal assistance programs to help low-income patients afford Biktarvy could complicate the board’s ability to collect data on whether the drug is affordable.
“We would essentially have to figure out how to deal with the many different components of the federal and state government and local governments,” Anderson advised. “That, to me, is the real challenge here, dealing with Biktarvy.”
The ADHD treatment Vyvanse did not make the cost-review cut for similar reasons.
Board member Joseph Levy said that moving away from more complicated drugs would be “OK,” since it’s the first round of cost review, but those drugs can be considered by the board in the future.
Vincent DeMarco, a health care advocate who has been a long time supporter of the board, called Monday’s meeting “historic.”
“In that they actually identified some drugs,” he said after the meeting. “They’re making some substantial progress. We understand that this is not an easy thing.”
York said the board has a team of five staffers to gather any additional information now that the cost review process is underway.
“We very much have to prioritize resources, but I think what the board sent to us, I think is completely reasonable,” York said.
The next PDAB meeting is scheduled for July 22 and should be in-person again, according to Mitchell. The board hopes to discuss the findings of the cost review study at that meeting.
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