In Maryland, drug price controls will not help patient affordability

A Publix Super Markets pharmacy manager picks up a drug from Miami. Photo by Joe Raedle/Getty Images.

At a time when Maryland could be accelerating medical innovation to meet the world’s health challenges, our state’s policymakers are taking steps that could slow medical advances and disrupt patient access and care.

The state’s Prescription Drug Affordability Board (PDAB), established in 2019, recently voted to begin the process of imposing upper payment limits (UPLs) on up to six drugs 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 would limit the amount of reimbursement for a drug that providers, pharmacies, and other health care facilities would receive.

The PDAB vote came after patient advocates and medical innovators expressed serious doubts about the board’s rationale and the lack of transparency in their process.

As a member of PDAB’s Stakeholder Advisory Board, I have serious concerns 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 will do nothing to directly improve patient affordability or access to care.

First, PDAB decisions could cause a chilling effect on medical innovation in our state. Maryland’s life sciences ecosystem – comprising 2,700 companies, 54,000 workers and leading federal and academic research institutions – develops 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 investment, not potentially limit it.

Second, the PDAB’s flawed UPL setting process neglects the actual costs patients pay for drugs. By considering only the net cost of a drug, the PDAB fails to account for how insurance plans and pharmacy benefit managers (PBMs) influence patient costs. Insurance carriers and PBMs often receive substantial discounts from drug manufacturers, but are not required to share those savings with patients. PDAB cannot discern the cost of a drug without considering PBM and insurance carrier costs.

Furthermore, setting arbitrary UPLs could restrict patient access to drugs as supply chains are disrupted and health plans adjusted, leading to health disparities and loss of access to treatments that were prescribed by a provider, not a quasi-group -audience consisting of five people.

Many stakeholders in the health care ecosystem have expressed concern about the unintended consequences of establishing a UPL. Health HIV, an organization that advocates for people living with HIV, ADVISED“any disruptions in access to needed drugs 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 cease operations and remedy these defects. If they do, they won’t be alone.

Oregon Prescription Drug Affordability Council recently delayed reviewing its costs for similar reasons. Their study of stakeholders found that “more than half of respondents did not believe that a UPL would lead to cost savings, with many expressing concerns about lost revenue, decreased patient access and increased patient costs.”

We can improve patient accessibility without impacting the life sciences workforce or patient access by considering all factors that contribute to out-of-pocket costs. For example, Maryland’s Share the Savings Law would require carriers and PBMs to share up to 85 percent of drug discount savings with patients. The General Assembly should take up this bill in January and consider a simple question: Why not let patients benefit?

The Board’s process left patients and providers questioning the Board’s commitment. Ninety seconds to testify or submit comments without dialogue shows a lack of interest in patients’ concerns.

PDABs need to allow for more feedback from patients, providers and other stakeholders. They will learn that UPLs, by potentially restricting access to medicines, can force patients to use alternative medicines that do not meet their needs, which can lead to harm and increased costs elsewhere in the health care continuum. Non-medical switching, a practice prohibited in several states, will now be codified by a UPL.

The PDAB’s misguided focus on drug price control risks medical innovation and jobs in Maryland while doing nothing to improve drug affordability or protect Marylanders’ access to drugs.