Board trying to lower drug costs urges Marylanders to help ‘fill in’ info gaps

Before a state board can begin the process of determining if certain prescription drugs pose an affordability challenge to Marylanders, officials of the Prescription Drug Affordability Board are seeking feedback from patients, physicians and manufactures to provide additional context and first-hand experience about trying to afford medications treating HIV, eczema, and diabetes and other conditions.

“We really do hope to get a lot more feedback from the public,” Andrew York, executive director for Prescription Drug Affordability Board, said Monday at a virtual meeting of the board’s stakeholder council.

“This is the chance to kind of fill in the gaps…We’d love to hear the clinician experience. The patient experience. And certainly from all of the different folks from the supply chain,” he said. “So, really looking forward to a lot of really productive public comment.”

The Prescription Drug Affordability Board (PDAB) is currently tasked with finding ways to reduce the costs of medication for workers on the state’s health care plan.

The board is authorized to set “upper payment limits” that state and local government health plans can be forced to pay to provide selected drugs to their employees. Health care advocates hope the board will be able to bring down costs for all Marylanders.

Currently, the board is considering eight name brand prescription drugs that treat a variety of diseases to see if those drugs pose an affordability challenge to consumers. The drugs under consideration are: Biktarvy, Dupixent, Farxiga, Jardiance, Ozempic, Skyrizi, Trulicity, and Vyvanse.

Stakeholder feedback is part of the selection process before the drugs can undergo cost reduction efforts.

PDAB’s stakeholder council is composed of 26 people who represent various points of view on the prescription drug industry, including representatives from drug companies, insurers and unions, as well as pharmacists, nurses and select members of the public.

Some experts have offered written comments and oral testimony expressing fear that the process to set up an upper payment limit could reduce access to treatments for significant medical needs, particularly those living with HIV.

Jen Laws is CEO of the Community Access National Network (CANN), a patient advocacy group focused on issues related to HIV and other conditions. Laws offered a disclaimer that CANN is primarily funded by pharmaceutical companies, such as PhRMA, Walgreens, Jassen and others.

In his oral testimony to the stakeholder council, Laws said that there could be “serious problems” if the board-implemented upper payment could create access challenges to HIV treatments, and expressed concerns about the public ability to engage in the drug selection process.

“What affordability actually means is just a lack of access,” he said. “We’ve got to look at this comprehensively from the patient perspective.”

York said the selection process will consider whether the board’s cost reduction efforts could negatively impact access for patients.

“The entire purpose of the board is to increase access to drugs, not decrease access to drugs. So, I think the board would seriously wait and consider anything that could risk access to medications,” York said.

The board referenced several different cost indicators to create the preliminary list of potentially “unaffordable” drugs, but the analysis did not include any cost reduction efforts from various state or federal programs already in place that offset out-of pocket costs for patients.

Deron Johnson, a member of the stakeholder council who is director of state government affairs at Amgen, a biotechnology research company, was concerned the council do not yet have information about about various cost reduction efforts, making it difficult for the council to determine if there is a tangible affordability concern for the drugs in question.

“Without knowing the rebate information, without knowing patient assistance information or other cost sharing methods that might reduce patient out-of-pocket costs, the question I really have is…without that information, what are we truly doing here?” he asked the council.

York said that the next step of the cost review process would include gathering information on available rebates and cost assistance measures available to people relying on the selected drugs.

“That is something that would come in as part of the cost review process,” York said.

Another council member, Glenn Schneider, chief program officer for the Horizon Foundation, a philanthropy in Howard County focused on public health and health equity, suggested the board consider avoiding drugs that are already part of a federal price negotiation process for those on Medicare, a federal health care plan for retirees.

“I do caution us really looking at drugs that are subject to drug negotiation by the federal government,” Schneider said.

The Inflation Reduction Act’s Medicare Drug Negotiation Program is similar to the PDAB’s efforts to reduce prescription drug costs for certain populations.

Two medications in the federal price negotiations are also being considered for PDAB’s cost reduction efforts: Farxiga and Jardanice.

Farxiga is used for chronic kidney disease, heart disease and type 2 diabetes. Jardanice has similar applications.

“I worry that if we get too far into this, if we decide on any of the drugs that are in that negotiation process, I just think it would take years and years worth of legal wranglings between the state, federal government and manufacturers,” Schneider said. “And that wouldn’t be good for everybody else.”

PDAB has been slow to begin operating and has not yet implemented measures to bring down drug costs, due in part to a veto from former Gov. Larry Hogan (R) amid pandemic-induced economic uncertainty in 2020 that delayed the board’s formation.

Just in January, the board started the drug selection process, which will likely continue for several months. When the board finally selects drugs to review, then board members can consider cost reduction efforts such as upper payment limits.

Marylanders still have a few days to submit public comments for the stakeholder council to consider before they make their final selection on which drugs will receive further inquiry on affordability challenges.

The current public comment period to submit testimony to the stakeholder council closes on May 10.

“Comments may be submitted to [email protected] with ‘Drugs Referred to the Stakeholder Council Comment’ in the subject line,” according to the PDAB’s website.

The Prescription Drug Affordability Board will hold its next meeting on May 20.

Disclosure: The Horizon Foundation is a financial supporter of Maryland Matters.

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