Maryland drug-affordability board updates committee on cost reviews and potential upper payment limits

The Health and Government Operations Committee heard an update from Andy York, executive director of the Maryland Prescription Drug Affordability Board, on the board’s cost-review and policy-review work, including its authority to set upper payment limits for state and local government purchasing and programs. York said the board has selected six drugs for in-depth cost reviews and is analyzing data gathered through requests for information; he said some initial reviews could be completed as early as this spring, though no upper payment limits have been set.

The board’s statutory mission, York said, is “to protect state residents, state and local governments, commercial health plans, health care providers, pharmacies licensed in the state, and other stakeholders within the health care system from the high cost of prescription drug products.” He described three core activities: a structured cost-review study process, a policy-review process that can recommend actions including upper payment limits, and provision of resources for legislators and patients.

The board and its work matter because it is charged with assessing whether particular drugs create affordability challenges and recommending or implementing policies that affect public payers and programs. York said the board is “the 1st in the nation” in this model and noted the work is intended to address both patient out-of-pocket burdens and broader payer costs that can differ significantly because of confidential rebates and other off-invoice adjustments.

York summarized the cost-review process as a multi-step…