Andrew York, executive director of the Maryland Prescription Drug Affordability Board, told the Senate Finance Committee on Jan. 9 that the board has begun cost reviews of high-impact drugs, has approved an action plan to set upper payment limits (UPLs) for state and local government purchasers, and will publish proposed regulations to implement those limits.

The board, created by the General Assembly in 2019 and funded after a 2021 veto override, is a five-member independent agency supported by a 26-member stakeholder council. "Our purpose is protecting the state residents, state and local governments, commercial health plans, health care providers, pharmacies ... from the high cost of prescription drugs," York said.

Why it matters: the board’s work could lower what Maryland state and local purchasers pay for specific drugs and produce taxpayer savings, but York and senators noted that, under current plan structures, those savings may not automatically reduce what patients pay at the pharmacy counter.

What the board has done and plans to do: York described a five-step cost-review study process that includes identification, selection, data collection, analysis and results. The board has selected six drugs for its first round of reviews: Farxiga, Jardiance, Ozempic, Trulicity, Dupixent and SKYRIZI. Staff have collected data for the first four drugs and York said the board expects to conduct those cost-review determinations "hopefully sometime this spring." For the remaining two drugs the board will issue a separate request for information and then proceed with study.

If the board determines a drug creates an affordability challenge, York said the board can pursue a policy review that may result in non-UPL policies or a recommended UPL. "An upper payment limit is a tool in the toolbox, but we are equally weighting other policy options that can address the affordability challenges," York said. He described a multi-step regulatory process in which staff propose a methodology, publish calculations for public comment, and the board adopts final regulations under Maryland’s administrative procedures.

Regulatory timetable and public input: York said the board’s UPL action plan was approved by the board in September 2024 and by the Legislative Policy Committee in October 2024. The board expects to publish proposed implementing regulations in the Maryland Register "potentially Jan. 10" and those proposed rules would be open to a 30-day public comment period before final action.

Scope and limits: Under current law the board’s UPL authority applies to state and local government purchasers — for example Medicaid (the Medical Assistance program), direct state purchases (corrections, state hospitals) and state or local employee health plans. York said a statutorily required report, due to the General Assembly on or before Dec. 1, 2026, will analyze the legality, obstacles and benefits of expanding UPLs to cover all purchasers in the state and will include a recommendation on whether the legislature should expand the board’s authority.

Patient impacts and pass-through questions: Committee members asked whether any UPL savings would reach patients at the counter. York said many state and local plans use flat copay structures rather than coinsurance tied to drug cost, meaning UPLs for state purchasers would most directly produce taxpayer or plan savings. He noted implementation choices can be made so savings are shared with patients — for example, basing coinsurance on net prices or expressly directing that insurer savings be passed through to consumers — but said those provisions may require separate policy or statutory action.

Other work and 340B: York said the board operates a patient navigation program to help Marylanders find lower-cost options and will deliver a separate explanatory report on the federal Section 340B program to the legislature in 2026 as required by recent state legislation. He said the board will aim to provide neutral, evidence-based guidance to lawmakers and executive agencies on complex supply-chain issues.

Comparisons with other states and litigation risk: York said Maryland is watching other states’ efforts. Colorado has moved farther in making affordability determinations but faces ongoing litigation; Minnesota recently created a board with broad authority; New York and Massachusetts offer procedural examples for UPL work in Medicaid; Oregon has not adopted full-state UPL authority. York said these developments inform Maryland’s approach and also contribute to implementation risk.

Next steps: the board will continue data collection and cost reviews this spring, publish proposed UPL regulations for comment, and prepare the statutorily required 2026 report on possible authority expansion. York said the board intends to be a resource to the Senate Finance Committee and other policymakers.

Ending: The briefing closed with committee questions about pass-through protections, formulary coverage for state plans, public outreach and the board’s timelines; York said the board has not set a public timeline for the 2026 report but will meet the statutory deadline and is available for follow-up hearings.