House rejects amendments on Prescription Drug Affordability Board; bill advanced for third reading

The Maryland House of Delegates spent extensive floor time debating amendments to legislation concerning the Prescription Drug Affordability Board (PDAB) and the board’s authority to institute upper payment limits intended to lower prescription costs. Multiple amendments introduced by delegates sought additional guardrails around patient access, rare‑disease drugs, industry impacts and pharmacy protections; all were rejected by recorded votes or roll calls during the session segment.

Lawmakers discussed several recurring themes: the potential for upper payment limits to reduce patient access via formulary changes or supply shortages; the need for transparency and patient engagement before limits take effect; the possible impact on the state's life‑science and biotech sector; and protections for independent community pharmacies. The minority leader and multiple amendment sponsors urged safeguards, citing concerns that unilateral limits could prompt drug manufacturers or insurers to change formularies, restrict supply, or shift costs to patients. The vice chair of the committee and other supporters of the PDAB framework argued the board’s existing statutory process and stakeholder avenues provide sufficient review and that lowered drug prices ultimately improve access for patients who cannot afford medicines.

Key amendment outcomes recorded on the floor (motion text condensed):

- Amendment 783722/1 (required PDAB to certify that any upper payment limit would not reduce patient access, and to consult with patient advocacy groups including rare and chronic disease patients): defeated by roll call, 36 yes, 96 no.

- Amendment 293321/1 (study of potential effects of upper payment limits on the state's biotechnology and life‑sciences industry, including impacts on investment and clinical trials): defeated by roll call, 35 yes, 99 no.

- Amendment 113920/1 (prohibit use of quality‑adjusted life years (QALYs) as a metric in PDAB decision making): defeated by roll call, 35 yes, 97 no.

- Amendment 5737291/1 (exclude orphan drugs from upper payment limits unless an alternative treatment exists): failed (clerk reported negative result; record indicates amendment did not carry).

- Amendment 503520/1 (require the board to return to the Legislative Policy Committee for review before setting upper payment limits for the commercial market): failed (clerk reported negative result).

- Amendment 573427/1 (create waivers to exclude drugs from PDAB limits when FDA or Maryland Department of Health shortage designation, an essential medication determination, or a provider‑determined continuity‑of‑care need is present): failed on roll call.

- Amendment 583124/1 (prevent an upper payment limit set below a pharmacy’s acquisition cost and protect dispensing fees for small community pharmacies): failed on roll call.

After rejecting the amendments, the clerk reported no further amendments and the bill was ordered printed for third reading. The House did not record a final passage to enactment in the transcript segment covered here.

Delegates on both sides of the debate provided concrete examples and figures during floor remarks: speakers referenced that the PDAB had held multiple public meetings since formation (one speaker said 26 meetings since 2021 with only 5 available online; a stakeholder council had 18 meetings with only four archived), that an aggregated market would represent roughly "6,000,000 covered lives," and that the life‑sciences sector employs tens of thousands in Maryland (one speaker said "54,000 life science jobs" and estimated a $20 billion annual contribution). Supporters of the PDAB emphasized that the board’s mandate includes consideration of supply‑chain impacts and that the statute already directs the PDAB to consider stakeholders during its process.