Council hears briefing on state drug board's upper payment limits for Jardiance and Ozempic

Vinny DeMarco, president of the Maryland Health Care for All Coalition, and Andrew York, executive director of the Maryland Prescription Drug Affordability Board (PDAB), briefed the Annapolis City Council on July 16 about the board's recent cost-review work and proposed upper payment limits for two drugs.

DeMarco said the coalition helped win creation of the PDAB in 2019 and credited renewed state support for allowing the board to move more quickly. He told the council that high prescription prices force patients to skip needed drugs and raise premiums, and that the board's work aims to reduce those costs for state and local government payers.

"Drugs don't work if people can't afford them," DeMarco said, adding that many Maryland locals struggle with co-pays and out-of-pocket costs.

York described the board's cost-review process. He said the PDAB selected six drugs for review (Jardiance, Farxiga, Ozempic, Trulicity, Skyrizi, and Dupixent), has completed cost studies on three of them, and has set upper payment limits (UPLs) for two: Jardiance and the diabetes indication for Ozempic. Under current Maryland authority, UPLs apply to state and local government payers; York and DeMarco said local governments can opt in for 2027 and that a law passed in 2025 will allow the board to extend protections to all payers beginning 01/01/2028.

The presenters gave government savings estimates tied to the UPLs: Jardiance was presented as yielding roughly $320,000 a year in savings for state and local governments, and Ozempic (for diabetes use) was presented as yielding about $5.8 million a year in government savings. York emphasized those figures refer to aggregated savings for government purchasers, and that actual savings for any employer or plan will vary by contract, utilization and whether plans are self-insured or fully insured.

York explained how UPLs are implemented operationally: the board publishes a per-unit upper payment amount and state and local employee health plan contracts or pharmacy benefit manager (PBM) contracts must include provisions to require compliance. For 2027 jurisdictions may opt into these contract provisions; beginning in 2028 the requirement will be mandatory for state and local government contracts.

Council members asked how Annapolis could participate. York said PDAB staff will work directly with municipal HR and benefits teams to amend contracts and provide technical support. He also encouraged the city to collect constituent reports of drugs that pose affordability barriers and to host or promote PDAB public forums this fall. DeMarco said the coalition's first public forum is scheduled for Sept. 9 in Baltimore and that they hope to hold one in Annapolis.

Several council members pressed for further detail on how savings flow to employees and retirees. York said savings are realized as per-unit reductions; for self-insured employers savings typically reduce the employer's claim costs directly, while for fully insured plans the state insurance commissioner has authority to require insurers to pass savings through to consumers via rate-setting.

The presentation concluded with the presenters offering follow-up to city staff, providing contact details for constituent assistance, and volunteering to coordinate with municipal HR and the Maryland Municipal League to reach local employers.

The council did not take a vote; presenters requested collaboration on town halls and follow-up with city staff to evaluate whether to opt in for 2027.