The sometimes sky high prices of prescription medications for Medicare and Medicaid patients in Maryland may be a thing of the past in the coming years if a new state board is successful. The Maryland Prescription Drug Price Affordability Board, the first of its kind in the state, released its first annual report Tuesday. Board members say they’ve got big goals next year which includes forcing price limits on pharmaceutical companies.
“What we published today was an update on our cost review process,” said Andy York, executive director of the board. “As part of that process, we have to identify the drugs that are eligible for these cost reviews. It's a series of a few hundred drugs right now.”
The next step is for the board to work through what the cost review process will look like and then determine which drugs are deemed unaffordable.
Nationwide, there were more than 1,200 prescription drugs with prices outpacing the rate of inflation in the past year. The cost of some medications jumped by nearly $20,000, according to the report.
Maryland’s Medicare and Medicaid programs spent more than $6.8 billion for prescription medications in 2019, compared to $6.4 billion in 2018.
The report identified which medications cost the most and state leaders deem unaffordable, such as Eliqus, the brand name of a pharmaceutical medication that reduces the chance of blood clots due to irregular heartbeats.
It’s been a long struggle between state governments responsible for running Medicaid and Medicare programs to insure the oldest and poorest residents and businesses which develop and manufacture medications.
Insurance companies often pass on higher prescription drug prices to consumers in a private insurance market. But the state government can’t do that for residents relying on Medicaid and Medicare.
In 2019, Maryland lawmakers pushed to create the new board to shed some light on what they saw as opaque practices in the pharmaceutical industry. The goal is to set an upper limit on how much the state is willing to pay manufacturers for some medications.
The idea of state agencies pushing to regulate drug prices caught on. Since Maryland passed the bill, six other states formed their own affordability boards, according to Vincent DeMarco, president of Maryland Healthcare For All, a group that lobbied for the bill to create the board.
“It established a way that states can make high-cost drugs more affordable for their people,” DeMarco said. “Politically, it was important to note that a big pharma can be defeated. Drugs don't work if people can't afford them. That is why the board is so, so important for Maryland and the nation.”
But it was not smooth sailing, even after lawmakers voted to create the new board.
In 2020, Gov. Larry Hogan vetoed funding the state board, arguing it would raise taxes during the coronavirus pandemic which has lingered for nearly three years.
In 2021, the Maryland legislature overrode the veto, but the damage was already done and the board was set back by about a year, officials said.
Now the board is ready to move forward.
Affordability for insulin is one priority. Maryland capped insulin copays for Medicare and Medicaid patients at $30, which is $5 cheaper than the national cap.
York said the board is looking for ways to make sure uninsured and underinsured diabetics get the medicine they need.
“One option is potentially partnering with manufacturers to take existing advantage of existing insulin affordability programs, a lot of them have patient assistance programs,” he said. “That seems like the most direct route. Another is taking advantage of insulin that is purchased through federal discount program. I would expect that to a pretty quick rollout, potentially in early- to mid-2023.”
