Prescription Drug Affordability Panel Gets to Work

State House lobbyists Gilbert J. Genn and J. William Pitcher and pharmaceutical lobbyist Michelle Jacquis, greet Van T. Mitchell, chairman of the new Prescription Drug Affordability Board, on Monday in Annapolis. Photo by Bruce DePuyt

Members of a new prescription drug panel pledged on Monday to do a deep dive into the factors that cause consumers to experience sticker shock at the pharmacy counter.

The five-member Prescription Drug Affordability Board held its first meeting, a 90-minute organizational session, in Annapolis — under the watchful gaze of a roomful of lobbyists and other observers.

Afterwards, the members said they fully appreciate that state policymakers are frustrated by the high cost of prescription drugs — and that consumers and the taxpayers who fund state and local government drug plans are eager for relief. But they said it’s important to arrive at the right answers, even if doing so takes time.

“We’re learning. This is a first-in-the-nation type of activity,” said Gerard F. Anderson, a professor of health policy and management at the Johns Hopkins University Bloomberg School of Public Health and a member of the board.

“So we’re taking it slow and trying to figure out exactly which drugs to focus on and then trying to understand the industry.”

The board was created by the legislature in 2019 to study prescription drug prices that government workers pay. The goal of health care advocates is to expand the board’s portfolio eventually so that it tackles pharmaceutical prices in the entire marketplace.

Where it finds that drugs pose an “affordability challenge,” the panel can recommend “upper payment limits” — the maximum that a state or local government drug plan will be willing to pay. The General Assembly’s Legislative Policy Committee will then make a final decision on whether to apply a payment cap.

The panel is to give particular focus to brand-name medications that cost $30,000 a year or more, or have a $3,000 increase in the price of a cost of treatment from one year to the next.

Several county executives testified last year that a relatively small number of medications is blowing a hole in their budgets. Whether the panel looks at those drugs first, or others, has yet to be determined, members said.

Anderson said there are three main categories that are ripe for investigation — specialty drugs used by a small number of patients but which have costs that can run into the millions; drugs like insulin that are in widespread use; and those that see sudden price increases “that are hard to justify.”

Public hearings around the state will give consumers the opportunity to suggest which “drugs they’re most interested in,” he said.

Panel member Eberechukwu Onukwugha, an economics professor at the University of Maryland School of Pharmacy, expressed the hope that the community listening sessions will put the panel in touch with people with little exposure to the health care system and those who are overlooked by researchers.

“It’s an important opportunity that we get around, go to the different counties, hear from people — and hear from people who in some circles are called ‘hidden populations,’” she said.

“The state is very diverse and we want all of that reflected in the feedback.”

The panel’s first public outreach session is schedule for Feb. 18 in Baltimore County. A time and location have yet to be determined.

The tool Maryland hopes to use to bring down drug prices — “upper payment limits” — is untested, and pharmaceutical firms are monitoring the state’s actions closely. By one estimate, more than half the people attending the panel’s first session were lobbyists representing various drug manufacturers.

“I think it’s going to be very complicated,” said Johns Hopkins professor Joseph F. Levy Jr., a panel member. “Just lowering drug prices across the board is not necessarily a good thing. We have to think about trade-offs and we have to think about unintended consequences.”

The panel’s first focus will be a study of the generic drug market. A report to the General Assembly on prices, their impact on insurance premiums, drug shortages and other matters is due by June 1.

By Dec. 31, the panel is to report to lawmakers on the “drug chain,” including the pharmaceutical distribution and payment system — and how other states are attempting to get a handle on costs. The report is to include both findings and recommendations for how Maryland might proceed in 2021 and beyond.

“These are very complex issues,” said Anderson. “Why is a drug so expensive and what is a reasonable amount to pay for that drug? It’s going to take a long time for us to figure that out.”

For now, the panel needs office space, a website, an executive director and support staff — all of which Chairman Van T. Mitchell, a former state delegate and Health Secretary, is working on.

He’s also hoping to craft, for this year’s General Assembly session, legislation that covers the commission’s expenses, so it is not a drain on general fund revenues.

Panel members were also briefed on the state’s ethics system, since all must file disclosure forms that list any potential conflicts they might have.

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