In 2019, amid grand promises, state lawmakers launched an effort to force down the price of medications through the creation of a Prescription Drug Affordability Board.
By creating an entity with a mandate to provide consumers with relief, lawmakers boasted, they were making Maryland the first state to take the pharmaceutical industry head on. (Something Congress, with its fondness for Big Pharma campaign contributions, has refused to do.)
Nearly three years later, the board’s initial mandate remains narrow — to determine which medications cost too much, then to set up a legally defensible method of capping the amount that state and local government health plans can be forced to pay to provide those drugs to their employees.
The board’s work to date has yet to benefit consumers or taxpayers. The panel has been bogged down with administrative chores such as coming up with a way to fund its work and hiring an executive director.
Despite the slow start, the board’s chair, former state Del. Van Mitchell, said the panel is generating momentum. A funding source has been identified, an executive director has been hired, and a “Stakeholder Council” is in place, to provide community and industry input.
Mitchell said he expects the coming months to bring a set of recommendations on how to force down sky-high drug prices. “We’re getting there. We’re getting organized. We’re ready to present some good things in the next 90 days…,” he said in an interview.
The pharmaceutical lobby fought the creation of Maryland’s affordability board, and it has boosted its presence in states that are making similar noises. Any cost reduction or containment scheme that Maryland adopts will likely face legal challenges from the industry, Mitchell conceded. “Interfering with the market is a real concern of a lot of people, and it should be,” he said.
“I’m not looking for a quick win,” he added. “I want to find some things that are sustainable and make good policy and good sense, not just a headline.”
Vincent DeMarco, head of Maryland Healthcare for All, an advocacy organization, expressed optimism that whatever price-cutting mechanism the board latches onto will survive scrutiny. “States do that all the time,” he said. “They do that with utilities. States do that with so much that they get involved in protecting their citizens from all kinds of acts.”
The national campaign to reduce the cost of prescription medications received an enormous boost when Congress passed and President Biden signed the Inflation Reduction Act, a measure that — among other things — will allow Medicare to use its purchasing power to negotiate lower drug prices. Democrats and consumer advocates have fought for decades for such an action.
The IRA also caps monthly insulin costs for Medicare beneficiaries and it requires drug companies to pay rebates if drug prices rise faster than inflation.
Under the law that established Maryland’s prescription drug board, the panel must provide recommendations next year on how to make drugs more affordable for all Marylanders — not just those covered by state and local government health plans.
Beginning this week, Maryland residents will have the opportunity to describe for the board how they’ve been impacted by the cost of medications. The Maryland Health Care for All Coalition and AARP Maryland are sponsoring a series of forums to be held across the state; a statewide virtual forum is set for Tuesday evening.
“This is a key time for the board as it begins implementing programs to reduce drug costs,” said Jim Gutman, an AARP Maryland leader and a member of the stakeholder council, in a statement. “The specific details from the public in these forum sessions will be extremely valuable in this.”
On top of its slow start to fund its operations and hire staff, Mitchell said the board has struggled to obtain drug-price data. Such data is essential for the panel if it is to ask legislative leaders to declare a subset of drugs “too expensive.”
“That’s been a problem,” he said. “It’s hard to find data that’s not two years old.”
Mitchell and affordability board’s new executive director, Andrew York, a former research analyst with the federal Centers for Medicare & Medicaid Services, meet regularly with leaders in other states. There has been talk of pooling resources to assemble good numbers.
“We’re never going to have $1 million to go buy data every year,” he said. “That’s just not how we’re set up.”