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Drug affordability board receives list of Rx’s to begin cost review selection process

Pharmaceutical Market
Photo by Angela Breck.

A Maryland board tasked with reining in prescription drug costs has a broad list of medications that might undergo a “cost review” — the first step in identifying which drugs are expensive for Marylanders on the state’s health plan, with the hopes of bringing those costs down.

Following a board meeting Monday, the state’s Prescription Drug Affordability Board (PDAB) is now working with a large list of “eligible” prescription drugs that meet certain statutory or regulatory that could indicate a drug is difficult for Marylanders to afford. But the “eligibility list” is not currently available to the public.

The board members are working with a list of what are called National Drug Codes, or NDCs, which serve as the identifier for medicines registered with the U.S. Food and Drug Administration. Drugs identified on this list do not necessarily mean they are unaffordable for Marylanders, but they might be contenders for further investigation by the state.

Prescription drugs will often have multiple NDCs registered with the FDA, as there are individual codes for different doses of the same drug. The drug may come in different forms, such as pills, inhalers, injections, topicals, or other routes of administration. Each variation of the medication can have a different NDC registered with the FDA.

The board has received a list of over 2,000 NDCs, but it is not yet clear how many individual prescriptions are being considered for eligibility.

The eligibility list was developed out of requirements set by statute as well as additional policies set by the board itself.

One of the metrics in consideration is wholesale acquisition cost, which is the prescription drug manufacturer’s list price for a drug to wholesalers or direct purchasers without considering potential discounts and rebates.

According to Andrew York, executive director of the Prescription Drug Affordability Board, there are 707 brand name NDCs with a wholesale acquisition cost of over $30,000, qualifying those drugs and drug variations for the initial eligibility list under state statute.

There were also 884 brand name NDCs that saw an increase of $3,000 on their wholesale acquisition costs per year or over the course of treatment. Those prescription drugs are also on the initial eligibility list.

There are 483 generic drug NDCs that costs $100 or more for a 30-day supply or less and saw a price increase of at least 200%.

In addition, the board added regulations that allow members to look at other markers for potential affordability challenges, including aggregated spending and pricing data as well as patient out-of-pocket costs.

‘Board-facing’ list

The eligibility list is not published for the public to see.

York says that the board will narrow down the list a bit and gather input from the “stakeholder council” —26 people who represent various points of the prescription drug industry, including representatives from drug companies, insurers and unions, as well as pharmacists, nurses and select members of the public.

Once the board has narrowed down the list after consulting with the stakeholder council, there will be a 30-day public comment period for Marylanders to weigh in on the shorter list of drugs under consideration.

The 30-day public comment period will likely occur after the board’s March meeting, according to York.

“Since there are thousands of eligible NDCs, and the Board will realistically only be focusing on a small subset of those NDCs, we thought it would be best for the Board to indicate which drugs that they were most seriously considering through their process for nominating and Selecting Drugs for Referral to the Stakeholder Council,” he explained in an email Wednesday.

“This will prevent the public from spending a lot of time and resources researching drugs that were not currently under serious consideration by the Board for Referral to the Stakeholder Council,” he said.

York says that the board will likely select drugs for the actual cost review process based on all the information gathered by its May meeting.

He previously said he hoped the list of “unaffordable” drugs will be complete in fall 2024. Once the list of drugs has been finalized, the board will begin the cost review process to look for ways the state can consider cost reduction efforts for Marylanders on state health plans. Actual cost reduction efforts appear to be months away.

Prescription board sets tentative 2024 cost review plan to identify expensive drugs

The board, created by legislators in 2019, has been slow to begin operating, due in part to former Gov. Larry Hogan (R) vetoing a bill that would have funded the board’s work.

Gov. Wes Moore (D) signed legislation last year that reaffirms the board’s authority to issue upper payment limits and extends deadlines set in the earlier law. The General Assembly also carved out an additional $1 million in the 2024 state budget for the board’s operations.

The board spent a majority of 2023 establishing a policy framework to begin the selection and cost review process.

A group of health care advocates called the Maryland Health Care for All Coalition is pushing legislation this year to expand the authority of the board to reduce costs for all Marylanders, not just state employees.

The legislation will receive its first hearing in the Senate Finance committee on Feb. 7. The House Health and Government Operations Committee will consider the legislation the following day.


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Drug affordability board receives list of Rx’s to begin cost review selection process