Prescription drug board considering several popular treatments for future cost reviews

A board tasked with reining in prescription drug costs is starting to narrow a list of medications that might be eligible for “cost review,” in hopes of finding ways to bring down expenses for Marylanders on the state’s health plan.

The Prescription Drug Affordability Board (PDAB) is considering eight name brand prescription drugs that treat a variety of diseases, including diabetes, HIV, and attention-deficit/hyperactivity disorder (ADHD), to see if those drugs pose an affordability challenge to consumers.

“So right now, what we’re talking about is identifying drugs to consider for cost review, and then potentially referring those drug products to our stakeholder council,” Andrew York, executive director of the board, said Monday at a PDAB board meeting.

“This is the start of what’s going to be a pretty intensive process with a lot of opportunities for the public to provide comment,” he added.

Some medications in consideration have multiple dosages of the same drug. For example, Vyvanse, a central nervous system stimulant primarily aimed at managing the symptoms of ADHD, has seven different dose strengths listed as part of the board’s preliminary list.

Here are the drugs currently under consideration for potential cost review efforts down the line:

— Biktarvy, an antiretroviral combination drug used to treat HIV

— Dupixent, used to treat moderate-to-severe eczema

— Farxiga, used for chronic kidney disease, heart disease and type 2 diabetes

— Jardiance, used for chronic kidney disease, heart disease and type 2 diabetes

— Ozempic, used to help control blood sugar levels for adults with type 2 diabetes, which is also being used as a weight loss treatment for certain patients

— Skyrizi, used to treat plaque psoriasis and crohn’s disease

— Trulicity, used to help control blood sugar levels for adults with type 2 diabetes

— Vyvanse, used to treat symptoms of ADHD and can be used to treat binge eating disorder

The board is still weeks out from making a final selection about which drugs will officially go into the cost review process. But the preliminary list narrows the selection down from over 2,000 potential prescription and dose options that were eligible for consideration.

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

The prescription drugs under consideration met certain statutory and regulatory metrics that indicated to board members the medications might pose affordability challenges for consumers.

Those metrics include out-of-pocket costs for consumers and wholesale acquisition costs, which is the prescription drug manufacturer’s list price for a drug to wholesalers or direct purchasers without considering potential discounts and rebates.

HIV treatment in question

One of the drugs under consideration, Biktarvy, was the subject of several written testimonies that urged the board to ensure that the cost review process does not create access problems to the medication.

Jeremy Browning, director of the Maryland Commission on LGBTQIA+ Affairs, said the commission is concerned that some future price reduction efforts may create unintended consequences.

“We urge the Maryland PDAB to thoroughly assess the social and structural determinants of health in connection with efforts to end the HIV epidemic before evaluating any HIV medication,” Browning said in his written testimony. “By doing so, we can better understand the far-reaching implications of our decisions on medication affordability and accessibility, as well as their impact on public health efforts to combat HIV.”

Karoll Cortez, an infectious disease physician at the Greater Baltimore Medical Center, says that disruption in access to Biktarvy would be stressful for her patients with HIV.

“Most of my patient are on Biktarvy and are doing well. The patient population I care for are mostly Brown, Black and queer. Many of them have other medical needs such as mental health issues…As a long-term care provider I am very concerned that the cost review study of Biktarvy may impact accessibility to the drug by my patients who are doing well on it,” Cortez wrote.

She urged the board to “make an assessment of the potential impact that cost review will have in the accessibility to the drug in the state of Maryland” before the board officially selects Biktarvy for cost review.

Similar Biktarvy-related testimony came from the HIV/AIDS-focused policy group Community Access National Network, which has corporate partners from pharmaceutical associations and companies such as PhRMA, Walgreens and Janssen.

PhRMA, the trade group representing pharmaceutical companies, is a long-time opponent of state prescription drug affordibilty boards.

Stami Williams, a PhRMA spokesperson, said that Maryland’s PDAB should “prioritize medicine access and affordability for Marylanders.”

“Government price setting simply is not the answer,” Williams said. “After half a decade and millions of dollars to support the board, this process has failed to save patients one cent and their concerns are going unaddressed. Putting decisions that should be between patients and doctors in the hands of unelected bureaucrats is not working.”

Board’s next steps

Actual cost reduction efforts appear to be months away.

Now that the board has a preliminary list of drugs to consider, there will be a 30-day public comment period for consumers, drug manufacturers and other invested parties to send in their thoughts on the selected drugs.

The list will also be considered by the board’s stakeholder council, composed of 26 people who represent various points of view on 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 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.

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

The preliminary list comes just days after health care advocates waved the white flag on legislation in the 2024 session aiming to expand PDAB’s authority to use cost reduction efforts on medications for all Marylanders, not just those on the states prescription drug plans.

While the legislation received support from the Maryland Legislative Black Caucus and certain lawmakers, some argued that there had not been enough time for the board to conduct its current statutory responsibilities, so it would be premature for policymakers to expand its role.

Health care advocates hope the 2025 session will be a more opportune time to revive the legislation.

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