PDAB weighs diabetes drug affordability, as Moore weighs bill to expand PDAB

Yahoo

20-05-2025

Medication vials marked for calibration await counting at the Exchange Pharmacy at Joint Base Andrews, Md., July 27, 2023. (Photo by Staff Sgt. Jared Duhon/U.S. Air Force)
A Maryland board tasked with bringing down prescription drug costs is working through a 'dossier' of a medication to treat type 2 diabetes — the first of many such reports to determine if there are ways for the state to save money on certain medications.
The Prescription Drug Affordability Board unveiled a 92-page draft report Monday for Farxiga, a brand-name medication for dapagliflozin, to help board members determine if the drug is 'unaffordable' for Marylanders.
It is the first of several dossiers analyzing the cost burdens of six popular prescription drugs in an effort to find avenues for the state to save on medications for those on the state's health plan.
PDAB staff have been working on the Farxiga dossier since November, according to Andrew York, executive director for the board. He hopes that future dossiers will be easier to pull together now that staff have a format to work with.
Six drugs were selected for 'cost review,' and address several conditions including Type 2 diabetes, heart disease, kidney disease, eczema, Crohn's disease and more.
Dupixent
Farxiga
Jardiance
Ozempic
Skyrizi
Trulicity
'I think staff now knows the time it takes to put these dossiers together,' York told the board during the virtual Monday meeting. 'That organizational process and cross referencing to make sure that everything is available to the board — that took a lot of time and effort. But now that that template's in place, I think we'll be moving forward pretty quickly.'
Since the board's inception in 2019, it has been involved in a lengthy rule-making process to determine what drugs could be expensive for state employees and to establish methods to bring those costs down.
In March 2024, PDAB board members officially selected six drugs to undergo the 'cost review' process, part of which includes an information gathering period to develop a dossier on the drugs. But the board has yet to bring down costs for any drugs on the state health plan.
Meanwhile, Gov. Wes Moore (D) is expected to sign off on legislation Tuesday to expand the authority of the board to bring down costs for more Marylanders, not just those on the state plan.
Critics in the legislature and the pharmaceutical industry cited the pace of the board's progress to argue unsuccessfully against expanding PDAB's authority, but House and Senate bills to do just that passed by comfortable margins this year.
House Bill 424 and Senate Bill 357 would allow the board to establish what are called upper payment limits on the commercial market, to place a limit on how much the state is willing to pay for certain drugs. The board currently has that authority for state employees and others on the state health plan.
The expanded authority would only go into effect a year after the board has successfully placed upper payment limits for two drugs on state health plans – meaning it will still be some time before the state can wield its new authority on the commercial market.
But the dossier Monday sheds some light on different considerations that the board will use to determine if it will take action to reduce state spending on Farxiga — including overall state spending on the drug, prevalence of the diseases that the prescription drug treats, and costs of the disease to the health care system.
In Maryland, about 10.5% of adults aged 18 years or older had been diagnosed with diabetes as of 2022 data, the report says.
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'In Maryland, for calendar year 2021, total and per-patient medical costs attributable to diabetes were $6.506 billion and $11,909, respectively,' the report says, citing data from the American Diabetes Association.
The dossier reports similar data for other conditions Farxiga is often prescribed to treat, such as heart failure and Chronic Kidney Disease.
From 2022 through 2023, Maryland spent $1.4 million on the most common dosage of Farxiga (10 MG) for those on the state health plan – about 289 Marylanders, according to the dossier.
The dossier reports that out-of-pocket costs for Farxiga can vary, depending on insurance coverage.
The median cost for 10 milligrams of Farxiga cost $160 for those with commercial insurance in 2023, but those on the state health plan paid $60 for the same dose. Meanwhile, those on Medicare paid a median of $158.90, according to 2022 data.
But portions of the report are redacted from the public due to confidentiality restrictions, and the dossier is not finalized yet. Following Monday's meeting, PDAB staff will make tweaks on the dossier to more clearly relay the information. The Farxiga dossier will then go up for a 15-day public comment period.
Staff is working on a dossier for another drug that helps treat type 2 diabetes called Jardiance, which should also be available for public comment soon, according to York.
The board still has to officially determine if Farxiga or Jardiance pose an 'affordability challenge' before board members can consider next steps to bring down costs, which could include setting upper payment limits. Savings for the state health plans still appear to be a ways off.