House set to approve expansion of drug board's authority to lower costs

Yahoo

20-02-2025

Medication vials marked for calibration await counting at the Exchange Pharmacy at Joint Base Andrews in Camp Spring in this file photo from 2023. (Photo by Staff Sgt. Jared Duhon/U.S. Air Force)
House Democrats beat back a series of Republican amendments on party-line votes Wednesday, setting up a final vote on a proposal to expand the authority of a state board created to lower prescription drug prices in Maryland.
Del. Bonnie Cullison (D-Montgomery) defended House Bill 424, which would expand the authority of the Prescription Drug Affordability Board from drugs purchased by state health plans to drugs purchased by any drug provider in the state. She rejected GOP arguments that the board would set a limit on prices.
'We're not controlling anyone's prices. We are controlling our own budgets,' Cullison said of the upper payment limits the board could set. 'We cannot price it. What we can say is, 'This is how much we're going to pay. This is how much we can afford.''
The exchange, and the failed Republican amendments, may have given some a twinge of déjà vu: Both were strikingly similar to the 2019 debate when PDAB was first approved.
'We're not telling the pharmaceutical companies what they can charge,' Cullison said on March 26, 2019, according to a Maryland Matters account. 'We are telling them what Maryland is willing to pay.'
Despite its creation in 2019, PDAB has little to show to for its efforts so far, due to administrative delays and challenges from the COVID-19 pandemic. It was only last year that the board identified six common prescription drugs that it is currently analyzing the affordability of, but it has not yet negotiated lower costs for any medications.
Republicans are skeptical of the board's ability to reduce costs for Marylanders, and believe it could create more problems than it solves. Among their amendments were two — to ensure that the board's actions do not end up restricting access to life-saving drugs, and to protects parts of the pharmaceutical industry from negative impacts by the board.
'The people in this industry, I don't think any of them are villains,' Minority Leader Jason C. Buckel (R-Allegany) said. 'I don't think any of them are heroes. The pharmaceutical manufacturers, the insurers, the pharmacies, the doctors — all of them take a little cut of where all the money goes. All of them are affected by this in certain ways.'
He offered an amendment that would require the board to certify that its actions would not create access issues for patients. But Cullison noted that the board already considers the potential affect on the supply and access to drugs before moving forward on any actions for cost reduction.
'In the original statute that created the Prescription Drug Affordability Board, the purpose was to protect Marylanders, protect members of the supply chain, including pharmacies, from the high cost of prescription drugs,' she said.
Buckel also offered an amendment to require a study of the effects upper payment limits would have on the biotechnology industry. Both amendments failed on party lines.
Cullison said the board already assesses how its actions might affect both patients and stakeholders in the pharmaceutical industry. That said, Cullison conceded that because the board has not yet implemented any cost reduction efforts, the state does 'not have an example' of the complete outcomes of PDAB actions.
'We have a theory. We have a concept. We're ready to go to test this concept,' she said. 'But I know that we have to do something. We cannot continue at this rate of increase for pharmaceutical drugs.'
Minority Whip Jesse T. Pippy (R-Frederick) offered an amendment to require approval from the state's Legislative Policy Committee before the board can place an upper payment limit on prescription drugs.
'We have no idea how this is going to play out,' Pippy said. 'Simply adding the check and balance as we had in the original legislation … I think is the right decision.
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'It's a tremendous amount of unknown with a significant amount of consequences if this goes south,' he said.
But Cullison said the Legislative Policy Committee has already weighed in on the upper payment limit process, and the board should not have to seek additional approval.
Pippy's amendment failed, as did the remaining four Republican-sponsored amendments.
The House will likely vote on the bill on HB 424 — which is co-sponsored by Del. Jennifer White Holland (D-Baltimore County) — this week and move it to the Senate, where its fate is less certain.
Senate Bill 357, sponsored by Sen. Dawn Gile (D-Anne Arundel), has yet to move out of the Senate Finance Committee, but Giles believes it will get a committee vote next week. Gile said her staff is 'working out some amendments' on the Senate version of the legislation.
Vincent DeMarco, president of Maryland Health Care for All, said that back in 2019, the Senate was more skeptical of the PDAB proposal. It initially proposed setting up a study of prescription drug affordability challenges and potential options to address the issue, but the chamber agreed to PDAB after the House added the Legislative Policy Committee review and narrowed the board's scope to just state health plans – which the current bill would reverse.
DeMarco said he is 'feeling very hopeful about the Senate' this year.
'We never want to prejudge anything or count any chickens, but based on reactions at the hearing and talking to individual senators, we're feeling hopeful,' he said.
DeMarco also anticipates that the House will approve the legislation with an 'overwhelming vote,' which he says will 'help to move the issue forward in the Senate.'