Latest news with #Bill424
Yahoo
20-05-2025
- Health
- Yahoo
PDAB weighs diabetes drug affordability, as Moore weighs bill to expand PDAB
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. SUBSCRIBE: GET THE MORNING HEADLINES DELIVERED TO YOUR INBOX '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.
Yahoo
03-04-2025
- Business
- Yahoo
Legislators propose bills to back data centers, legislate blockchain technology
Photo illustration by Getty Images. Energy and tech are colliding as the Montana Legislature grapples with cryptocurrency, blockchain technology, and data centers. This session, lawmakers are taking up bills that could impact the high-tech industry in Montana for years to come, from ones that ease oversight and taxes for data centers to another that would help legislators grasp complex new technology on the landscape. Data centers are the digital infrastructure backbone for many advancements, including blockchain technology, but use significant amounts of energy. House Bill 877, brought by Rep. John Fitzpatrick, R-Anaconda, is called the Montana Data Center Development Act, and seeks to block the Public Service Commission from preventing a utility from serving large customers in a way the agency itself opposes. 'It strips away PSC oversight. It's a deregulation bill,' said PSC President Brad Molnar, in the House Energy, Technology and Government Relations Committee. 'Call it what you want to, it's a deregulation bill.' Proponents included NorthWestern Energy, which argued it would be able to produce enough electricity to meet new demands. Senate Bill 330, brought by Sen. Gayle Lammers, R-Hardin, seeks to build legislative capacity for understanding blockchain and digital innovation as well as seeks inroads with companies engaged in blockchain and digital finance. It was sent to Gov. Greg Gianforte's desk on an 81-18 margin on Monday afternoon. 'It really is going to be a big educational bill, and that's what's neat about it,' Lammers said in an interview with the Daily Montanan. 'And it kind of solves the problem that everybody has with it. They say, 'Oh, I just don't understand, and I don't know,' and that's why I brought this bill.' Two other bills seeing movement also touch on the business, technology and power. House Bill 424, brought by Rep. Katie Zolnikov, R-Billings, seeks to revise taxes for Class 17 properties, which include data centers. Meanwhile, Sen. Daniel Zolnikov, R-Billings, has brought Senate Bill 265, which seeks to revise cryptocurrency laws in the state. It would affect so-called 'network tokens' and would formally regulate businesses using blockchain technology. Network tokens are used in payments as an alternative to a payment card number. Underneath all the technology bills is an underlying question as to whether Montana has the energy capacity to serve both its residential and industrial customers. Cold is a major worry — there's a lot of demand for energy when winter hits, and 'brownouts,' when there's a reduction of power in a specific area, are a major concern for some in the Legislature. NorthWestern customers recently had to pay an extra $39 million following a cold snap because the utility had to buy power on the market. 'We need to make sure that the power that's going to satisfy these larger loads doesn't become a critical and potentially problematic factor when we're at 20 below zero, and we've already experienced that,' Sen. Chris Pope, D-Bozeman, told the Daily Montanan. In December 2024, NorthWestern Energy announced an expectation to serve 'up to' 450 MW of power to data centers, according to Jo Dee Black, a spokesperson for the company, in an email to the Daily Montanan. Black added the utility owns 1,065 MW of production capacity, but it 'would be wrong to state that all that generation, or all generation from an owned-generation resource, would serve a single class of customers.' NorthWestern is also adding to its capacity, both at the coal-fired plant in Colstrip, and its new methane-fired plant in Laurel. But Molnar said data center businesses will put permanent pressure on energy providers. 'Data centers, they don't scale up or down,' Molnar said. 'They are a constant run of their computers storing and generating data. They do not ramp up and down based on how much electricity is available.' At one point, NorthWestern was producing about 1,600 MW of electricity. Peak demand in 2023, according to the utility, was about 2,000 MW. During the hearing for Fitzpatrick's bill, Alan Olson, who was lobbying for NorthWestern, was asked if the utility could provide enough base load energy to meet customer demands. 'Today, we are short,' Olson said to the committee. This session has seen a push to bring nuclear power to Montana, cited by tech companies as a way to ramp up domestic power production. Fitzpatrick's bill brought the need for more production — and whether or not the utility can serve all of its customers — to the forefront. NorthWestern believes it will have enough generation capacity to follow through on the commitments it makes to businesses drawing large amounts of power, such as data centers. 'Recently, the PSC seems to have developed a novel interpretation of the law, which suggests that they get to decide whether or not Northwestern can serve a new industrial load,' Fitzpatrick said on Monday in House Energy. 'This bill simply says no, it's not within the purview of the PSC authority to tell NorthWestern who it cannot serve as long as the proposed new customers can demonstrate that the services received does not harm existing customers.' The bill says the PSC's 'role does not extend to prohibiting large electric customers from obtaining service from certain public utilities.' Fitzpatrick is a former NorthWestern lobbyist. There's been frustration from some Democrats with NorthWestern as well. 'Northwestern Energy says, 'Oh, we can absolutely provide this energy,'' Minority Leader Katie Sullivan said in an interview with the Daily Montanan. 'And at the same time, they come to us and say, 'We have an energy crisis, and we can't supply energy to homes anymore.'' Currency mining is one the purposes of data centers, an industry some legislators want to grow in Montana. Currency mining, or proofing, is an energy-intensive process that essentially involves a computer solving complex math problems. The more computers and larger the system, the faster it can process those problems, and miners can receive cryptocurrency as a reward for doing so. In 2022, the U.S. Energy Information Administration reported cryptocurrency mining 'probably represents from 0.6% to 2.3% of U.S. electricity consumption.' To put it in perspective, one estimate out of Columbia University's Climate School had cryptocurrency worldwide uses as much electricity as the country of Argentina. More computers means more energy consumption. This was at the heart of disputes in Missoula County several years ago, which eventually led the county to develop zoning regulations for cryptocurrency. Essentially, the county forced mining companies to source clean power for their operations. A bill in 2023 — SB 178, brought by Sen. Zolnikov — took away a municipality's ability to pass certain laws regarding cryptocurrency mining. While energy usage is an important discussion point on data centers and new technology, Montana's economy is too. As Bozeman continues to develop as a tech hub and Montana remains an attractive place to live, legislators say some foresight will likely be needed to guide future laws. Lammers' bill, SB 330, will do just that. A new task force created by his bill will be made up of a handful of legislators as well appointees of the governor, Senate and House leadership. The Attorney General's office and State Auditor will also have representatives on the task force. Their goal will be to provide recommendations that will shape future laws, as well as to attract businesses to the state. The businesses aim to bring include energy-intensive data centers, a focus this session, but a major debate across the state for about a decade. Lammers' bill specifically deals with blockchain technology. The blockchain is a type of ledger that records information transferred between entities. Cryptocurrency — a decentralized, digital currency — has been most commonly associated with blockchain, but it's not the only application. Advocates, including Lammers, point to potential in medical records, uses in agriculture, and tracking supply chains. Proponents of the technology, including IBM, say it's more secure — it's stored on a network rather than on one server — and reduces the risk of fraud as blockchain records cannot be altered. Medical records, for example, are either stored electronically or as physical copies. The idea is technology like blockchain can make accessing records easier and quicker. Additionally, blockchain technology does not require a third-party to approve a transaction, keeping things between two entities. The bill was heard in the House Energy, Technology and Federal Relations Committee on March 19 and had several proponents, including the Montana Bankers Association and the Satoshi Action Fund, a nonprofit dedicated to advocating for Bitcoin, a type of cryptocurrency. 'We believe that Bitcoin and Bitcoin mining have the potential to positively impact our environment, our grid, our economy, and society as a whole,' the Satoshi Action Fund states on its website. However, a 2023 United Nations study pointed to serious environmental concerns with Bitcoin, which it said is highly dependent on fossil fuels. Not all of the pushback against blockchain technology and the data centers needed to run them involve energy. A controversy in Butte over CryptoWatt, a cryptomining company, involved a majority owner who was indicted in a $722 million Ponzi scheme. Some legislators are wondering if this new technology has staying power or is the right industry for Montana to embrace. 'I think a lot of the problems with the reputation of cryptocurrency now was it was oversold and became a pretty easy Ponzi scheme to get into and scam, you know, pump and dump,' Rep. Kelly Kortum, D-Bozeman, said in an interview with the Daily Montanan. 'There are legitimate uses of cryptocurrency and Bitcoin, but it's been so abused by so many bad actors that they've lost a lot of credibility on their practical, real world uses.' Legislators also discussed the makeup of the task force, a minor controversy. There's also the question of what type of businesses Montana wants, an idea that doesn't exactly hold to partisan lines. For example, Senate President Matt Reiger, R-Kalispell, said he likes small businesses in Montana and 'the rural feel.' 'You can make great money just being in the trades,' Reiger said during a media presser. 'You don't need a tech job. You probably make more being a plumber, honestly.' Senate Bill 265, brought by Sen. Zolnikov and co-sponsored by Rep. Zolnikov, a married couple, has yet to hit the House floor, but had a hearing in the House Energy, Technology and Government Relations Committee the same day Lammers' SB 330 was heard there. The legislation is regulatory in nature, Sen. Zolnikov said during the hearing. 'We're trying to attract these very on-the-leading-edge technology companies to our state and give them a framework in which they can live and play within without worrying about being thrown out or breaking a law they didn't know they're breaking,' Zolnikov said. The legislation would also make it law that a governing authority can't disallow a business from taking digital assets or currency as a form of payment. It also formally allows the operation of businesses either using or developing software for blockchain operations. There's also a securities exemption, which Zolnikov said would clear up ambiguities in the law. The U.S. Securities and Exchange Commission requires, 'Every offer and sale of securities must either be registered under the Securities Act of 1933' or have an exemption. 'This bill, with the help of the auditor's office and other individuals, creates a clear pathway for entities who want to be in America, who are legitimate.' To be sure these companies don't get bogged down with federal U.S. Securities and Exchange Commission requirements, the bill also offers an exemption, which Sen. Zolnikov said would clear up ambiguities about whether they need to register. House Bill 424, brought by Rep. Zolnikov, seeks to make the business climate more friendly and stable for businesses utilizing data centers. The bill does this by creating incentives for on-site energy production at data centers and extending the timeframe in which those businesses can be built. Some regulations surrounding the data centers sunset in 2027, she said during a floor debate on March 24. That bill included an amendment from Rep. Fitzpatrick dealing with the price of power and taxation. Data centers would only be able to sell excess power for cost of production, in an effort to prevent price gouging during electrical emergencies. The amendment also revises the tax rate on power production, putting it in class 13 — the power plant class — after a period of 10 years. The property tax rate for data centers is 0.9%, while power plants pay a 6% property tax rate. Power generation facilities at data centers would slowly have their rate increased over time, treating it as an introductory rate. Lastly, the amendment would also not exempt data centers from paying into tax increment financing districts. 'Class 17 property regarding data centers currently exist in state law,' Rep. Zolnikov said during a floor session on March 24. 'What we're doing in this bill is we're expanding this class to include power generation behind the meter, and this is what's key to supporting grid resiliency and benefiting Montana in times of electrical emergencies.' Some representatives took issue with who would be on the task force created by SB 330. The amendments made some people feel more at ease with the legislation, Lammers said. The amendments put six legislators on the task force, as well as the state auditor and attorney general or their designees. The governor also gets to pick five people to put on the task force and those individuals who would need to have experience with blockchain, cryptocurrency, financial technology or digital innovation technology. The majority leaders in both the House and Senate also get to pick four other members each who do not have to be in the legislature. Minority leaders in both chambers get to pick one representative each. 'I'm worried that some of the members selected could not necessarily be experts, but be marketing experts,' Kortum said. 'And that's something we're seeing nationwide.'
Yahoo
12-03-2025
- Business
- Yahoo
Indiana proposal to boost nuclear development, recover costs from customers clears committee
Rep. Ed Soliday, R-Valparaiso, leads an energy committee on Tuesday, March 11, 2025. (Leslie Bonilla Muñiz/Indiana Capital Chronicle) Indiana legislation boosting early forays into nuclear power earned utility company support on Tuesday, but passionate opposition from ratepayer groups. It advanced from committee on a bipartisan 10-3 vote. With demand on the rise, Hoosier political and energy leaders are increasingly eyeing emerging technology — small modular nuclear reactors, or SMRs — as a possible solution. The United States hosts no operational SMRs. Across the globe, only China and Russia have functional ones. Some want Indiana to lead, but nuclear development is pricey. Sen. Eric Koch, R-Bedford, told the House's energy committee that he hopes to 'incentivize earlier deployment by removing what I understand to be the single-biggest barrier.' His Senate Bill 424 would offer public utilities bringing SMRs to Indiana a path to recover pre-construction costs — including anticipated spending — from their customers before they obtain certificates of public convenience and necessity from the Indiana Utility Regulatory Commission. Included are expenditures for design; engineering; environmental analyses and permitting; federal approvals, licensing and permitting; equipment purchases and more. Once the IURC gives a utility permission to start spending, the company would be able to request approval of a rate schedule to pass those costs on to customers. Regulators would have to approve if they find the costs reasonable in amount, consistent with their best spending estimate, and necessary to support SMR development. A utility could recover 80% of approved costs under the resulting rate schedule within three years at most. It would defer the remaining 20% for recovery as part of its next general rate case. Indiana Michigan Power — one of the state's 'big five' investor-owned, regulated monopolies — featured heavily in discussion. Two of the state's largest incoming data centers, for Amazon Web Services and Google, will be in I&M territory. President and CEO Steve Baker said tax incentives and other economic development efforts are drawing more big customers and big loads into Indiana. 'Our customers are concerned about our ability to supply these loads and do that in a sustainable sort of way,' Baker told the committee. I&M is 'considering' an SMR at its coal-fueled Rockport power plant, he said, which is set to shutter in 2028 by federal consent decree. A state-funded Purdue University report last year found the plant is among eight Indiana coal plant sites well-suited to SMR development. Several representatives from Spencer County, which hosts the plant, said the legislation would ensure a major property tax contributor, charitable giver and employer stays in their community. That prompted Rep. Matt Pierce, D-Bloomington, to remark later, 'I can understand why, from the perspective of the locals, they would certainly want to have that project built, particularly if the cost of the project is borne by people outside of their area.' Ratepayer advocates maintained opposition. 'Say no, no, to subsidizing financially healthy, investor-owned utilities (and) tech behemoths who have deep, deep pockets,' Citizens Action Coalition Executive Director Kerwin Olson said. Olson expected I&M to begin its cost recovery asks once the bill becomes law — although an SMR wouldn't come online at Rockport until at least 2036, in the utility's estimate. 'If they make a filing in 2025 or 2026, whatever they file for, this bill says they have to recover that by 2029 — for a project that may never, ever happen,' Olson said. '… Where are the provisions that require the utilities to refund customers their money?' Koch previously said his proposal contains 'important consumer protections.' Under Senate Bill 424, costs exceeding the IURC's best estimate wouldn't get passed to ratepayers unless regulators deem the spending 'reasonable, necessary, and prudent' in supporting reactor development. Expenditures for canceled or abandoned projects wouldn't be recoverable without the same 'reasonable, necessary, and prudent' finding. Even so, a utility wouldn't earn returns in such cases unless regulators also find the decision was 'prudently made for good cause,' that profit is 'appropriate … to avoid harm' to the utility and its customers; and that costs will be offset or reimbursed through other, listed means. Olson and others weren't convinced. 'I think 'reasonable' and 'prudent' are my least favorite words in the English dictionary; (they're) written by lawyers for lawyers,' Olson said. He noted that the legislation doesn't define those terms. His other concern: 'It's the 'shall' provisions. The bill is littered with, 'The utility shall recover,' (and) 'The commission shall approve.'' Delaney Barber Kwon, the community and government affairs manager for Indiana Conservation Voters, asked the committee to consider alternative ways to support SMR development, like tax credits, public-private partnerships and more. Joe Rompala, representing Indiana Industrial Energy Consumers Inc., similarly requested that lawmakers pursue other forms of cost recovery, like the partnership-heavy pilot program in Senate Bill 423. The trade organization includes more than 20 of the state's largest energy consumers, he said. Sam Carpenter, executive director of the Hoosier Environmental Council, noted that Virginia has capped SMR development cost recovery totals to just $125 million over five years and limited rider increases for the typical residential customer to $1.40 monthly. Disagreements abounded over the legislation's timing. Pierce, the Bloomington Democrat, said SMR is 'not quite proven' and that Indiana should wait for the technology to get better and cheaper. Advancing Koch's proposal now, he said, would make ratepayers into 'guinea pigs for this experiment called an SMR.' But I&M's Baker previously feared that if Indiana moves too slowly, it may struggle to compete for power-needy economic development projects. Baker said I&M wants to ensure that 'we're not too far in front, but we're not so far behind that we don't have the ability to act on this.' The legislation earned a full-throated endorsement from Energy and Natural Resources Secretary Suzanne Jaworowski, one of Gov. Mike Braun's cabinet appointees. She said this chance to 'deploy proven technology' aligns with Braun's agenda and 'all-of-the-above approach' to energy. 'This is (such) a unique moment in time that I don't want to see Indiana miss out on the opportunity to have federal support, private-public partnership support,' Jaworowski said. 'Not only do we have a demand signal from industry that they want this technology, … they're also willing to help pay for it so that it is not all on the backs of the ratepayers.' Identical language within another measure, House Bill 1007, has also crossed into the Senate. That's after the committee on Tuesday stripped out the only difference: a 2035 expiration date on the cost-recovery provisions. Chair Rep. Ed Soliday, R-Valparaiso, said he 'convinced' Koch to remove it because 'we don't know when these are going to come online.' The Indiana General Assembly meets often enough that it can enter a date later if needed, he said. The twinned language is necessary because lawmakers plan to push both across the finish line, Soliday told the Capital Chronicle, citing 'powers above my head.' The committee didn't take up detailed edits filed for a carbon dioxide storage and transmission measure — or accept testimony — before a vote. Author Sen. Sue Glick, R-LaGrange, has dubbed it a 'clean-up' effort for previous legislation. Lawmakers authorized a pilot project, led by Wabash Valley Resources, in 2019 and revisited it in 2023. In between, in 2022, they established regulations for carbon sequestration projects and exempted the pilot from those requirements. Glick's Senate Bill 457 seeks to build on those endeavors. Indiana Senate approves education measures, narrowly OKs carbon storage measure It would exempt pipeline companies from needing to get certificates of authority in certain cases. The legislation would also create a permit for exploratory wells and well conversions; add inspection provisions; charge new fines for legal violations; and tweak other fee amounts. It would direct fee and fine proceeds away from topic-specific funds toward the state's General Fund — changes made by Sen. Ryan Mishler, R-Mishawaka, who leads the powerful Senate Appropriation Committee. An exhaustive amendment filed ahead of the committee's meeting would've undone that, redirecting monies back to carbon sequestration trust and administrative funds and specifying that the funds exist to defray state spending to manage and monitor projects. It wasn't called. 'The chair will not be accepting any amendments,' Soliday said during the meeting. 'There will probably be an amendment as a trailer to another bill. The debate is who can create funds.' 'We are at the mercy of the Appropriations Committee, as you all know, and (the) Ways and Means (Committee),' Glick added later. 'So we'll live with whatever they decide we can do.' Senate Bill 457 will head there next for a finance-focused review, after committee members advanced it in an 11-2 vote featuring bipartisan support. Rep. Tim Wesco, R-Osceola, critiqued the concept but voted in favor. 'Carbon sequestration, in my view, is likely the most expensive boondoggle of this decade. It is wasteful and pointless — but, I feel, otherwise harmless,' Wesco said. 'Companies … want to spend money to do it, so, we'll let them.' SUBSCRIBE: GET THE MORNING HEADLINES DELIVERED TO YOUR INBOX
Yahoo
20-02-2025
- Health
- Yahoo
House set to approve expansion of drug board's authority to lower costs
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. SUPPORT: YOU MAKE OUR WORK POSSIBLE '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.'
Yahoo
07-02-2025
- Health
- Yahoo
Maryland lawmakers want limits on pricey prescriptions, say health care system is ‘failing us'
BALTIMORE — For most of her life, Erica Miller suffered from a medical condition she didn't know she had. When she finally got a diagnosis and treatment, the cost of her medication varied wildly month-to-month from as low as $45 to as high as $600 — even with insurance. She couldn't afford the care she needed. Maryland lawmakers want to help residents like Miller who battle exorbitant prescription prices, and they are pushing bills in the state House and Senate to limit costs. 'Our health care system is not just broken,' said House Health and Government Operations Vice Chair Bonnie Cullison. 'It's really failing us.' Throughout her life, Miller could not silence the noise in her brain. Miller, a mother and Baltimore resident, has adult ADHD — a diagnosis she didn't receive until she took her son to get tested. As the doctor described the symptoms, she said a 'lightbulb went off.' 'It was a moment that was just kind of an eye-opener,' Miller said. She tried to manage it on her own for a while, but it became difficult. Miller found a therapist and began trying to manage her ADHD with medication. That's when she found Vyvanse, a prescription drug used to treat ADHD and binge-eating disorder. Miller told The Baltimore Sun about when she knew she had finally gotten her dosage right. She said that she cried on the phone to her then-husband, telling him her 'brain is finally quiet.' 'My mind is quiet, and I'm like, 'Is this what it feels like?'' Miller said. 'For anyone who has not experienced or suffered from ADHD, your brain can be very, very busy. For the first time, I didn't experience an 'on' brain.' Miller was now able to focus and advance in her career. But she ran into a snag with the high and inconsistent costs of her prescription. House Bill 424 and Senate Bill 357, sponsored by Cullison, Del. Jennifer White Holland, Senate Education, Energy, and the Environment Committee Chair Brian Feldman and Sen. Dawn Gile, all Democrats, seek to expand the authority of the Maryland Prescription Drug Affordability Board and allow it to set upper payment limits on medications for Marylanders. Cullison said that if the board lowers the cost of prescriptions, commercial market insurance companies would be required to lower premiums or implement different copay or coinsurance structures. Under Maryland law, the Prescription Drug Affordability Board, a five-member independent agency created by the legislature in 2019, can only limit the costs paid by state and local government agencies for prescription medication. It is currently looking at possibly setting upper payment limits for Jardiance and Farxiga, which are used to treat diabetes. Cullison said these two medications represent the 'single biggest cost for state employee health plans.' Between 2020 and 2024, the price of those drugs in the state skyrocketed from $14.5 million to $29.3 million. Cullison said that Maryland has contributed $870 million in research grants to develop both. Dr. Andrew York, the executive director of the Prescription Drug Affordability Board, said cost review studies are currently being performed on six additional drugs. Under the bill, upper payment consideration for the general public would not go into place until the board implements payment limits for purchases through the state and local governments. Drug prices are negotiated between manufacturers and insurance company pharmacy benefit managers. 'Pharmaceutical companies are not regulated in any way except for their product. Their product is regulated, their pricing is not,' said Cullison. 'It was supposed to be managed by competition, but … I don't think competition is working on behalf of the people who need the drugs.' Testifying in opposition to the bill, Kristen Parde, the deputy vice president of state advocacy for PhRMA, said that establishing upper payment limits could disrupt the pharmaceutical supply chain and 'threaten patient access to needed medicines.' '[Upper payment limits] create uncertainty in a complex system, making it harder for providers to secure medications at state-prescribed prices, leading to treatment disruptions, or inability to access medicine for patients,' she said. Patients testified before lawmakers Thursday, asking them to consider what the potential reduced availability of life-saving drugs could mean for them. 'This legislation could make it harder for patients to access the treatments they need to survive and manage diagnoses like breast cancer,' said Marquita Goodluck, a breast cancer survivor. 'While the goal of lowering drug costs is important, the [Prescription Drug Affordability Board] has yet to deliver on this promise.' Former Gov. Larry Hogan, a Republican, vetoed the 2020 bill that was poised to create the funding stream for the Prescription Drug Affordability Board during his second term as governor, citing its cost and the coronavirus pandemic as his reasons to delay its work. Del. Nic Kipke, an Anne Arundel County Republican, said Thursday that he is worried price controls issued by the board could lead to rationed prescriptions or worse products. York called upper payment limits 'a tool in the toolbox,' saying that they are not necessarily the answer for every situation. He said that the first action the board would likely take is to see if it can promote market competition. Cullison said Wednesday that companies have not refused to sell their drugs in other developed countries with regulatory standards, using Germany as an example. Regarding medication pricing, the German federal government functions similarly to the Prescription Drug Affordability Board. There, a group of stakeholders and medical experts negotiate the price with each other and then take their negotiation to drug companies. The results are stark when compared to U.S. prices. In America, Skyrizi, which is used to treat moderate-to-severe plaque psoriasis, has a wholesale acquisition cost of $21,017. It's $3,711 in Germany. 'The German health care system is not like ours, I'm going to say that out front,' Cullison said. 'But these are the same drugs, being made by the same companies that we're using here in America.' Big price tags on prescriptions have a tangible impact on Marylanders. The high, varying prices of her prescriptions coincided with stressful events in Miller's life. She got divorced and was no longer insured through her ex-husband's health care plan. She was now a single mother, and keeping up with the cost of her medication was becoming untenable. 'Even with a decent job to accommodate for the varying costs, it was still a struggle,' Miller said. 'I have to take the prescription. I'm in executive leadership. I need to be able to make sure that I can function at that level so I can continue to provide for my family.' She said she was having to make decisions between paying rent or paying for her medication. There were a couple of months that she didn't take it. 'The 'quiet' mind went away, and the 'noisy' mind came back, and trying to navigate that along with a divorce — it just became too much,' Miller said. What Miller has experienced is not uncommon. According to Cullison, one in three Marylanders skip doses, ration drugs, or do not pick up prescriptions from the pharmacy because of the costs. There are also racial disparities in access to affordable drugs. According to White Holland, Black and Latino adults over 65 are nearly twice as likely to report difficulty affording medications when compared to white people in the same age bracket. Not taking her prescription began to affect Miller's work performance. She switched to Focalin, a different ADHD medication. The cost was a consistent $90 each month, but she said it doesn't work as effectively for her as Vyvanse did. Miller said she ended up losing her job. She pointed to her inability to manage her ADHD with a drug that worked for her. 'I think a lot of people don't think that being a middle-class corporate professional, that they could be impacted,' said Miller. 'I didn't expect to experience a divorce. I did not expect now, at this point in my life, to be a single mother of two. I didn't expect for this to happen, and now I'm having to juggle financial resources because these pharmaceutical companies want to play Russian roulette with what we can afford.' ----------
