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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
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.'
