Maryland’s Prescription Drug Affordability Board (PDAB) met on Monday to discuss the first round of drugs it has targeted for cost reviews—and could eventually be considered for upper payment limits (UPLs)—which include diabetes treatment medications, Ozempic, Trulicity, Jardiance, and Farxiga.
The medications were chosen based on data, stakeholder input and public comment. The three manufacturers of the targeted diabetes medications—Sanofi, Novo Nordisk, and Eli Lilly—all submitted written comments opposing PDAB cost reviews and any subsequent UPLs for the drugs. Cynthia Ransom, senior director of government strategy at Eli Lilly, said she opposed the board’s selection of Trulicity for a cost review.
“Trulicity is affordable. Patients in Maryland paid an average of $2 to $39 per month for their therapy, which equates to only 0.2 percent to 4 percent of the list price. This affordability stems from exceptional access provided by payers within the state, as well as affordability programs provided by Lilly,” Ransom said.
Trulicity is used by children and adults over 10 with Type 2 Diabetes to improve blood glucose levels. Eli Lilly is concerned a UPL would limit access to Trulicity, Ransom said.
“In addition, UPLs are unlikely to impact the patient out-of-pocket experience at the pharmacy counter, which is the ultimate goal of the creation of the board and its regulations,” Ransom said.
Novo Nordisk wrote in opposition to a cost review for Ozempic, a weekly injection for people living with Type 2 Diabetes used to improve blood glucose levels, noting,“The unintended consequences of (a UPL) could adversely impact access to treatment and worsen health outcomes for patients living with diabetes and related chronic diseases.”
PDAB presented some drug cost data at the meeting. It found that the average payer out-of-pocket cost per patient on commercial insurance for Trulicity in 2022 was $380, while the average cost for Ozempic was about $293. The average cost for Jardiance was $245, while the average cost for Farxiga was about $304.
Board member Gerard Anderson expressed confusion about how cost reviews or UPLs would cause access or affordability issues.
“I don’t understand how a lower price—I mean, as somebody trained in economics, if the price goes down, affordability and access goes up—[would do that] so people who make an argument that it’s going to affect access and affordability … I really need to understand why you think a lower price would do that,” Anderson said.
Anderson discussed patient assistance programs and coupons for medications.
“It’s the drug companies or the patient assistance programs which make the decision as to who gets the drug, for how long, under what conditions, and gather a lot of information from the person.”
— Anderson
A motion to conduct a cost review for Skyrizi, a medication used to treat psoriasis, was passed unanimously. Board member Joesph Levy worked to get Metformin, another diabetes therapeutic, onto the board’s therapeutic equivalents list for cost comparisons. The board also approved a motion to add Metformin and insulin varieties to its list of therapeutic alternatives, which will allow it to consider that information and data as part of the drug’s cost review.
A UPL action plan would need to be implemented before any UPLs can be set. The board is working to get input from the Stakeholder Council to better hone in on the plan’s framework. As soon as the action plan is approved by the Legislative Policy Committee, the board can set a timeline for when UPLs for the targeted drugs could become active.
Readers interested in learning more about health policy issues in Maryland can register to attend our 2024 Maryland State of Reform Health Policy Conference, which will be held on June 7 at the Baltimore Marriott Waterfront. A “Legislators Discuss Health Policy” panel will be held at 2:15 p.m.