Q&A with Maryland Prescription Drug Affordability Board Executive Director Dr. Andrew York

Dr. Andrew York is the Executive Director for the Maryland Prescription Drug Affordability Board a newly created board in Maryland working to address prescription drug costs. According to the annotated code of Maryland, “the purpose of the Board is to protect State residents, State and local governments, commercial health plans, health care providers, pharmacies licensed in the State, and other stakeholders within the health care system from the high costs of prescription drug products.”

In this Q&A, Dr. York goes into detail on the history of Maryland’s Prescription Drug Affordability Board, the goals of the board, and what they’ve been working on during the first half of 2021.

 

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Matt Beuschlein: Can you tell me about the Maryland Prescription Drug Affordability Board and what you’re hoping to achieve?

Dr. Andrew York: “The Maryland Prescription Drug Affordability Board was created in 2019, and is charged with making drugs more affordable for Marylanders both as taxpayers and as patients. We’re supposed to protect them from the high costs of prescription drugs. The work that we’re doing is to create a report, analyze the issues in Maryland and look through the supply chain to identify where there are affordability issues. 

There’s a number of different stakeholder groups. I think all of them have great ideas and important feedback. But I think one of the values that comes from a board like this is the fact that it can take all those different views into consideration and fit policies together to make sure that they’re all working toward the same goal.” 

 

MB: You mentioned you’re going to work on looking through the prescription drug supply chain and identify where there are affordability issues. Do you have any specifics on where you’ll start? Where do you hope to make the most progress? 

AY: “I think that’s step one for the board to decide. What are these issues and which ones are we trying to address? There are a number of different issues that could affect drug affordability, and each of those issues could have a completely different solution. 

For example, you could have very specific high cost drugs that, you know, may be extremely effective, but may be very expensive that can have effects on state budgets. You can have long term brand name drugs that have been going up in cost over time and have had an increasing impact on payers, employers, and patients. You can have some that are just high general spend even though the actual drug cost itself may be low. With all of these scenarios, you also have to work through the issues of out-of-pocket costs to the patient versus the overall cost to the health care system and the taxpayer. 

This is all to say that there are a number of different issues with a number of potential solutions, and I think it’s important to be clear in what we want our policies to achieve as we work through these issues.  

The policy that we are most often asked about is upper payment limits (UPLs) because it’s the policy that most directly fits within the Board’s authority. We would likely need to address our goals and priorities if we decide to move forward with upper payment limits because of how we would develop that process. We would need to create an action plan, which would be  presented to the Legislative Policy Committee for approval. 

As part of that plan, I would picture us going through a process that addresses what you were asking in your question. We would set the criteria to answer questions like: What is the exact issue we’re trying to address? Which buckets of these drugs are the ones that are the biggest concerns? And then how do we target those? And unfortunately, each of those buckets has different policy solutions…I think that’s the most important thing we’ll do, work through the process of setting priorities and then building the criteria for identifying the drugs that would be most important to us.”

 

MB: You’ve been the Executive Director for about six months now. What’s the experience been like? Have you been able to accomplish anything notable that you’re excited about? What’s on the agenda for the next six months?

AY: “First of all, this is my dream job, the position is amazing. The team’s amazing. Our partners throughout Maryland, both within the government and our external stakeholders, have been phenomenal to work with. 

We just voted on two contracts to start analyzing the data. The contracts were approved, we’re going through the process of finalizing, and that means we will actually be in the hard data. The real work starts now.

Most immediately, we have two reports that are due at the end of this year, which is where we’ll spend most of our time. Also, if the Board decides to move forward with setting UPLs, we will start creating the action plan for those because I think there is a lot of work to do to put something like that in place. 

So right now, there’s a lot of “here’s what we’re going” to do rather than the actual doing. But that being said, I think we’re looking for opportunities to make an impact as soon as possible. For example, we are trying to support our partners in the legislature with things like their reverse auction legislation that they passed and the PBM legislation that they’ve considered. We’re also trying to directly serve Maryland patients that are currently facing affordability issues whenever and however we can.”

 

MB: What are some of the biggest challenges that you see are going to be in your way for trying to lower some of these costs for prescription drugs?

AY: “The complexity of the supply chain makes things very difficult. If you are trying to reduce drug costs, you need to define what that actually means, get a disparate group of stakeholders to all agree on what the priorities should be, and figure out how different policies should land. Each stakeholder group is going to have their priorities that they feel very strongly about, and it will be very difficult to come to a consensus on the best way forward. Navigating a very complex supply chain and very engaged stakeholders with their own priorities, I think it’s going to be pretty interesting. 

Also, we’re the first board of this kind in the country, so there are inherent challenges in kind of just paving the way and addressing some of these very novel issues. We’ll be looking at existing policies and other states and seeing if they would fit into Maryland, but some of the policies we would consider can be the first of their kind. So that would also be its own challenges, just navigating, how do you address these completely novel ideas and policies?”

 

MB: Is there anything else we haven’t touched on that you want to make sure our readers know?

AY: “We have an open door policy, and we want to hear from everyone. Some of the most impactful and meaningful feedback that I hear is from patients on the ground; Marylanders that are saying, ‘this issue is affecting me.’ We’re taking everything to heart. We have an open door policy to make sure that everyone can have their voice heard. The work is happening now, we invite everyone to join in on that effort.”

 

This interview was edited for clarity and length.