After becoming the first state to establish a Prescription Drug Affordability Board (PDAB) in 2019, Maryland is set to draft and publish a plan of action for setting upper payment limits on prescription drugs by May 15th.
On April 11th, Gov. Wes Moore signed House Bill 279 into law, which re-establishes PDAB’s authority to set upper payment limits—under certain circumstances—for prescription drugs that are purchased and paid for by and through certain state and local government entities, plans, and programs. Entities include state or county correctional facilities, state hospitals, and health clinics at state institutions of higher education.
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The 2019 legislation that originally established the PDAB was statutorily set to sunset after two years. This year’s renewal of the bill represents the state’s ongoing commitment to making prescription drugs more affordable.
“This session marked the passage of important legislation sponsored by Senator Brian Feldman and Delegate Bonnie Cullison to codify the PDAB’s authority to establish upper payment limits on high-cost prescription drugs for state and local government entities,” stated the Maryland Health Care for All Coalition.
HB 279 was signed as an emergency measure that’s necessary for the immediate preservation of public health and safety. PDAB, in collaboration with the PDAB Stakeholder Council, will draft a plan of action for setting upper payment limits that includes the cost of administering the drug; the cost of delivering the drug to consumers, and other relevant administrative costs related to the drug.
The PDAB stakeholder council will provide stakeholder input to assist the board with making decisions to protect the state and its residents, and other stakeholders in Maryland’s healthcare system.
Any upper payment limits that are established will be for prescription drugs that have led to, or will lead to, affordability issues. The board will monitor the availability of any prescription drugs for which upper payment limits are set, and if there becomes a shortage of a prescription drug in Maryland, PDAB will reconsider whether an upper payment should be altered or suspended.
Drafting a plan of action for setting upper payment limits will consist of several steps. PDAB will identify prescription drugs that are eligible for a cost review, including assessing the highest total spending for different medications, the highest percentage change increase in total spending on them, all types of insulins, and the highest average patient total out of pocket costs.
The board will select at least 25 prescription drugs for cost review, which will then be referred to the stakeholder council for input. An open meeting will be held about the selection of prescription drugs, and the selected drugs will be posted on the PDAB website.
PDAB may request information from prescription drug manufacturers, pharmacy benefit managers, health insurance carriers, wholesale distributors, health maintenance organizations, and managed care organizations, who have 60 days to respond to the request.
Under the cost review process, the board will also examine whether certain prescription drugs raise affordability concerns for Maryland’s healthcare system through high out-of-pocket costs for patients, and if those costs are consistent with labeling approved by the FDA or by standard medical practice.
The PDAB will then create and adopt a report which outlines the information considered by the board when conducting the cost review, and will summarize the board’s decision. The draft will be published as soon as possible, according to the PDAB, and will receive any additional written public comments by May 18th. At the next PDAB meeting on May 22nd, members will consider draft regulations.
In a statement, AARP Maryland State President Jim Campbell noted how the reestablishment of the PDAB, in addition to other impactful health legislation passed this session, will specifically benefit aging Marylanders.
“In the end, Marylanders 50 and over will have more services and resources to age in place,” Campbell said. “After the House and Senate leadership slammed the gavel one last time to signify sine die, the PDAB will be able to look at more costly pricing, the behavioral health 9-8-8 hotline will be fully funded, and folks seeking long-term care and dementia care will have access to a navigator who will help connect them to the services they need.”
By Dec. 1st, 2026, the PDAB and the stakeholder council will report to the Senate’s Finance Committee and House’s Health and Government Operations Committee about the legality, obstacles, and benefits of setting upper payment limits on all purchases or payor reimbursements of prescription drugs in the state.
The groups will also report recommendations about whether the General Assembly should pass legislation to expand the board’s authority to set upper payment limits to all purchases and payor reimbursements of prescription drugs in Maryland.
The PDAB regularly meets on the fourth Monday of every other month. The stakeholder council also meets every fourth Monday of every other month, and their next meeting will be on June 26th.