Maryland Moves to Cap Costs for High-Priced Diabetes Medications
Maryland is taking aggressive steps to combat the rising cost of prescription drugs. The Maryland Prescription Drug Affordability Board (PDAB), an independent unit of state government, is working to protect the state’s healthcare system and its residents from unaffordable medication pricing.
- The PDAB is moving toward approving payment caps for Jardiance and Farxiga.
- Ozempic and Trulicity have been identified as “likely unaffordable” and are entering a cost review process.
- The board’s goal is to limit what state and local governments pay for these high-cost drugs.
Targeting Type 2 Diabetes Medications
The board is focusing its current efforts on several brand-name drugs used to treat Type 2 diabetes and related conditions. These medications are critical for patient health, but their high costs can strain both government budgets and individual patients.
Approaching Price Caps for Jardiance and Farxiga
The PDAB has taken significant steps toward approving upper payment limits for two specific medications: Jardiance (empagliflozin) and Farxiga (dapagliflozin). Board members have ordered staff to draft the specific language required to set limits on what state and local governments will pay for these drugs. While these caps have been under consideration for years, they still require official approval in a future board meeting before they are finalized.
Recent Reviews for Ozempic and Trulicity
In a recent move, the board determined that the blockbuster drugs Ozempic (Novo Nordisk A/S) and Trulicity (Eli Lilly & Co.) are likely unaffordable for Marylanders. These two medications have been added to a list of drugs targeted for potential payment caps.
The process for these drugs involves a monthslong cost review. The board has voted to collect public comments and data to determine whether state health plans should have limits on what they pay for these specific treatments.
How the Affordability Board Works
The PDAB functions as a safeguard for the Maryland healthcare system. By reviewing the affordability of high-cost drugs, the board can intervene when prices become a barrier to care. The process typically involves:
- Referral: Identifying drugs that may be unaffordable.
- Review: Collecting data and public testimony via a stakeholder council.
- Action: Setting an upper payment limit (a “ceiling”) on what government entities will pay for the medication.
Frequently Asked Questions
Which drugs are currently being considered for price caps?
The board is currently moving toward caps for Jardiance and Farxiga, while Ozempic and Trulicity are undergoing cost reviews to determine if caps are necessary.
Who does this price cap affect?
The primary targets of these caps are the amounts that state and local governments are willing to pay for these medications.
When will these price caps take effect?
The exact timeline is not yet finalized. For Jardiance and Farxiga, the board is currently drawing up the language, and final approval will happen at a future meeting.
Looking Ahead
Advocates, including the Maryland Health Care for All Coalition, view these actions as a major step forward. By establishing a precedent for payment ceilings on high-cost medications, Maryland aims to create a sustainable model that eventually makes essential drugs more affordable for all residents.