Maryland Among States Working to Curb Soaring Rx Drug Prices

As federal action on prescription drug costs remains limited, states across the country are stepping in with new laws to make medications more affordable for residents.

According to an article from Stateline, in 2025 alone, at least 31 states have enacted nearly 70 laws targeting various parts of the complex drug pricing system, from Pharmacy Benefit Managers to drug manufacturers.

Prescription drug prices continue to rise, and local governments are increasingly footing the bill. Counties support solutions that will effectively solve this problem. However, counties do have concerns with bills that seek to limit the tools Pharmacy Benefits Managers (PBMs) can use to negotiate pharmaceutical prices on behalf of their clients, including county governments. Doing so would significantly disrupt counties’ ability to provide county staff with the best and most fiscally responsible benefits for their public service.

Other states have created or expanded drug affordability review boards, which can set upper payment limits or review high-cost medications for fairness and necessity. Maryland is leading in this area, becoming the first state to establish a Prescription Drug Affordability Board in 2019. Legislation expanded its authority earlier this year, allowing it to address drug prices for all Marylanders, not just state employees. The board is now exploring limits on high-cost drugs used to treat chronic conditions such as diabetes. MACo testified in support of this legislation, citing the growing financial burden of prescription drug costs on local governments and their employees.

Similar boards and laws are emerging in states like Colorado, which recently capped prices on a costly arthritis drug, and California, which plans to offer a state-produced generic insulin for just $11 per pen starting in 2026. While supporters argue that these measures provide patients with much-needed relief, critics caution that price caps could discourage innovation or limit pharmacy access.

Despite the debate, one thing is clear: states are increasingly leading the charge on drug affordability. With federal policies progressing slowly, state lawmakers and regulators are experimenting with new approaches to bring transparency and fairness to a system that affects millions of Americans and budgets at every level of government.

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At the 2025 MACo Winter Conference Human Resources session, “Rx for Retention: County Strategies for Prescription Drug Spending ,” panelists will explore the complex drivers behind prescription drug costs and examine how changes in both state and federal policies could affect county health plans and prescription drug costs.

The 2025 MACo Winter Conference will be held at the Hyatt Regency Chesapeake Bay Hotel in Cambridge, MD, from December 10-12, 2025. This year’s theme is “Local Leadership, Lasting Impact: Shaping What’s Next.” More information can be found on our conference website.