#MACoCon Recap: Strategies for Prescription Drug Spending

Prescription drug costs are no longer a back-office benefits issue for counties; they’re a frontline challenge shaping budgets, workforce retention, and long-term sustainability.

Counties across Maryland are facing a familiar but intensifying challenge: how to sustain high-quality employee health benefits as prescription drug costs continue to climb. At MACo’s Winter Conference, the panel “Rx for Retention: County Strategies for Prescription Drug Spending” brought together county leaders, policy experts, and benefit consultants to unpack what’s driving pharmacy costs and, more importantly, what counties can do about it.

The discussion opened with a practical, on-the-ground view from Beverly Churchill, Human Resources Director for Queen Anne’s County, who outlined how rising pharmacy costs directly affect county budgets, benefit design, and workforce retention. Using real plan data, Churchill illustrated how a relatively small number of high-cost specialty drugs can account for a disproportionate share of total prescription spending, even as counties maintain strong generic dispensing rates and utilization controls. With county governments competing for talent while managing tightening budgets, she emphasized that simply shifting costs to employees is not a sustainable solution.

Churchill also highlighted how evolving state legislative proposals could shape how counties manage pharmacy benefits. She highlighted HB 321, which would have expanded the definition of “purchaser” in state law and applied additional insurance requirements more broadly across pharmacy benefit arrangements. These limitations would disrupt counties’ ability to provide comprehensive, affordable health benefits to employees while increasing costs for both counties and their employees.

Building on that local perspective, Steve Milligan, Vice President of Sales and Consulting at Keenan Pharmacy Services, zoomed out to broader pharmacy trend lines affecting public employers nationwide. While medical cost growth has remained relatively flat, pharmacy spending, particularly specialty medications, continues to rise sharply, driven by new high-cost therapies and a pipeline dominated by specialty drugs. Milligan walked through a range of benefit management strategies counties are using to respond, including independent clinical management, utilization review, patient assistance programs, and alternative sourcing options. The common thread, he noted, is proactive engagement, using clinical oversight and benefit design tools to promote appropriate use of medications while protecting both plan affordability and patient outcomes.

The policy dimension of prescription drug affordability was addressed by Andrew York, Executive Director of the Maryland Prescription Drug Affordability Board (PDAB). York provided an overview of the Board’s mission, structure, and growing authority, highlighting its role as a tool for managing prescription drug costs across state and local government plans. He explained how the PDAB conducts in-depth cost reviews of select high-impact drugs and, when warranted, advances policy recommendations, including the potential use of upper payment limits, to address affordability challenges without restricting patient access. Importantly for counties, York emphasized opportunities for collaboration as the state moves toward implementation, noting that any initial upper payment limits for local government plans would be structured to work within existing benefit systems.

Moderated by Senator Dawn Gile, the conversation tied these perspectives together around supporting a healthy, stable county workforce while exercising responsible stewardship of public funds. Panelists underscored that prescription drug spending is no longer just a health plan issue; it is a recruitment, retention, and fiscal sustainability issue for counties of all sizes.

Title: Rx for Retention: County Strategies for Prescription Drug Spending

Speakers:

  • Beverly Churchill, Human Resources Director, Queen Anne’s County
  • Andrew York, Executive Director, MD Prescription Drug Affordability
  • Steve Milligan, Vice President, Sales and Consulting, Keenan Pharmacy

Moderator: The Honorable Dawn Gile, Maryland State Senate

More about MACo’s Winter Conference: