Maryland’s Prescription Drug Affordability Board has taken another step to rein in prescription costs. The Board voted to cap payments for Ozempic in state and local government health plans, a move projected to save public employers millions each year.
Maryland’s Prescription Drug Affordability Board (PDAB) determined Ozempic is unaffordable for people living in the state. The Board voted to place upper payment limits on the diabetes and weight-loss drug for state and local government health plans, a move expected to save public employers roughly $5.8 million annually.
As previously covered by MACo, PDAB was created by the General Assembly in 2019 and formally funded in 2023. It was designed to address the opaque and escalating prices of prescription drugs. The review process includes industry data collection, stakeholder testimony, and a deep dive into pricing trends, highlighting out-of-pocket costs, inflationary increases, and state and local spending.
In an article from WYPR, the recent decision marks the second time the Board has exercised its authority to cap payments for high-cost prescription drugs. The limits on Ozempic are scheduled to take effect next year for state and local government plans and could expand to all insurance plans in Maryland by 2028. The first time the Board exercised its authority was when it unanimously determined that two common Type 2 diabetes medications, Jardiance and Farxiga, may pose an affordability challenge to the state’s health care system.
Some critics argue the policy could unintentionally limit patient access by creating new barriers for individuals who rely on the medication. Although supporters of the move say Ozempic’s popularity and patent protections have contributed to rising costs that are straining healthcare budgets.
From the WYPR article:
Because of Ozempic’s popularity, the, and because the manufacturers have patent exclusivity, the price has been set very high, so it’s both been a strain on our health care system as health plans struggle to keep up with the demand and cover that. It’s also been hard for patients to afford it when they want to because it’s off label as well, said Cathrine Kirk Robins, the deputy director of Maryland Healthcare for All.
Last month, the Board also approved upper payment limits for the diabetes drug Jardiance, a decision projected to save public health plans an additional $320,000 annually.
