Maryland Moves Forward With Upper Payment Limit Policies

As noted in the Value of Care Coalition’s most recent blog post, Colorado and Maryland Prescription Drug Affordability Boards (PDAB) are both in the process of considering how to set upper payment limits (UPL) on certain drugs. While the timeline in Colorado remains unclear at the moment, Maryland’s PDAB is moving full steam ahead.

In Maryland, the PDAB recently unveiled its UPL Action Plan and offered a brief public comment period. This opportunity for feedback resulted in 113 pages of questions and concerns.  The staff presentation grouped these concerns into categories and attempted to offer verbal assurances to stakeholders, but individual board members seemed to dismiss them.

One Board member said they’re seeing “diminishing returns” on receiving public input, offering the belief that stakeholders seem to be saying the same things over and over. He did not, however, acknowledge the Board could address these concerns to prevent their recurrence.

Another comment defended the lack of detail on how the Board would avoid unintended consequences, pinning the lack of specificity to the uniqueness of each drug. Not discussed was any solution to the primary unintended consequence – diminished access to treatments. This should concern Marylanders with any health condition.

And finally, one member applauded the work so far while noting that, despite best intentions, they still may not get it 100% right – implying that something less is acceptable when patient health is what’s at stake.

The Board went on to approve the UPL Action Plan, sending it to the Legislative Policy Council which has 45 days to approve it.  The Board is scheduled to meet again October 28. However, as they race to move forward, the meeting may be moved up if the Legislative Policy Council acts quickly.