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Md. prescription drug bill filled with compromises

Sen. Brian Feldman, D-Montgomery (File photo)

Sen. Brian Feldman, D-Montgomery (File photo)

Sometimes compromise means recognizing things could have gone worse. That seems to be the view of advocates of measures aimed at controlling what Marylanders pay for their medication.

Legislation introduced in January would have created a board to set upper payment limits on what Marylanders could pay for high-cost prescription drugs.

By the time the bill passed late Monday night, the new board must first study multiple ways to control drug prices before it can seek approval from legislative leaders to set up the upper payment scheme.

“It’s not everything we wanted in January,” said Vincent DeMarco, president of the Maryland Citizens’ Health Initiative, one of the bill’s biggest backers. “But as a standalone bill, it’s a tremendous step forward. Really, it has in it what we wanted, which is the creation of this board.”

Under the legislation that passed, the Prescription Drug Affordability Board can seek approval July 2021 to set upper payment limits for high cost drugs purchased for state and local government employees as a pilot program.

Approval would come from the Legislative Policy Committee, made up of every standing committee chair and party leader in the Senate and House of Delegates. If that committee fails to give its approval, the board could seek the approval of the governor and the attorney general instead.

DeMarco said approval from the committee makes sense because it would “invest the legislature in the process.”

The board could go back to the full legislature in 2023 for permission to take the payment limit scheme beyond just government employees.

Sen. Brian Feldman, D-Montgomery, who managed the bill on the Senate floor, said the legislation was designed to create “roadblocks.”

“There’s extra roadblocks for upper payment limits,” he said. “We said you may get to that same place, but you’re going to have to look at a lot of different things.”

The drug board has been commissioned to look at not just upper payment limits, but ideas for bringing down drug prices across a supply chain that includes manufacturers, wholesalers, pharmacy benefit managers and insurance carriers. Proposals specifically mentioned in the bill are reverse auctions and bulk purchasing.

The board will submit annual reports to the legislature starting next year.

Drug manufacturers vehemently opposed any mandated payment limits in the legislation. They hope the board will choose a different option.

“As the new board created by HB 768 considers and evaluates a broad range of policy ideas, we are confident it will determine price controls are the wrong approach — that this dangerous policy is unconstitutional, would put patients’ access to medicines in danger and cannot be implemented effectively,” Nick McGee, a spokesman for the Pharmaceutical Research and Manufacturers of America, said in a statement.

McGee also said that upper payment limits could hurt patient choice and the state’s biotech industry.

When the bill came out of the House of Delegates, where it was sponsored by Del. Joseline Peña-Melnyk, D-Prince George’s and Anne Arundel, it would have automatically allowed the drug board to set payment limits for drugs for government employees as a pilot program for potential expansion statewide.

But the Senate moved in the opposite direction. If it had had its way, allowing even that step after study by the drug board would have required approval from the entire legislature, not just the Legislative Policy Committee.

That would have taken too much away from supporters, DeMarco said.

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