The Maryland Prescription Drug Affordability Board (PDAB) voted Monday (July 28) that AstraZeneca’s Farxiga and Boehringer Ingelheim’s Jardiance are both unaffordable, a step toward limiting the amount state and local governments can pay for the two popular drugs.
The PDAB will next vote on whether to set an upper payment limit. Maryland state delegate Bonnie Cullison (D), who has sponsored Maryland PDAB legislation in the past, cheered on the vote at the meeting.
“I just want to say with the most sincere thanks to you and your staff for bringing this to light and taking this first step,” she addressed the board. “I know it’s been an arduous process but it was arduous simply because you gave every opportunity to every possible stakeholder to be engaged in this process. No one can say this process was not transparent.”
Farxiga, for type 2 diabetes, heart failure and chronic kidney disease, and Jardiance, for type 2 diabetes and reducing the risk of cardiovascular disease in adults with type 2 diabetes, are the first drugs to be deemed unaffordable by the Maryland PDAB. Colorado’s similar board has voted that Amgen’s psoriasis and arthritis drug Enbrel, Janssen Biotech’s Stelara for Crohn’s disease and other indications and Novartis’ Cosentyx for psoriasis, arthritis, and other indications are all unaffordable.
According to the drugs’ dossiers, prepared by the board, total Maryland spending in 2023 for Farxiga included over $108 million by commercial plans, over $7 million by state and local governments, and in 2022, over $3 million by Medicaid. Jardiance spending in 2023 included costs of over $230 million for commercial plans, over $6 million for state and local governments and in 2022, over $16 million in Medicaid.
Joseph Levy, a member of the PDAB, proposed to the board to find a better way to access information on how copay programs are being used in the state. He said the board attempted to look at the programs but concluded there were not “reasonable amounts of public information” on the programs.
The same sentiments exist in Colorado, with concerns that setting an upper payment limit for Enbrel may result in Amgen ending patient assistance programs. Amgen did not respond to questions from Inside Health Policy on the company’s plans for the copay assistance programs if the board sets an upper payment limit.
Vincent DeMarco, president of Maryland Health Care For All Coalition, commended the vote in a statement to Inside Health Policy.
“We urge the PDAB to as soon as possible put a reasonable upper payment limit on what state and local governments pay for these lifesaving drugs which could save Maryland taxpayers millions of dollars,” he said. “We look forward to the PDAB next year using its authority under legislation enacted this year to also make these and other high-cost drugs more affordable for all Marylanders. Drugs don’t work if people can’t afford them.”
If Boehringer Ingelheim and AstraZeneca follow the example of companies impacted by the Colorado PDAB, Maryland is likely to face lawsuits.
Amgen sued in Colorado, saying the PDAB’s actions were unconstitutional. A Colorado district court recently ruled against Amgen, but the company could file a new case once an upper payment limit is set.
The votes come after the Maryland Governor signed a bill expanding the PDAB’s authority, applying the upper payment limits set by the board to cover drugs purchased by any provider in the state, which doesn’t kick in until 2026.
Various patient groups, including the Value of Care Coalition, the National Psoriasis Foundation and AiArthritis, testified against the bill, raising concerns over access and saying the upper payment limits may not translate into patient savings. Some patient advocacy groups tied to pharmaceutical companies have been under fire for parroting the same arguments made by drugmakers.
Other drugs on Maryland’s list for consideration as unaffordable include Eli Lilly’s Trulicity, Novo Nordisk’s Ozempic, AbbVie’s Skyrizi and Sanofi’s Dupixent. -- Luke Zarzecki (lzarzecki@iwpnews.com)