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Maryland could cap prices for Ozempic and other diabetes drugs

A state board picked those products and two others for reviews that could lead to "upper payment limits."

The Maryland Prescription Drug Affordability Board is moving ahead with reviews that could lead to "upper payment limits" for Ozempic, three similar drugs that help control diabetes and obesity, and two anti-inflammatory drugs.

The board selected the six drugs for review May 20. Public comments on the candidates are due July 22. State lawmakers will have to approve any moves to impose the upper payment limits.

"Upper payment limits are novel policy tools to try to make prescription drugs more affordable," Andrew York, the board's executive director, said recently during a webinar on state prescription drug management strategies that was organized by the Center for American Progress.

The upper payment limits would apply to the health plans that buy prescription drugs for Maryland's state, county and local employees. The limits would also apply to state direct purchases of drugs and to Medicaid and other state-funded medical assistance programs.

The board also develops reports on prescription drug pricing and affordability, York said.

"This continues to be a high-priority target for a lot of our policymakers," he said. "We hope to be a resource for those entities that are working through these issues."

Because drug supply chains are complicated and opaque, finding out what kinds of rebates are flowing to whom and what plans' and patients' real net costs are difficult, he said.

The other webinar speakers were Shabnam Salih, director of the New Jersey governor's Office of Health Care and Affordability and Transparency, and Dr. Beth Slamowitz, a senior policy advisor at the Nevada Department of Health and Human Services.

Salih's office administers laws that have imposed caps on out-of-pocket costs for insured patients who buy insulin, asthma inhalers or EpiPen emergency allergy shots.

Slamowitz talked about the state's participation in the multi-state ArrayRx prescription drug discount card program.

Manufacturers' views: In addition to Ozempic, the list of drugs up for review in Maryland includes the diabetes and obesity drugs Farxiga, Jardiance and Trulicity and the inflammation-fighting drugs Dupixent and Skyrizi.

AARP Maryland has written to support upper payment limits for the drugs.

The manufacturers of the drugs oppose the cost reviews. Cynthia Ransom, an executive at Eli Lilly, wrote to the board to ask for it to leave Trulicity off its cost review list.

She pointed out that typical patients in Maryland pay only 0.2% to 4% of the Trulicity list price, or just $2 to $39 per month.

"We feel Trulicity is both competitively priced both based on the clinical value it provides and the class in which it competes," she wrote.

Reporter: Allison Bell


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