County Leaders Urge Prescription Drug Board To Set ‘Upper Payment Limits'

By Danielle J. Brown, Maryland Matters

September 30, 2025

County leaders urged the Prescription Drug Affordability Board on Monday to move quickly to set an upper payment limit on two popular drugs prescribed for the treatment of Type 2 diabetes.

They got some of their wish. The board directed staff to proceed on the process that will be needed for it to approve upper payment limits on Jardiance and Farxiga, but it also told staff to investigate alternative methods to keep costs of the drugs down.

The county leaders spoke at the outset of a 2.5-hour meeting, just the latest in the almost six-year history of the board as it moves slowly toward reining in the cost of select prescription drugs for state workers and state health plans.

The board is closing in on approving upper payment limits, a cap on what the state would be willing to pay for the drugs Jardiance and Farxiga. But the board is also looking at “non-UPL” options still. Those include imposing a penalty on drug manufacturers for price increases that exceed the rate of inflation, creating navigators to help patients find the most-affordable drug and, the most complicated option, finding a way to decouple compensation for pharmacy benefit managers, the middlemen who negotiate lower drug prices, from inflation or rebates.

For the county leaders — who are featured in a new digital advertising campaign to bring attention to the board’s work — the answer is upper payment limits, and soon.

“In my county, these costs are straining our budget, and once upper payment limits are set, we will be able to save money that can protect services and ease the burden on our taxpayers,” said Charles County Commission President Reuben Collins. “It’s critically important that you act as soon as possible to upper payment limits on what state and local governments pay for these medicines. We also urge you to act quickly on other high-cost drugs under review.”

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The talking points were the same for Anne Arundel County Executive Steuart Pittman, Howard County Executive Calvin Ball and Montgomery County Executive Marc Elrich, who all testified in Monday’s virtual hearing.

Ball called it “unacceptable for Howard County residents … to have to choose between paying for their prescription drugs or buying groceries,” and all of the county officials repeated some version of the statement that “drugs don’t work if people can’t afford them.”

That point was seized on by opponents of upper payment limits, who said UPLs could backfire, by removing the incentive for drug makers and pharmacy benefit managers to negotiate on prices, putting needed drugs out of reach of some patients.

“Carriers and PBMs [pharmacy benefit managers] control how drugs are covered and their incentives are tied to rebates, not patient affordability,” said George Huntley, CEO of the Diabetes Patient Advocacy Coalition. “Changing rebate flows without protecting patients could easily create unintended consequences.

“That’s why the board should focus on non-UPL solutions directed at reducing patient costs and preserving access: point-of-sale rebates, delinking PBM compensation and out-of-pocket protections for Marylanders so they can afford their medications predictably,” he said.

The board is currently tasked with lowering drug costs for those who have health care plans through the state, a goal it has yet to achieve since its inception in 2019 due to several hurdles and a lengthy rule-making process. It only recently determined that the two popular drugs to treat type-2 diabetes and other conditions may pose “an affordability challenge.”

But health care advocates are urging the board to move quickly on implementing upper payment limits on the two drugs. That’s because a law that will go into effect October will allow the board to expand its cost-lowering efforts to the private insurance market, not just for those on the state’s health plan.

That expansion will only occur one year after the board successfully implemented upper payment limits on two drugs to cap how much the state is willing to pay for those medications.

To nudge the board in that direction, the four county leaders who testified Monday, along with Baltimore Mayor Brandon Scott, are being featured in a social media campaign sponsored by Maryland Health Care for All coalition to bring attention to the board’s work to bring down prescription drug costs.

Jardiance and Farxiga are the first prescription drugs that successfully underwent a “cost review” process that considered various market factors to determine if the medications were likely unaffordable for Marylanders and the state to pay for.

Farxiga, a brand name for the drug dapagliflozin, and Jardiance, a brand name for empagliflozin, are the first drugs to make it all the way through the cost review process, which involves collecting data, industry secrets and public testimony from different parts of the health care system to help the board determine if a drug is unaffordable. Four other drugs have been identified for cost review next.

PDAB staff are still pulling together information for determine how do bring down costs on those drugs. Upper payment limits, which is a cap how much the state is willing to pay for those medications, are just one tool that the state could use for cost reductions. But the board will need to implement upper payment limits in order expand its authority from the state’s health plan to the private insurance market.

Created in 2019 by the General Assembly, the Prescription Drug Affordability Board was slow to launch due in part to a veto from former Gov. Larry Hogan (R) amid pandemic-induced economic uncertainty in 2020 that delayed the board’s formation.

After Gov. Wes Moore (D) allocated funding for the board’s operation in 2023, the entity went through lengthy rule-making to create the “cost review” process for targeted drugs.

Opponents of the board’s effort in the pharmaceutical industry criticize the board’s lack of progress over the years, and believe that board’s actions will make life-saving drugs less accessible to patients who need them.

Cost savings for the state, and for Marylanders, are still a ways off.

Also on Monday, the board announced that Dr. Georges Benjamin will be replacing Joseph Levy, a professor in health economics at Johns Hopkins University, on the board. Benjamin has been executive director of the American Public Health Association since 2002, and served as Maryland’s secretary of health from 1999 to 2002, in addition to other roles.

— Maryland Matters editor Steve Crane contributed to this report.