The EACH/PIC Coalition submitted a letter to the Maryland PDAB in response to proposed changes to the Cost Review Study Process.
The letter stated:
“Ultimately, the board’s cost review is about increasing affordability of prescription medications. A narrow focus on systemic or payer-level costs overlooks the most meaningful measure of affordability, whether individuals can obtain and adhere to the medications they need is the most critical metric. Therefore, we urge the board to prioritize patient costs as a key determinant of affordability and focus specifically on patient out-of-pocket (OOP) costs.”
“Further, we urge the board to focus on patient-reported obstacles to care and address the underlying factors that contribute to patient hardship in affording and accessing their needed medications.”
“Our recent Patient Experience Project: Patient-Reported Affordability & Unaffordability Survey 2.0 aimed at better understanding why patients report medications affordable or unaffordable. Patients described the role of insurance coverage rules, cost-sharing structures, cumulative healthcare expenses, income, financial assistance availability, and changes in life circumstances in shaping their ability to remain on treatment over time. These contextual factors frequently determined affordability far more than the price of the medication itself.”
“Determining these factors that influence patient affordability will ultimately better equip the board to address them through tailored policy remedies. Drawing conclusions without this data or basing decisions on state or system costs risks overlooking real patient problems and could ultimately exacerbate existing barriers.”