The EACH/PIC Coalition submitted a comment letter to the Maryland PDAB, providing input on the proposed UPL framework for Jardiance, which is in final consideration by the board.
The letter stated:
“We continue to underscore the limitations of a UPL in addressing patient affordability. UPLs may change what insurers or the state pay for a medication, but they do not cap or guarantee reductions in patient out-of-pocket costs. As our coalition has cautioned before, these policies can introduce new incentives for insurers and pharmacy benefit managers (PBMs) that may ultimately restrict access to needed treatments through greater utilization management, formulary reshuffling, or adverse tiering. These shifts risk delaying or disrupting care, and as our Patient Experience Study has demonstrated, insurance barriers, not price alone, are often the real drivers of patient hardship and perceived ‘unaffordability.'”
“Furthermore, patients reported that treatments are not interchangeable and that accessing the correct medication is critically important for patients with chronic conditions. Therefore, while intended to reduce costs, implementing a UPL without complementary patient protections could worsen the very challenges patients already face.”
“Maryland’s proposal to apply the “maximum fair price” (MFP) established by the Medicare Drug Price Negotiation Program (MDPNP) to state programs is concerning because those prices were negotiated specifically for the Medicare population and benefit design. Those rates reflect the structure and cost-sharing rules of Medicare, which are not the same as those that apply in state-regulated coverage. Applying those prices outside of Medicare assumes the markets function the same way, and they do not.”
“Further, the establishment of UPLs at MFP rates does not guarantee any savings for patients. Patients could instead face higher copay or coinsurance rates to retain access to that drug or alternatively be forced to switch to a more expensive drug, which results in higher profits for their PBM. Recent research from the Pioneer Institute has shown that patient OOP costs have increased by an average of 32 percent under the MDPNP even before the maximum fair price caps for the first round of drugs went into effect on January 1st.”
“Simply importing Medicare pricing may create disruption without meaningfully improving what patients actually pay or experience.”
“As the board continues its deliberations, we urge it to establish a clear and transparent framework for evaluating non-UPL policy options and to ensure these alternatives are given equal weight alongside UPL proposals. Based on available evidence and lived patient experience, PBM delinking and related insurance reforms are far more likely to reduce patient costs without introducing new access barriers or disrupting care.”