The EACH/PIC Coalition submitted a comment letter to the Maryland PDAB, providing input on the proposed UPL frameworks for Ozempic and Trulicity, which were considered by the board during their February 23rd meeting.
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 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.”
“We urge the board to establish clear safeguards before advancing any UPL frameworks and to continue exploring its policy alternatives, including reforms that directly address PBM and insurance practices that most influence patient costs.”
“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.”
“Setting prices based on class-wide comparisons may unintentionally encourage insurers and PBMs to treat distinct therapies as substitutes, when patients’ lived experience shows they are not. We urge the MD PDAB not to inadvertently promote policies that do not emphasize the importance of maintaining patient access to preferred and effective therapies.”
“These experiences reinforce that drugs within the same class cannot be evaluated as interchangeable without risking harm to the patients who rely on them. Pricing approaches that flatten those differences risk reinforcing coverage policies that overlook patient value and could unintentionally disrupt access to the therapies that work best for them.”
“In closing, we respectfully urge the Maryland PDAB to reconsider pursuing UPLs and instead focus on policy remedies that directly address the obstacles patients themselves identify as driving affordability challenges.”