Rx for a Healthier Maryland—You Can help!

Imagine suddenly being diagnosed with diabetes at age 24 and having to move back to your parents’ home to afford your insulin. Or facing brain tumor treatment at age 40 and spending all your savings to pay for the drugs to save your life. Horror stories like these—from two Maryland women—are increasingly common across the nation as skyrocketing drug prices drive patients into poverty—or death.

But Maryland has a chance to tackle this crisis through an innovative bill heard in both houses of the General Assembly on March 6. This legislation, HB768/SB759, would create a Prescription Drug Affordability Board to ensure that high-cost prescription drugs are available to Marylanders. The Board, an independent rate-setting agency, would review prescription drugs that create affordability challenges. For example, the price of Herceptin, a breast-cancer-treatment drug, has climbed by 78 percent since 2005, with an annual price tag of $60,000 (despite having been on the market for two decades).

Specifically, the Board will review the cost of brand-name medications that enter the market at $30,000 or more a year. It would also review existing brand-name medications that increase in price by $3,000 or more per year or during the course of treatment, and generic medications that increase by $300 or more a year. The Board will assess a broad range of economic factors to set appropriate payment rates for reviewed drugs, allowing pharmaceutical manufacturers the opportunity to justify their prices. Once a fair payment rate is determined, the Board will set an upper limit that applies to the entire supply chain. By setting a cap rather than specifying prices, the legislation aims to avoid constitutional challenges that caused previous bills targeting price-gouging to be overturned in court.

The legislation, introduced by Delegate Joseline Peña-Melnyk of Prince George’s County and Senator Kathy Klausmeier of Baltimore, has 98 cosponsors in the House alone. Several county executives support it as well, including Montgomery County’s Marc Elrich, Prince George’s County’s Angela Alsobrooks, and Harford County’s Barry Glassman, as well as Baltimore Mayor Catherine Pugh. The Washington Post coverage of the bill features patients suffering great hardship because of soaring drug prices. Maryland would be the first state to establish such a board.

The pharmaceutical industry fiercely opposes the bill, claiming that the proposed caps will stifle innovation or threaten the availability of needed drugs. Yet these same companies spend far more on advertising than on research and development, notes Vincent DeMarco, president of the Maryland Healthcare Initiative, the bill’s leading advocacy group. “Drugs Don’t Work If People Can’t Afford Them,” he tells everyone who will listen.

Maryland Health Insurance Option (Protect Maryland Health Care Act of 2019)

Another ingenious bill, introduced by Delegate Peña-Melnyk and our own District 15 Senator Brian Feldman, would create a “Health Insurance Down Payment Plan” to give uninsured Marylanders, at tax time, the option to pay a fee or instead purchase health coverage. The Washington Post, in endorsing the bill (Maryland Health Insurance Option, Protect Maryland Health Care Act of 2019—HB814/SB802) declared “Here’s a Way Maryland Can Stabilize Obamacare, despite Federal Sabotage.”

The Affordable Care Act (ACA), a great success in Maryland, reduced the uninsured rate of Maryland women aged 19̵̵-64 from 14 to 7 percent. The ACA gives access to federal subsidies to purchase coverage that is high-quality (because of ACA requirements) in the individual market. Yet that progress is in danger because of the Trump Administration and Republican sabotage of the ACA, particularly the decision to end enforcement of the individual mandate (the requirement to purchase health insurance or pay a fine), which supports the ACA’s affordability. Federal enforcement of the individual mandate requirement will end in 2020.

Under the bill, Marylanders would be asked if they had health coverage for the past year when they file their taxes. If they say no, they will be given the option to pay a fee to the state or use the fee money to purchase quality health coverage. Estimates suggest that roughly 31,000 Maryland women would be able to purchase health coverage for no more than the fee amount, plus the federal subsidies they are now qualified for. The bill would help stabilize premiums and improve affordability for everyone.

So how can you help?

Sign up for WDC’s amazing Advocacy Alerts from Ginger Macomber or visit the Maryland Healthcare Initiative for updates. At this writing, the bills are still in committee, and emails and calls to the Senate Finance Committee members, in particular, would help significantly. WDC will issue regular alerts, and we encourage our members will step up to support these exciting bills.