BALTIMORE — There's been significant discussion about lowering prescription drug prices, but many people say they haven't seen changes at the pharmacy checkout. Maryland has real controls in the works, but if you're struggling now, there are tools that could help.
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After being diagnosed with adult ADHD, Erica Miller hoped the right medication would finally bring relief. She struggled to organize her thoughts and turn off her creative thinking. Then one day, she experienced silence.
"Maybe about 6-7 years ago when I had gotten my prescription right. And that was the first time that I felt my brain was quiet. It was settled," Miller said.
But that relief was short-lived when the cost of her medication kept fluctuating.
"One month it was $400 then one month it was like $70 to $80," Miller said.
She went through a divorce, lost her insurance, and when she couldn't afford her medication, she says she lost her job.
"Because I couldn't follow through on my executive functioning," Miller said.
Miller is now back on track with a new job and an insurance plan that has significantly brought down costs. But this experience drew her to activism and a seat on the stakeholder council for the Maryland Prescription Drug Affordability Board (PDAB).
Vincent DeMarco, president of Maryland Health Care for All, advocated for a state mechanism to bring down drug costs.
"In 2019, we advocated for the first in the nation Prescription Drug Affordability Board, which simply says you can charge whatever you want, but for this particular drug or these drugs, we're only going to pay this reasonable amount," DeMarco said. "Drugs don't work if people can't afford them."
It's one of only four state boards in the country with rate-setting authority and works similar to what the federal government is doing in negotiating drug prices for Medicare.
"We have the authority to do something called setting upper payment limits, which is a novel policy, basically to make drugs more affordable for the state," said Andrew York, executive director for the board.
PDAB starts by identifying high-cost drugs.
"Then we do something called a cost review study where we get to really look under the hood and understand if and how that drug is unaffordable for patients in the healthcare system. And then based on our findings, we then recommend policies to make those drugs affordable," York said.
So far they've looked at six drugs, mostly diabetes medications including Farxiga, Jardiance, Trulicity and Ozempic, plus autoimmune drugs Skyrizi and Dupixent. York anticipates upper limits could be approved this year, but it only applies to state-sponsored health plans for now. The state passed a law last year that would expand upper payment limits to all Marylanders. That will happen one year after the board puts two payment limits in place, likely in 2027.
In the meantime, York encourages all consumers to take action.
"Talk to your pharmacist and talk to your provider. As you see these bills, you can always ask them and they're kind of your frontline experts and the ones that are ultimately putting you on the prescription," York said.
He also recommends calling your insurance company to ask if there are more affordable options, then looking to other resources.
"These are things like manufacturer patient assistance programs, foundations and nonprofits. You can also look at cash options such as lGoodRx or the Mark Cuban Cost Plus Drug Company. These are all resources that can make your drugs cheaper," York said.
If you hit a dead end, the Prescription Drug Affordability Board says you can contact them directly by emailing pdab@maryland.gov. If they can't answer your question, they'll help point you to someone who can.
The An Arm and a Leg podcast also offers a Prescription Drug Playbook that breaks down prescription drug pricing and cost-saving options for patients.
This story was reported on-air by a journalist and has been converted to this platform with the assistance of AI. Our editorial team verifies all reporting on all platforms for fairness and accuracy.