
Maryland’s prescription drug affordability board (PDAB) passed resolutions affirming that Eli Lilly and Boehringer Ingelheim’s Jardiance (empagliflozin) and AstraZeneca’s Farxiga (dapagliflozin) carry affordability challenges to the state’s residents, in a meeting on 28 July.
These resolutions will now kickstart a process whereby the board will consider policy measures to address the affordability issues with these drugs, including one to set up an upper payment limit (UPL), which the pharma industry and several lobbying groups have consistently opposed.
PDABs have been set up in at least 10 states in the US, with similar proposed legislation in several states. These state boards are made up of experts in the field, with most including physicians, health economists, pharmacists, and others. Each state has taken a unique approach with the framework governing these bodies with a distinct mandate and scope. However, the main objective across these boards is the same—to review and address rising prescription drug prices through several measures.
Prescription drug prices have been in the news following tariffs, an executive order on the Most Favored Nation (MFN) policy, and the negotiations under the Inflation Reduction Act (IRA) for Medicare Part B drugs. Amidst these polices on the federal level, the role of states in influencing drug prices is often underestimated, but is still likely to be key given historical precedence, and recent Medicaid cuts.
The Maryland PDAB made significant strides in formalising this review process, culminating in the July 28 meeting, where the board members deliberated on information contained in dossiers prepared for each drug. “The next step is we go into our policy review process,” Andrew York, Executive Director of the Maryland PDAB, tells Pharmaceutical Technology.
Jardiance and Farxiga prices closely scrutinised
After a drug is set to have an affordability challenge, the PDAB’s executive committee is tasked with finding the drivers behind those affordability challenges, and what policies the state can implement to address these, says York. Board meetings, like the latest Maryland PDAB, are usually livestreamed and are being closely followed by pharma companies, lobbyists, legal experts, patient advocacy organisations, and more.

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By GlobalDataIn the July 28 meeting, the board determined Farxiga had an ‘affordability challenge’ because the percentage change of its wholesale acquisition cost (WAC) over time was substantially higher than the rate of inflation; in certain cases, patient out-of-pocket costs were disproportionate to the net costs by the payers; and the total gross spending for Farxiga for state and local markets exceeded 1% of prescription drug spend for state and local governments.
AstraZeneca did not respond to this news service for a comment, but in a July 5 letter to the board, an AstraZeneca spokesperson said that Farxiga accounts for only a fraction of the state’s spending—$20–30 million—while Maryland spends $6 billion on diabetes care. The spokesperson said the drug’s cost analysis does not take into account the burden of chronic kidney disease and heart failure, and the therapy’s impact in treating those conditions.
In Jardiance’s case, the board said the drug presented an affordability challenge due to similar reasons, with the proportion of total gross spending for Jardiance by state and local governments exceeding 1.8% of gross spending for the state and local governments. Boehringer said the PDAB’s analysis using total gross spending did not represent out-of-pocket costs, or discounts and rebates that influence the final cost of a drug to a patient, in a July 9 letter.
In 2024, Jardiance earned EUR8.4 billion ($8.8 billion), while Farxiga sales touched $7.7 billion. As part of the board proceedings being public, the cost review analysis made public includes information on each drug’s commercial and Medicaid utilization spending, its Medicare negotiated price, and more.
Opinions divided on approach to improve access
Chief among the concerns from pharma companies with PDABs is any measure to set a UPL on the drugs. On the subject of UPLs, York says, “That’s probably the thing that we’re most famous for. But right now, I think our board looks at it like it is a tool in the toolbox.”
Throughout the public comment process, several patient advocates have expressed concerns that a UPL may deter companies from making their drugs available in a certain state. However, Peter Maybarduk, who directs the nonprofit Public Citizen’s access to medicines group, says this concern should not deter any review of drug prices. “Companies are responsible to shareholders. It [discontinuing access] would be extreme stance, especially if patients are outraged,” he says.
Apart from Jardiance and Farxiga, both most commonly prescribed to patients with diabetes and cardiovascular issues, four other drugs have been chosen to be part of the drug review process—Novo Nordisk’s Ozempic (semaglutide), Eli Lilly’s Trulicity, AstraZeneca’s Dupixent (dupilumab), and AbbVie’s Skyrizi (risankizumab).
York says the policy review for multiple drugs is likely to take place in parallel depending on whether they are said to present affordability challenges. The next meeting for the Maryland PDAB is scheduled for 15 September, 2025.
This story is part of a reporting fellowship sponsored by the Association of Health Care Journalists and supported by The Commonwealth Fund.