Costs can't be ignored by the drug regulator – just ask patients who can't afford prescriptions

I read A. Mark Fendrick's October 18 commentary with great interest for three reasons.

First, I am a professor at Johns Hopkins University who researches drug pricing. Second, I am one of the five board members of the Maryland Prescription Drug Affordability Board (PDAB). Maryland Attorney General Anthony Brown appointed me to a second five-year term this year. Third, Fendrick is a distinguished researcher at the University of Michigan who studies value-based purchasing.

Fendrick makes the very important point that you need to consider more than just the price of the prescription drug. I agree.

But if he read all of the materials the Maryland PDAB has written on this topic, he would see that the Board has published reports on 1) the operation of Pharmacy Benefit Managers (PBMs); 2) the very complex supply chain affecting access to medicines and; 3) In addition to setting an upper payment limit on the amount the state can pay for prescription drugs, the PDAB is considering options.

Furthermore, had he read the committee's website, he would not have made the erroneous claim that Maryland taxpayers are paying for the PDAB. The board is funded by fees collected from supply chain participants, not Maryland taxpayers.

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What Fendrick doesn't address in his commentary is the impact of high drug prices on patients, the public and the government that pays for the drugs.

The Maryland PDAB has received letters from patients, industry and other interested parties. We receive many very helpful suggestions and have revised our approach based on this feedback. What struck me about Fendrick's comment was how similar it was to the comments we received from the pharmaceutical industry.

The committee selected the first six drugs based on several criteria, but one of the most important was the cost of the drug. There are six medications on the first list. These are all very expensive medications that are advertised daily in newspapers, on television and on social media. The data shows that there are high out-of-pocket costs for each individual patient and for all patients.

The data I reviewed as a member of the Maryland PDAB shows that the Medicaid program pays significant amounts for each of these six drugs and the state pays a large amount for each of these drugs to provide health coverage for state and county employees .

Paying high prices for these drugs significantly limits access to these drugs and forces the state of Maryland to make difficult policy decisions. Numerous studies have shown that 40% of the population has not filled a prescription due to the high cost of their prescription medications. When the state provides prescription drug coverage to Medicaid recipients and state and county employees, the state or county has fewer resources to allocate more money to schools, police, environmental protection or other services.

Fendrick's work focuses on value-oriented purchasing and insurance design. I can't imagine anything being of greater value to a patient than having access to a prescription medication. But if the patient cannot afford the drug, it has no value.

Many medications cost over $100,000 and if the patient is responsible for 20% of the cost, which is common with many commercial insurance plans, the cost to the patient is $20,000. How many Marylanders can afford $20,000? As a result, they forego it and no value is created.