While we support the Maryland Prescription Drug Affordability Board (PDAB) goal of addressing affordability of treatments, we believe that the current approach of the Board to set upper payment limits (UPLs) on the proposed drugs for review will neither benefit patient health outcomes nor result in reduced out-of-pocket costs for patients.
We support changing the state EHB benchmark plan to one that covers all FDA-approved tests and drugs to treat and prevent HIV, hepatitis B, hepatitis C, and opioid use. It is a timely juncture for states that wish to improve access to testing, treatment, and prevention for HIV and viral hepatitis to consider an update to a more generous EHB benchmark plan. The recently finalized 2025 Notice of Benefit and Payment Parameters has created new opportunities for states to define what comprehensive health insurance should look like and to close gaps in coverage.
We voice our strong support for Rhode Island’s H 8041 (“An Act Relating to Insurance—Prescription Drug Benefits”) which stipulates that, when calculating an enrollee’s overall contribution to any out-of-pocket maximum or any cost-sharing requirement under a health plan, an insurer or pharmacy benefit manager shall include any amounts paid by the enrollee or paid on behalf of the enrollee by another person. We thank you for considering this legislation and are pleased to offer our support.
HIV+Hep strongly supports AB 2180. It simply requires that the copay assistance which beneficiaries receive counts towards their out-of-pocket obligations. By passing this law, California will join 19 other states (Arkansas, Arizona, Colorado, Connecticut, Delaware, Georgia, Illinois, Kentucky, Louisiana, Maine, Oklahoma, North Carolina, New Mexico, New York, Tennessee, Texas, Washington, West Virginia, and Virginia), Puerto Rico and the District of Columbia in protecting consumers by assuring their copay assistance will count towards cost-sharing obligations.
We believe Maryland policymakers should focus on those issues that directly impact patients, such as PBM regulation and reform, standard plan designs with reasonable deductibles and nominal copays, and ensuring copay assistance counts. We note that the General Assembly is currently considering HB 879, legislation that would ensure that copay assistance programs will count toward deductibles and out-of-pocket maximums, and the Senate is considering SB 595.