Six years ago, Maryland made national headlines by creating the first-ever Prescription Drug Affordability Board (PDAB). It was heralded as a groundbreaking step to make prescription drugs more affordable and give families some breathing room at the pharmacy counter. But today, the results are impossible to ignore — and deeply disappointing. Despite all the promises, the PDAB hasn’t lowered a single prescription cost. Not one. Instead, it risks adding more red tape and fewer choices for the patients who need help most.
The board’s main lever — the so-called upper payment limit — sounds like a fix on paper. In reality, it’s a distraction. These limits don’t touch the true reasons families struggle with medication costs: skyrocketing insurance deductibles, confusing coinsurance rules and the shadowy role of pharmacy benefit managers (PBMs) who quietly dictate what patients pay. By focusing on list prices instead of these structural problems, the PDAB is fighting the wrong battle — and Marylanders are paying the price.
The disconnect between theory and lived experience couldn’t be clearer. A recent survey found that even patients paying as little as $0 to $10 a month still described their medicines as unaffordable — because of insurance design, medical bills and benefit restrictions. Every single patient who stopped taking medication due to cost cited these insurance barriers, not the drug’s list price. Yet the PDAB continues to ignore this reality. If the board truly wants to make a difference, it must shift its focus — urgently — from abstract price limits to the actual pain points families face every day.
Doctors and patients alike are sounding the alarm. Nearly 90 percent of Maryland specialists say the PDAB’s approach will limit treatment choices and make it harder to care for patients effectively. Meanwhile, patients describe a system that is opaque and exclusionary — public meetings that are hard to access, decisions that are hard to understand, and policies that seem to happen to them, not for them. The very people the PDAB was meant to help feel silenced and sidelined.
Other states have learned these lessons the hard way. New Hampshire recently repealed its PDAB after five years of wasted effort and zero savings for patients. In Colorado, even health plans warn that the administrative burdens of upper payment limits could outweigh any potential benefits. Maryland shouldn’t repeat these costly mistakes — it should learn from them.
This isn’t just a policy debate; it’s a moral one. Maryland’s African-American communities already face the highest burdens of chronic illness — especially heart disease and hypertension. Black Marylanders die from heart disease at far higher rates than their white counterparts, and in Baltimore City, they make up nearly three-quarters of all heart disease deaths. Nationally, Black Americans are 20% more likely to have high blood pressure and less likely to have it under control. The last thing these communities need is another bureaucratic barrier between them and lifesaving treatment.
Real solutions exist — and they don’t come from price controls. Maryland should instead target what’s actually driving out-of-pocket costs: a lack of transparency among PBMs, insurance rules that shift costs to consumers and benefit structures that punish those with chronic conditions. By expanding direct support for families — especially in communities of color — we can deliver genuine affordability, not just political talking points.
After six years, the verdict on Maryland’s PDAB is undeniable: It has failed to make medicine more affordable. It’s time to stop pretending otherwise. Maryland doesn’t need another layer of bureaucracy — it needs real reform that lowers out-of-pocket costs, safeguards access to essential treatments and closes the health equity gap once and for all.
Marylanders deserve better. They deserve affordable prescriptions, transparent systems and policies that work for people — not against them. It’s time to move beyond the PDAB and toward real solutions that deliver real relief.
The Rev. Alvin C. Hathaway Sr. is the founder of the Justice Thurgood Marshall Amenity Center. He was pastor of Union Baptist Church from 2007 through 2021.
