Maryland's Prescription Drug Affordability Board is writing the rules for what happens after it sets an upper payment limit on a medicine, a cap on what state and local government plans will pay. Ahead of its November 16 meeting, the Board posted an emergency regulation that decides who can challenge one of those limits and what kind of evidence it will consider. Today, Patients Rising filed formal comments on that regulation. [PDF LINK: Read the full letter here]. This post explains what the rule does and why we think patients have been left out of it.
Maryland law already allows anyone harmed by an upper payment limit to appeal it within 30 days. The emergency regulation fills in the details, and the details are narrow. An appeal can only argue that the Board failed to follow its own statute or methodology. The Board will not consider broader policy or economic objections, or any new clinical, financial, or economic information that wasn't submitted during the original cost review. Filing an appeal does not pause the limit, and the Board decides each appeal on the written record, with no testimony. Appellants must file a formal petition of up to 20 pages, with strict formatting rules and exhibits drawn only from the existing record.
That structure may suit a company with a legal team. It is much harder to picture a patient using it.
The problems patients worry about most can only show up after a limit takes effect. A pharmacy or infusion center may stop stocking a treatment. A plan may change how a medicine is covered. A patient who has been stable for years may be moved to a different therapy while the paperwork catches up. None of that evidence can exist during the cost review, because the limit isn't in place yet. Under this rule, it can never be the basis for an appeal.
This isn't a hypothetical concern. The same November 16 agenda includes proposed upper payment limits on two diabetes and weight-management therapies. The patients most directly affected are Marylanders covered through county, municipal, and other public employee health plans, along with people served by state facilities. If access problems follow, the appeals rule decides whether anyone is listening.
We started from common ground. Maryland's upper payment limits are designed to lower what the State and local governments pay for prescription drugs, and we expect the State shares our view that those savings should not come at the cost of patients' access to their treatments. We do not object to an orderly appeals process. We asked the Board to make four changes so that process can hear from patients.
First, we asked for a post-implementation patient access review. The Board's separate monitoring rule asks government purchasers to report spending, net cost, formulary placement, and units once a year, but it collects nothing from patients. We asked for a public way for patients, caregivers, clinicians, and pharmacies to report access problems after a limit takes effect, reviewed alongside that annual data, with a clear path to reconsider the limit.
Second, we asked the Board to confirm in writing that patients, caregivers, and organizations acting on their behalf may file appeals, and to give patients plain-language instructions and a simpler form.
Third, we asked the Board to adopt the permanent version of this rule through standard rulemaking with a full public comment period, rather than leaving an emergency rule in place.
Fourth, because this rule makes the cost review record decisive, we asked the Board to strengthen patient input during the cost review itself. We thanked the Board for recently publishing the evidence file for one of the two biologic medicines it selected for review this summer, and asked that it make this standard practice, with a comment period before any preliminary decision.
The Board meets remotely on Monday, November 16, 2026 from 2:00 to 4:00 pm, and the public can register to watch on the Board's meeting page. Every letter we file is public, and we'll report back on how the Board responds.
If you live in Maryland and want to learn how to speak up at future Board meetings, join Maryland Patients Rising, our private online community with short trainings on how the Board works, how to submit a comment, and how to tell your story in 90 seconds. No experience is needed.
[PDF LINK: Read our full comments to the Maryland Prescription Drug Affordability Board (PDF)]