Last month, New Hampshire quietly ended its Prescription Drug Affordability Board. Legislators were right to repeal — not simply defund — this little-known entity that has existed since 2020. While tasked with the admirable goal of lowering prescription drug prices for patients, the structure by which these boards are created simply won’t achieve the desired outcome.
These boards may sound like a smart way to lower drug costs, but in reality, they add layers of bureaucracy that delay access to treatments and limit options. They rely on one-size-fits-all formulas that ignore the unique needs of individual patients. Even worse, they grant non-medical officials the authority to make decisions that should be reserved for doctors and patients.
The primary tool PDABs use is an upper payment limit, which caps the amount insurers will reimburse for certain drugs. But the limits don’t lower what patients pay at the pharmacy. Instead, they squeeze pharmacies and doctors, many of whom are already struggling with low reimbursements from middlemen known as pharmacy benefit managers. They, often owned by big insurance companies, profit by paying providers less than what it costs to dispense the drug.
Once in operation, the prescription boards rarely engage meaningfully with the people most affected by their decisions. Patients and providers often find themselves excluded from the process, with limited opportunities to offer input or raise concerns. A recent national survey from the Value of Care Coalition found that nearly all physicians felt there was insufficient communication between PDABs and the medical community. That disconnect leads to policies that may look good on paper but fail in practice, especially for those with complex or chronic conditions. A rheumatologist in Maryland said, “non-medical people should not be making medical decisions.” One endocrinologist also in Maryland put it bluntly, “There are no benefits to PDABs. Decisions will be based on money and not on patient safety.”
Clearly, providers have echoed concerns raised by patients for years. Health care consulting firms have said upper payment limits are likely to impact, “plan benefit design, patient cost sharing, and provider reimbursement.” One executive said, “Payers will not pass their savings (if any) onto individuals. It’s not realistic, and somebody will need to make up the differences.”
Some pharmacists have already stated that they will not stock drugs affected by Medicare’s maximum fair price, another price-setting mechanism. Or, in the case of Minnesota, their prescription board can press the easy button and simply adopt the maximum fair price for any drug deemed unaffordable. That could result in pharmacies stocking different medications simply to keep their doors open and requiring patients to switch treatments for non-medical reasons.
New Hampshire’s decision to shut down its PDAB sends a clear message: there are better, more patient-focused ways to address drug pricing. Congress is already considering reforms to rein in pharmacy benefit managers, and many states are cracking down on insurance schemes that divert patient assistance away from the people who need it most.
Drug pricing reform should be about patients and not politics. New Hampshire got it right. Other states should follow their lead.
William Murphy is the director if advocacy and public policy at the Epilepsy Foundation New England and has worked in epilepsy advocacy for over 40 years. He resides in Newport, Rhode Island.