Maryland Proposes Payment Caps For Ozempic, Jardiance

ANNAPOLIS, Md. — Maryland is considering limits on how much participating state and local government programs can pay for Ozempic and Jardiance, a move projected to save taxpayers millions of dollars but not directly reduce patients’ pharmacy bills.

Under regulations proposed by the Maryland Prescription Drug Affordability Board, government purchasers would pay no more than $274 for a 30-day supply of Ozempic and $204 for a 30-day supply of Jardiance, or $6.80 per pill for Jardiance.

If adopted, the limits would take effect Jan. 1, 2027. They would apply to eligible government purchasers, including state and local employee health plans and certain publicly operated hospitals, correctional facilities and clinics.

The proposal is not a statewide retail price cap. It would not initially apply to private-sector health plans or determine what uninsured customers pay. It also would not automatically lower copayments, deductibles or coinsurance for government employees whose plans are covered.

Instead, the limits would control how much participating government programs pay through their health plans, insurers and pharmacy benefit managers.

The board estimates the Ozempic limit would reduce annual spending by approximately $5.8 million for state and local employee health plans when compared with estimated prices after manufacturer rebates. A comparison with Ozempic’s listed price produced a higher estimate of approximately $23 million, but government plans often pay less than the listed amount because of rebates.

For Jardiance, the board projects savings of more than $300,000 annually compared with estimated prices after rebates.

Those calculations do not include purchases by some correctional facilities, state hospitals or clinics at public colleges and universities because the board did not have enough data to estimate their spending. Actual government savings could therefore be higher, depending on participation and purchasing levels.

The direct financial benefit would go to the government entities paying for the drugs. The proposal could benefit taxpayers through lower public expenditures, although the regulations would not control how state or local governments use the savings.

Drug manufacturers could receive less revenue from affected government purchases. Novo Nordisk manufactures Ozempic, while Boehringer Ingelheim and Eli Lilly market Jardiance.

Supporters, including AARP Maryland, Maryland Health Care for All and Public Citizen, argue that the limits would reduce taxpayer costs and give the state greater control over prescription drug spending.

Other organizations have stressed that reducing a health plan’s costs does not necessarily reduce a patient’s bill. The Ensuring Access through Collaborative Health and Patient Inclusion Council coalition said in comments submitted to the board that the limits would not guarantee lower out-of-pocket costs.

The regulations include a safeguard that would automatically suspend either limit if the Food and Drug Administration places the affected medication on its shortage list. The limit would resume once the shortage is resolved.

The public comment period ended July 27. The board continued to list the regulations as proposed as of Aug. 24. Its next scheduled meeting is Sept. 28.

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