MD HB424

Expands the Prescription Drug Affordability Board's authority to set upper payment limits for all purchases and payor reimbursements of prescription drugs in Maryland that create affordability challenges, contingent on first successfully implementing limits on two drugs for one year each by September 30, 2030

Adds four new members to the Stakeholder Council: a representative of the rare disease community, an oncologist, a patient advocacy organization representative, and expands total membership accordingly

Prohibits the Board from applying upper payment limits to drugs experiencing current shortages (as listed on FDA's database or determined by the Board), Medicare Part C/D reimbursements, or pharmacy dispensing fees

Requires the Board to consider impacts on 340B drug providers, rare disease patients, and to confer with Maryland Medicaid before establishing limits affecting that program to ensure federal compliance

Mandates annual reporting on upper payment limit effects including patient out-of-pocket costs, pharmacy reimbursement impacts, access for vulnerable populations, and effects on Maryland's biotechnology industry