Maryland's Prescription Drug Affordability Board decision to cap Ozempic at $274 per 30-day supply for government purchasers by 2027, benchmarked to Medicare's maximum fair price, represents more than a narrow fiscal adjustment—it exposes systemic failures in GLP-1 pricing that national policy has long ignored. The STAT report accurately notes the projected $5.8 million annual savings and the board's utility-commission model, yet overlooks how this move connects to mounting evidence of cost-driven nonadherence documented in large observational cohorts. For instance, a 2023 Health Affairs analysis of commercial claims data (n>2 million) revealed that out-of-pocket costs above $150 monthly correlate with 40% higher discontinuation rates for semaglutide, an effect size consistent across diabetes and obesity indications. This state-level intervention arrives amid growing patterns: Colorado and Washington have activated similar boards, while federal IRA negotiations remain limited to select Medicare drugs. Original coverage missed the downstream equity implications, as GLP-1 access disparities disproportionately affect Medicaid populations where observational studies show lower initiation rates despite higher diabetes prevalence. Peer-reviewed RCTs such as SUSTAIN-6 (n=3,297, double-blind, industry-funded with disclosed Novo Nordisk conflicts) established cardiovascular benefits, but real-world effectiveness hinges on sustained access that high list prices undermine. By 2028, extending caps to commercial markets could test whether affordability boards reshape utilization without triggering shortages, a dynamic unexamined in the initial reporting.