Virginia’s Prescription Drug Affordability Board proposal awaits Youngkin’s action

As a bill representing a yearslong quest to create a Prescription Drug Affordability Board awaits Gov. Glenn Youngkin’s signature, veto or amendments in the coming days, opponents hope it will once again meet his veto pen while supporters hope he’s had a change of heart. 

If enacted, the legislation would create an independent, nonpartisan board of medical and health experts tasked with analyzing data to set payment limits on drug prices within state-sponsored health plans. 

Youngkin previously described the proposal as “noble in its intent” but warned it could “limit access to treatments and hinder medical innovation” when he rejected last year’s proposal.

Del. Karrie Delaney, D-Fairfax, countered that pharmaceutical companies could fund innovation without raising drug prices by trimming costs in areas like advertising or executive salaries. 

“I think all one needs to do is look at the budget for these companies,” she said in a press conference earlier this year. “If a big pharma company needed to cut its budget, I think they could find other sources to do that.”

She has carried the bill before and is part of a bipartisan coalition of lawmakers that have pleaded its case in the legislature. 

“I think it’s time for us to try something new, and I’ve been really happy to support this,” said Del. Ellen Campbell, R-Rockbridge, a key co-patron of the bill. 

But the proposal has faced opposition from the Pharmaceutical Research and Manufacturers of America. The prominent trade group has lobbied against the bill and expressed skepticism about its potential effectiveness if such a board were established. 

Charise Richard, a senior director of state policy at PhRMA, stressed that PDABs are relatively untested, despite their surge in recent years.

While at least 11 states have implemented the boards, Maryland was the nation’s first. Created in 2019, opponents have pointed to how it was slow to be set up and has not yet yielded the amount of cost-savings at the core of its mission. Last fall, the board approved a process to set an upper limit payment to cap drug costs on state health plans. And an effort this year to expand the board resulted in heated debate in Maryland’s legislature. 

PhRMA also highlights that patients with rare diseases, who rely on specialty drugs that can come with higher price tags than more common drugs, have expressed concerns about PDABs’ potential to hinder, not help, them. 

While in opposition to PDABs, the organization is supportive of other proposals aimed at reducing skyrocketing prescription costs. Richard noted a recent Federal Trade Commission report showing how Pharmacy Benefit Managers are up-charging cancer, HIV and other specialty drugs as evidence that PBM reform is needed. 

PBMs act as intermediaries between health plans, drug manufacturers and pharmacies, but their lack of transparency has raised concerns. PBMs retain rebates and discounts from contracts, leaving consumers and pharmacies unsure how much savings are being passed on. 

This opacity has taken a toll on local pharmacies, which often receive reimbursement rates lower than the cost of medications.

“It’s been a long time coming that PBMs need to be held accountable,” Richard said. 

A bipartisan effort for Virginia to have a single state-monitored PBM also cleared the legislature this session and is likewise awaiting action from the governor. Local and chain pharmacists flocked to the Capitol from around Virginia in recent months to speak in support of that bill. 

Richard called the bill a “small but mighty step” towards PBM reform and said that her organization has also pressed for PBM’s compensation to be “de-linked” from the list price of medicines. 

March 24 is the deadline for Youngkin to take action on hundreds of bills that were sent to him this year. Though the PDAB proposal could garner another veto from him, it remains unseen how the PBM bill will fare.