(The Center Square) — Though lawmakers applied pressure to the governor this week by publicly calling on him to act, companion bills creating a Prescription Drug Affordability Board for Virginia were conspicuously missing from the list of 150 bills he signed on Thursday evening.
The Senate bill, introduced by veteran Sen. Creigh Deeds, D-Charlottesville, is meant to reduce the price of expensive medications for Virginians. SB 274 would authorize an appointed board to restrict what the state and other payers pay manufacturers for certain drug products in the commonwealth. Those medications are then sold to wholesale distributors, government purchasers, or pharmacy benefit managers, next to pharmacies, and finally, to the consumer.
The bill confines the board to set just 12 upper payment limits annually between 2025 and 2028.
“The undisputed truth is that the skyrocketing costs of prescription drugs are forcing many people to make impossible choices,” wrote one of the bill’s co-sponsors, longtime Sen. Bill Stanley, R-Franklin, in an op-ed to the Cardinal News.
“In my district and all over the commonwealth, too many have to choose whether to fill their prescriptions or put food on the table or keep a roof over their head. Too many are splitting pills or skipping doses because they’re trying to stretch needed medication out until their next paycheck.”
The bill is narrowly bipartisan. Just three Republican senators voted for the Senate bill, but two more supported the House version. One Republican delegate voted for both bills.
Sen. Mark Peake, R-Lynchburg, was one of those senators.
“I don’t like the fact that our prescription drugs in America cost a lot more… than they do in Canada and Europe, based on things that I have seen,” Peake told The Center Square. “I’ve heard from my constituents… how much prescriptions take out of their living expenses, and I get tired of seeing pharmaceutical commercials every three seconds on TV, and yet they’re charging our people fortunes for their life-saving prescriptions.”
Peake noted, however, that though SB 274 isn’t the type of legislation he’d normally endorse, he thinks the situation warrants an exception.
“I don’t like government intervention, and we don’t want the government being involved in private enterprise, but I feel like in this situation,” Peake said, “The pharmaceutical industry better get its act together and charge our people fair prices.”
In the past few years, Prescription Drug Affordability Boards have sprung up in a handful of states across the country, beginning with Virginia’s neighbor to the Northeast. Maryland established the nation’s first PDAB in 2019, and since then, Colorado, Maine, Minnesota, New Hampshire, New Jersey, Oregon and Washington have followed suit.
But the legislation’s detractors say the boards have been ineffective in these states and have failed to live up to their intended purpose. Maryland’s board is still getting off the ground, according to reporting from Maryland Matters.
“Maryland has yet to become fully operational, and others have struggled to implement their missions. To date, they have provided no savings to patients,” said Michael Eging, who testified against the bill before a House subcommittee. Eging is the Executive Director of the Rare Access Action Project, a nonprofit that advocates “for solutions to rare disease patient access in health care.”
Medications for rare diseases can be some of the most expensive, and some fear that pharmaceutical companies simply won’t sell their drugs in states that issue upper payment limits. Colorado’s board held a vote on the affordability of Trifakta, a drug used to treat cystic fibrosis whose price had nearly doubled from 2021 to 2022, and unanimously voted that the drug was “not unaffordable” after backlash from patients, medical professionals and other stakeholders.
“If an upper payment limit goes into effect, that decision could disrupt coverage for rare patients that currently utilize their insurance to access therapies purchased within the commonwealth and across state lines,” Eging continued.
Others argue since there are multiple players in the pharmaceutical supply chain – while the creation of the boards may be well-intentioned – it won’t solve the problem of high drug costs for consumers.
“To paraphrase Inigo Montoya from The Princess Bride, I do not believe this bill will do what you think this bill will do,” said the President of the Virginia Society of Rheumatology Harry Gewanter, addressing the Senate Commerce and Labor Committee. “And the reason is, when you look at the drug supply system, the manufacturers… are paying money out to wholesalers, to PBMs (pharmacy benefit managers), to insurers. You’re going to change the price at the top; you’re doing nothing with everybody else in this system.”
Gewanter also wrote an op-ed to the Cardinal News, urging Youngkin to veto the bills.
Supporters of the legislation say that those who warn of drugs being taken off the market in states with PDABs are simply fear-mongering and that those boards that have been ineffective likely haven’t been given enough authority.
Sen. Stella Pekarsky, D-Fairfax, voted for the bills and promoted Stanley’s op-ed on social media platform X this week.
“No one should ever have to worry about making a choice between buying medications or being able to pay for food and housing. And yet, that is the reality of many Virginians… I firmly believe that this is avoidable and the status quo is unacceptable,” Pekarsky told The Center Square in an email.
Youngkin has until Monday to sign or veto the legislation.
