Bill to Create a Prescription Drug Affordability Board Clears House of Delegates

Virginia’s multi-year attempt to establish a Prescription Drug Affordability Board is again advancing in the legislature, but it’s unclear if it will finally become law this time around. The measure passed the House of Delegates on Friday and will be taken up by the Senate next week, once the second half of the session begins.

The bipartisan proposal would create a special board of medical and health experts tasked with analyzing data to set payment limits on drug prices. The legislature approved it for the past two years, but former Gov. Glenn Youngkin vetoed it, citing concerns with stifling medical innovation and attracting pharmaceutical companies to the state.

Gov. Abigail Spanberger has not confirmed whether she would sign, amend, or veto the measure if lawmakers send it to her desk.

Now often referred to by lawmakers and advocates as the “Affordable Medicine Act” — a clear-cut sign of its goals — House Bill 483 sponsor Del. Karrie Delaney, D-Fairfax, told her colleagues Thursday that she is “continuing to work with stakeholders and the administration” to refine the bill.

Delaney and Sen. Creigh Deeds, D-Charlottesville, have carried the legislation several years in a row. The concept of the board aligns with Spanberger’s broad goals of addressing affordability struggles, and Deeds and Delaney said they are hopeful she’ll sign their measure into law.

In an interview on Thursday, Delaney said there’s still work to be done in the coming weeks of the legislative session to ensure that Virginia’s board won’t falter as other states’ boards have.

“Our goal is to really make sure that it is effective,” Delaney said.

She said the bill is needed now more than ever, as she continues hearing anecdotes from her constituents feeling forced to choose between medicine, paying their rent or mortgages, and buying groceries.

These struggles are playing out nationally and even inspired a plotline in the latest season of HBO’s The Pitt, wherein a diabetic character’s expensive ER visit stemmed from stretching his medication thin and a lack of health insurance.

Delaney said a PDAB can explore root causes in drug supply chains that factor into higher prices.

“On a bigger scale, it’s about understanding why (drug price surges) happen and who is accountable,” Delaney said. “Somewhere along the supply chain if we can identify ‘hey, this is where we’re seeing these jumps happen’ that gives us a precision approach at addressing costs for drugs.”

In opposing her bill, Del. Keith Hodges, R-Middlesex, noted his support for the idea but called the measure “highly flawed.”

Because states fund the setup of boards, Hodges cautioned that “taxpayers will be the ones that carry these costs.

“We have learned from where (PDABs) have gone right and where they have gone wrong,” he said. He highlighted mixed results in Maryland and Colorado, which are among the few states that have already set up such boards and that have not yet achieved their goals.

Maryland became the first in the nation to set up a PDAB in 2019, but it hasn’t made much progress until recently.

The 2020 COVID-19 pandemic spurred then-Gov. Larry Hogan to pull the board’s earmarked funding and not assign board members. Current Gov. Wes Moore started to get the ball rolling again by releasing those funds, but it took the board a year and a half to set up a regulatory framework and settle on six drugs to consider for cost reduction. The matter is still not a done deal.

Colorado’s PDAB successfully established a cap on Enbrel, a drug used for various autoimmune disorders. But the cap hasn’t yet taken effect.

After staving off a previous legal challenge, Colorado’s board is now facing a fresh lawsuit from the drug’s manufacturer.

Delaney said she continues to study Maryland’s PDAB experience for helpful insights. Virginia’s board can aim to align prices with drugs that have already garnered federal limits through Congress’s 2022 Inflation Reduction Act, she added. That federal law applied to Medicare-covered drugs, while Virginia’s board could be broader.

Amendments forecasted

As lawmakers near the midpoint of the session next week, all bills that clear one chamber must go through the opposite chamber. While floor amendments do happen, most often, bills are tweaked within the various committees they filter through. Delaney expects that her and Deeds’ bills will be similarly tweaked and is open to compromise.

“At some point we’re going to have to make the decision – ‘what is the line of what we’re kind of willing to give and take for this particular year?’” Delaney said.

Addressing affordability issues has been a key goal of state lawmakers and the governor this year. Spanberger pitched proposals to reduce costs in health care, housing, and energy during her campaign, but a PDAB was absent from her plans, and she stopped short of endorsing the idea in a sit-down interview with the Mercury last summer.

“I want to make sure that whatever we might implement in the future will be a best practice based on the success or challenges that other states have faced,” Spanberger said then.

While governors rarely comment on pending bills during legislative sessions, Spanberger’s team confirmed that she is in talks with both Deeds and Delaney as she considers the legislation.

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