Public Comments for: HB483 - Prescription Drug Affordability Board; established, drug cost affordability review, report.
I'm Greg Josephs and I'm in Ashburn. I want to thank Delegate Delaney for including an exemption for rare disease medications in this bill. Advocates like her and Senator Deeds hear our concerns and address them in this bill. After fighting and managing this disease (Myasthenia Gravis) for 23 years, this exemption is vital to ensuring patients like me have access to the lifesaving meds and therapies we need. Godspeed! Go
The Value of Care Coalition, a network of patient, provider and caregiver organizations, urges opposition to HB 483, primarily for two reasons: First, it's unlikely that savings, if any exist, will reach patients in a meaningful way. Insurers have indicated that if UPLs are implemented, patient costs will rise – not decrease – and that any savings to payers would likely be consumed by new compliance and administrative burdens. Second, substantial evidence suggests that access could be diminished. Surveys of pharmacists, doctors and health plans all point to this likely, and concerning, outcome. The bill relies heavily on Medicare’s maximum fair price, but studies have shown that drugs subjected to the MFP have seen patient out of pocket costs rise by 32% on average last year, with health plans increasing deductibles and shifting drugs to higher cost-sharing tiers. Finally, Virginia voters are hesitant about PDABs and upper payment limits as well. A recent survey by the Coalition shows support dropping dramatically when informed about concerns from important entities in the health care delivery system that directly shape the patient experience, like pharmacists, doctors and health plans. A full comment is attached. We kindly ask that you consider these concerns, and oppose HB 483. Thank you - Derek Flowers, Value of Care Coalition
The Diabetes Patient Advocacy Coalition (DPAC) appreciates the opportunity to express its concerns regarding HB 483. DPAC is an alliance of people with diabetes, caregivers, patient advocates, health professionals, and others working together to support public policy initiatives to improve the lives of Americans living with and at risk for diabetes and its complications. As an organization run by and for people with diabetes, DPAC seeks to ensure quality of and access to care, medications and devices for our community. We appreciate the Committee’s interest in addressing the prescription drug affordability crisis for Virginians; however, we believe that creating a Prescription Drug Affordability Board (PDAB) in the state is not the most direct way to address patient cost concerns. Even years after implementation, states that have established PDABs have not produced direct cost relief for patients, and their primary cost-control mechanism, Upper Payment Limits (UPLs), is misguided. UPLs or similar affordability actions will likely disrupt the rebate contracts between manufacturers and the PBMs who control plan formularies. PBMs have a well-established practice of preferring higher priced drugs that come with a higher rebate for preferential formulary placement. A UPL that results in lowering the rebate received by the PBM may result in that drug being excluded from the formulary or being placed on a higher copayment tier to dissuade the patient from using that medication. Either of those easily anticipated moves by the PBM will restrict patient access and raise patient cost despite the opposite intention. Another common PBM practice is to place restrictive prior authorization requirements on drugs that they want to steer patients away from, which they likely would do in reaction to UPLs. Prior authorizations are proven delay tactics and are detrimental to the management of chronic diseases like diabetes. This is especially frustrating to patients who have been taking the medication for many months or even years and now must get re-approved to continue their successful therapy. As an organization dedicated to protecting patient access and affordability, we respectfully urge the Committee to take steps that would immediately lower patients’ out-of-pocket costs by passing PBM reform measures. There is strong evidence supporting rebate pass-through policies that require insurers and PBMs to pass negotiated savings directly to patients at the point-of-sale. West Virginia, Indiana, and Arkansas passed such legislation in 2021, 2023 and 2024, respectively. Following implementation, rate filings for plans in Indiana and Arkansas saw no increase in premiums attributable to these policy reforms. In addition, delinking PBM compensation from drug list prices will limit future increases in list price, as it will remove incentives to inflate list prices and provide higher rebates to PBMs. It will ensure that patients benefit from the lowered list prices. A recent analysis on drug costs showed that delinking compensation from the list price of a drug could lower overall drug spending by about 15%. These approaches offer evidence-based pathways to improve affordability while minimizing the risk of unintended access disruptions that may be caused by setting up a UPL through a PDAB. Advancing these strategies should be central to the state’s efforts to protect patient access and affordability. Thank you for your commitment to Virginia patients.
I am here to speak on behalf of the PDAB. I am a physician Assistant who became a full time care giver of two aging parents and son whom I adopted with cerebral palsy. With one in four Virginians having to make the decision on whether or not to take their medications as prescribed due to the cost of medications and trying to pay for rent and everyday life needs. The choice of taking the medications needed to live and paying for shelter and food shouldn't be a constant choice Virginians should have to make to survival. Especially when we can have drug companies charge more reasonable rates for the medications that Virginian need.
The Biotechnology Innovation Organization (BIO) respectfully opposes SB271/HB483, which would create a Prescription Drug Affordability Board tasked with reviewing prescription drug costs and setting upper payment limits for specified prescription drugs. Government price controls like those proposed by this bill are an especially drastic action with unpredictable consequences. While the intent of this bill is to lower drug prices, we fear SB271/HB483 will fail to bring down costs for consumers or institutions and instead disincentivize development of new therapeutic breakthroughs. This bill will not lower prescription drug costs for patients because it does not address outof-pocket costs. Patients pay a given price when they visit a pharmacy based on what their health insurer determines—it is for this reason why two patients will pay a different price for the same drug. Out-of-pocket costs have been rising for patients as a result of decisions made by health insurers. SB271/HB483 does not address the price patients pay out-ofpocket and will therefore not directly impact patient affordability for prescription medications. This bill also provides no clear path for lowering prescription drug costs for public or private payers or the healthcare system overall. The price control scheme in HB 1724 is designed around the premise that prescription drug costs have ballooned out of control or are increasing at an unsustainable rate. Yet according to the latest OECD Data for 2023, pharmaceutical spending in the U.S. accounted for 12.4% of national health expendituresless than Canada (14.9%), Japan (17.6%), Germany (13.7%), France (12.9%), and over a dozen other OECD nations.1 And net prices for branded medicines continue to grow slower than inflation; in 2024, net price growth was 0.1% while the annual average CPI growth was 2.9%.2 Unfortunately, artificial price controls only serve to disincentivize biopharmaceutical companies from developing new, more effective therapies. Economists have estimated that government price controls can have a significant, damaging effect on the development pipeline. For example, one study found that an artificial 50% decrease in prices could reduce the number of drugs in the development pipeline by as much as 24%,3 while another study found investment in new Phase I research would fall by nearly 60%,4 decreasing the hopes of patients who are seeking new cures and treatments. Price controls will dampen investment and would not allow companies to adequately establish prices that will provide a return on investment. The average biopharmaceutical costs $2.6 billion to bring from research and development to market.5 They sacrifice millions of dollars, often for decades before ever turning a profit, if at all. In fact, 92% of publicly traded therapeutic biotechnology companies, and 97% of private firms, operate with no profit.6 Out of thousands of compounds only one will receive approval. For drugs that are advanced to phase I clinical trial, there is a 90% failure rate.7
As President of the Virginia Association of Hematologists and Oncologists (VAHO), I am writing to respectfully oppose SB271 and HB483, legislation that would create a Prescription Drug Affordability Board in Virginia. Since our founding in 1990, VAHO has represented Virginia’s largest community of oncologists and multidisciplinary cancer care providers, all dedicated to improving patient outcomes across the Commonwealth. We share your goal of making prescription medications more affordable. However, we have significant concerns that establishing a Prescription Drug Affordability Board, and authorizing the use of Upper Payment Limits, could unintentionally restrict access to critical cancer treatments for Virginia patients. Many oncology drugs are high-cost, highly specialized therapies with limited, if any, generic or therapeutic alternatives. When reimbursement is capped below the real-world cost of acquisition and delivery, providers may be unable to obtain or sustainably offer these therapies, and patients can face delays, disruptions in care, or loss of access to the most appropriate treatment. Cancer is not a condition where patients can wait while supply chains and coverage decisions adjust. Treatment delays can have real consequences, and even short interruptions can undermine outcomes. Measures that function as price controls risk shifting the burden of affordability onto patients and the physicians and clinics caring for them, particularly in community oncology settings where most Virginians receive treatment. To provide additional context, we would welcome the opportunity to share VAHO’s position statement on Prescription Drug Affordability Boards (https://drive.google.com/file/d/1utZjFR53XEgCZNLPytMshKCr8QXVCYff/view) and to discuss our concerns in more detail. We are also eager to work with you on practical approaches that improve affordability without jeopardizing timely access to medically necessary, life-saving cancer therapies. Thank you for your consideration, and for your continued work on behalf of Virginia patients and families.
The EACH/PIC Coalition urges subcommittee members to oppose H.B. 483 legislation to create a Prescription Drug Affordability Board or delay the upper payment limit authority until adverse impacts on patients have been studied and considered by the Assembly.
Submission Summary – Opposition to HB483 (Prescription Drug Affordability Board) Patients Rising respectfully submits this comment in opposition to House Bill 483, which would establish a Prescription Drug Affordability Board (PDAB) in Virginia. While HB483 is framed as an affordability measure, its structure does not guarantee lower out-of-pocket costs for patients and creates meaningful risks to access—particularly for working Virginians and those who rely on community pharmacies. At its core, HB483 relies on Upper Payment Limits (UPLs) that cap reimbursement, not manufacturer pricing. Pharmacies purchase medications from wholesalers up front and are reimbursed after the fact by health plans, PBMs, or government payers. Because manufacturers are not compelled to accept UPLs, the financial pressure created by this policy falls on pharmacies and, ultimately, patients. Pharmacies may be reimbursed below acquisition cost plus dispensing fees, which can lead to reduced participation, limited inventory, or non-medical switching. Patients may face narrower access without any guaranteed reduction in copays, coinsurance, or deductibles. HB483 also fails to reach most working Virginians. The bill explicitly recognizes that self-funded employer plans governed by ERISA are outside state authority and may comply only if they voluntarily opt in. Because a majority of Virginians receive coverage through these plans, PDAB decisions would apply to only a limited segment of the market, undermining claims that the bill will broadly reduce prescription drug costs. While HB483 includes reporting requirements regarding how savings are used, it does not mandate that savings be passed directly to patients at the pharmacy counter. The bill does not require reductions in cost sharing and does not address rebate-driven pricing practices or PBM spread pricing—key drivers of what patients actually pay. The bill also permits tying reimbursement to Medicare’s Inflation Reduction Act Maximum Fair Price. However, the real-world access impacts of IRA-negotiated drugs are still emerging. Early indications suggest that plans may shift formulary placement toward non-IRA drugs with more favorable reimbursement structures rather than improve patient affordability. Even with IRA in place, access disruptions, formulary instability, and non-medical switching remain real concerns. Experience in other states reinforces these concerns. PDABs have not demonstrated patient savings. Maryland’s PDAB has not lowered the cost of a single drug after more than five years. New Hampshire has shut its PDAB down, Ohio’s remains dormant, and Colorado’s first UPL is currently mired in litigation. Affordability policy should be judged by a simple standard: does it reliably lower what patients pay without compromising access to care? HB483 fails that test. It shifts financial risk onto pharmacies and patients, excludes a large share of working Virginians due to ERISA preemption, and lacks enforceable protections to ensure real patient savings. For these reasons, Patients Rising urges the House Labor & Commerce Subcommittee to reject HB483 and pursue patient-centered reforms that deliver real, immediate, and guaranteed affordability while preserving access to needed medications.
I am the executive director of the Rare Access Action Project, and we submitted complete comments over the weekend in opposition to the bill. Let’s be clear, a UPL has been found unworkable in other states. Why? Because the Upper Payment Limit in this bill only sets a limit on what plans can pay for a therapy. It does not set the acquisition cost of the medicine which can be higher than a UPL. Plans have already said in study after study that they will limit use. Pharmacists won’t be able to stock it. And PBMs will switch from it. Again, this data has been shared in our RAAP paper that has been submitted to the committee. And patients are already seeing in CO non-therapeutic restrictions and access challenges with the first UPL product, which by the way, also used MFP to set the UPL. Further, use of MFP, which is designed for Medicare, much like the best price for Medicaid, or FSS, or 340(b) pricing, is intended for those programs only. For a PDAB, those numbers are merely a surrogate plug in for a UPL, and all the problems associated with a UPL tag along for the ride. While we thank the patrons for seeking protections for rare patients, please remember only 5 percent of rare diseases and conditions have an FDA approved therapy. This means that a vast majority of rare patients rely on medicines and therapies that can and will be subject to review by a PDAB. So, a rare disease exemption exempts rare disease prescription drugs but not rare disease patients. Before requiring patients to navigate a new bureaucracy, we ask that the bill be referred to a study committee where that committee can examine the issues, can explore the potential for access disruption, and can shed light on impact for all patients in the Commonwealth. Thank you.
To the Chair and members of the Committee, SAARA of Virginia is in full support of HB483 and SB 271. Prescriptions can’t be effective if they can’t be afforded. Our organization is in support of efforts that intentionally create oversight through the creation Prescription Drug Affordability Board to aid in lowering cost of prescriptions. Respectfully submitted by Anika Richburg, Executive Director, SAARA of Virginia
While HDA understands the goals of this legislation, we would like to respectfully raise for your awareness the concern that applying a state-level price ceiling does not adequately account for how prescription drugs are bought and paid for in the U.S. Rather, placing a cap on in-state purchases but not out- of-state purchases would ultimately limit the ability of pharmacies, clinics or other points of care to recoup costs for administering or dispensing these products, which could result in sites of care in Virginia being unable to stock these medications. For example, while Maximum Fair Price represents the most that Medicare will pay for a drug, it does not change the national “list price” of drugs sold in the U.S. Rather, Medicare reductions in price is a federal effort that will involve several complex steps that can not be replicated at the state level. The attached letter outlines in more detail the destabilizing impact that HB 483 could have on the pharmaceutical supply chain and patient access to critical medications in Virginia. Thank you.
The Coalition of State Rheumatology Organizations (CSRO) would like to express concerns regarding HB 483, which would create a Prescription Drug Affordability Board that is empowered to apply the Medicare maximum fair price to physician reimbursements for provider administered medications. CSRO serves the practicing rheumatologist and is comprised of over 40 state and regional professional rheumatology societies nationwide whose mission is to advocate for excellence in the field of rheumatology, ensuring access to the highest quality of care for the management of rheumatologic and musculoskeletal disease. This legislation would establish a Prescription Drug Affordability Board that would have the ability to not only review the cost of prescription drugs, but establish upper payment limits. This legislation would set the upper payment limit for selected drugs at the Medicare maximum fair price for medications administered to patients throughout Virginia. This would in turn cap physician reimbursement for selected provider administered medications. We fear this proposal may actually limit patient access and drive up the cost of physician administered medications instead of making them more affordable for patients, while simultaneously causing significant financial strain on physician practices throughout Virginia. Please see comments attached.
Attached please find a letter of opposition to HB483 from the HIV+Hepatitis Policy Institute.
People living with rare diseases face extremely limited treatment options, as only 5% of rare conditions have an FDA-approved therapy. By excluding any "drug or biologic that is designated for a rare disease or condition,” you will ensure access to medication for patients living with a rare disease, who have no treatment alternatives. We appreciate the consideration of the unique circumstances of rare disease patients and therapies in this legislation. We urge the Committee to maintain the following section in the legislation: The Board shall not be required to identify every prescription drug product that meets the criteria of this subsection. The Board shall not include in such list of identified prescription drug products (i) any brand-name prescription drug or biologic that is designated for a rare disease or condition under 21 U.S.C. § 360bb and for which the only approved indication is for one or more rare diseases or conditions or (ii) any biological product that is derived from human blood or plasma. The Board shall determine whether to conduct an affordability review for each identified prescription drug product pursuant to the provisions of subsections C, D, and E”
(See attached letter)
Dear Chair Maldonado and Members of the House Labor and Commerce Subcommittee #1, On behalf of the Association for Clinical Oncology, I'm sharing a letter outlining concerns with the upper payment limit language in HB 483, which could jeopardize access to necessary care for Virginians with cancer. Please don't hesitate to reach out if you have questions with cancer care; we're happy to be a resource. Best, Sarah Lanford Associate Director of State Advocacy Association for Clinical Oncology (ASCO)
As President of the Coastal Virginia Medical Society, I respectfully oppose passage of the Prescription Drug Affordability Board legislation (HB483) today as it is being heard in the House Labor and Commerce Subcommittee #1. While it sounds good on the surface, using the word "Affordability" in the title, PDAPs have never saved any money, but rather end up costing hundreds of thousands of dollars per year. Patient costs will increase by over 30%. The "fixes"of this bill over last year's bill are minimal window dressing and will not result in any improvement. The fundamental problem is that the bill is structured incorrectly. The consequences will be decreased supply of life saving drugs and increased cost to the recipient. Please refer this bill to the Joint Commission on Health Care to study it more carefully and fix it so that it does what it is actually intended to do. Thank you.