Patient advocates are praising Virginia Gov. Abigail Spanberger’s May 19 veto of Prescription Drug Affordability Board (PDAB) legislation (HB 483 and SB 271), arguing that similar efforts in other states have failed to lower costs for patients while creating uncertainty around access to medicines.
Among those welcoming the decision were Tigerlily Foundation, a patient advocacy organization working to educate, advocate for, empower, and support young women, before, during, and after cancer.
“We’re deeply grateful to Gov. Spanberger for putting patients first and protecting access,” said Maimah Karmo, Founder and CEO of the Tigerlily Foundation and 20-year breast cancer survivor. Our community has been through enough. We cannot afford to experiment with policies that risk taking away the very medicines we depend on to stay alive.”
The Biotechnology Innovation Organization (BIO) also applauded Gov. Spanberger for her decision.
“BIO applauds Gov. Spanberger’s decision to veto SB 271 and HB 483—legislation that would have established a Prescription Drug Affordability Board (PDAB) and imposed arbitrary price controls in Virginia. The Governor’s action recognized an important point: even well-intentioned healthcare policies must be carefully designed to avoid unintended consequences for patients, providers, employers, and Virginia’s innovation economy,” said Patrick J. Plues, Senior Vice President of State Government Affairs & Affiliate Relations at BIO.
Three strikes, you’re out: Virginia should stop trying to push PDABs
This is the third time that the Virginia Legislature has attempted to push through PDAB legislation in the last five years.
“They previously passed legislation twice,” explained Brian Warren, Vice President of State Government Affairs at BIO. “However, it was vetoed by former Gov. Youngkin. The authors of the bill tried again with a new governor, though they ultimately were unsuccessful in convincing her of the approach in the bill.”
The repeated attempts to push through this legislation, as advocates have expressed, is not only frustrating, but a notable waste of time.
“A lot of people talk about this being an experimental policy, but at this point, we’ve seen it fail in other states and patients have paid the price,” said Karmo. “We do not want it here. It doesn’t help patients. And frankly, we are tired of watching legislators recycle policies that hurt us instead of listening to the people actually living with cancer every day. We could be using our time to develop legislation and policies that actually work and are informed by patients, not just politics.”
Warren has worked closely with patient advocacy organizations in states that have implemented PDABs—like Colorado and Oregon—and have seen how problematic they can be.
“I know that for patients who are paying attention, it’s been devastatingly stressful for them and their families,” said Warren. “I’ve been on the phone with rare disease patients in Colorado, in particular, who are panicking and asking, Do I have to move out of the state because I can’t get access to my medication if this were to be enacted?”
The problem with PDABs, as well as similar drug price control policies such as Most Favored Nation (MFN) and the Inflation Reduction Act’s (IRA) “price negotiations” is that they do not address the issue of patient out-of-pocket cost and fail to take into account problematic middlemen, such as pharmacy benefit managers (PBMs) or 340B entities.
“A lot of what has been going on legislatively feels like a bait and switch with the UPLs to MFN, and neither are going to save patients a single dollar,” said Karmo. “Our patients and community are especially worried about drug switching, because a lot of them are already having to do that with the cuts to Medicaid and other things going on right now. Their out-of-pocket costs have risen astronomically. We are living this. We are watching people have to choose between rent and their prescriptions. Making them also then potentially have to choose between switching to a drug that might not work for them when they’re already stable on a drug is not about affordability. That is failure.”
These policies also threaten patient access to medicines, because prescription drugs may be harder to source.
As Bio.News reported in 2024, ”The sale of drugs is not limited to in-state purchases. Many are working with out-of-state companies and organizations in a vast and complex medicine distribution network. The assumption that providers within a state only buy drugs in-state is a fundamentally incorrect assumption inherent in the PDAB system.”
It has been these persistent problems with PDABs that have proven them to be harmful in states they have been implemented in, with one state, New Hampshire, actually repealing its board.
“We are reaching a tipping point where a lot of the states that are considering PDABs are looking at other states that have tried to implement them and seeing that the process is inherently complex and unlikely to provide savings to patients where they need it most,” noted Warren. “Rather, they have spent a lot of money and time over the past several years on a program that is inherently unsuccessful while they could have done something more productive.”
Focus on policy that works
The other issue with how the legislation moved this year was that its review and consideration was notably less rigorous than in years past.
“Perhaps it was because they thought they had already passed the legislation twice, so it felt like old news, but during the committee processes, it really just kind of sailed through without a lot of consideration,” explained Warren.
In fact, it was not until Gov. Spanberger started voicing concerns with aspects of law, even adding amendments and notes, that there was any evidence that ins and outs of the legislation were really being investigated.
“We were glad to see that the Governor voice concerns and add amendments, but it was disappointing that even within that process, the patient voice wasn’t being incorporated,” said Karmo. “We are the ones who wake up every morning and take these medications. We are the ones who skip doses because we can’t afford them. We should be listened to. Ultimately, we’re all grateful for the veto, but we still want to be and deserve to be a part of the process moving forward.”
Gov. Spanberger noted in her veto that PBMs play a significant role in this in terms of what patients pay out of pocket, and only addressing the list price of a drug is not going to bring down the cost of medicines for patients.
The governor’s insight is a good start, and advocates hope that it will lay the groundwork for better and more engaged policy development.
“We’re glad that Gov. Spanberger is identifying PBM reform as an important policy,” said Karmo. “But let’s be clear: we already know these boards don’t work. We’ve seen them fail. We’ve watched patients panic. We have the evidence. So let’s stop rehashing the same unsuccessful thing over and over again and start doing something that actually helps patients.”
“We need to take a step back and take a more holistic view of the healthcare system, because no one party is responsible for the high cost,” concluded Warren. “We need to listen to patients more than anybody. We are grateful this governor is taking a leading role in that.”
