Virginia lawmakers are considering a bill to create a “drug affordability board,” which would align with provisions of the federal “Inflation Reduction Act” (IRA) that the Congressional Budget Office (CBO) said would impact the development of new medicines.
Senate Bill 271 would establish a Prescription Drug Affordability Advisory Panel tasked with analyzing drug pricing trends and recommending policies aimed at improving prescription drug affordability across the Commonwealth.
Under the proposal, the panel would study prescription drug pricing trends and provide policy recommendations to state officials on ways to address rising drug costs.
The proposal also intersects with the federal drug negotiation program created by the IRA.
“Virginia’s board can aim to align prices with drugs that have already garnered federal limits through Congress’ 2022 Inflation Reduction Act,” reported the Virginia Mercury.
The IRA authorized the federal government to negotiate prices for selected high-cost drugs covered by Medicare and set what the law calls “maximum fair prices” for those medications.
The CBO estimated those IRA drug pricing provisions could result in roughly 9 percent fewer drugs entering the market over 30 years, according to an analysis by the Commonwealth Fund.
Former Virginia Gov. Glenn Youngkin vetoed similar legislation in both 2024 and 2025. The earlier bills — HB 570 and SB 274 — would have created a state board empowered to review prescription drug prices and impose caps on what manufacturers could charge for certain medications.
“This legislation risks limiting patient access to essential medication by prioritizing costs over medical necessity,” Youngkin said in his veto message, adding that allowing a government board to impose payment limits could result in drug availability being determined “based solely on cost considerations” rather than the needs of patients and physicians.
Ross Marchand, executive director of the Taxpayers Protection Alliance (TPA), told the Richmond Leader the Virginia legislation could result in “limiting supply and reducing patient choice.”
“When the price of a medication is kept artificially low by bureaucrats, drugmakers think twice before investing in therapies that millions of Virginians rely on,” said Marchand. “Virginia lawmakers should focus on cutting healthcare red tape, not cutting off cures for residents.”
Earlier this week, the co-founder of a patient access advocacy group also said the proposal would put access to medications at risk.
“Patients should be the ones driving the conversation about their healthcare, not bureaucratic boards that have failed to deliver results in every state that has tried them,” said Terry Wilcox, Co-Founder and CEO of Patients Rising, in a post on the group’s website. “Virginia families deserve better than a costly experiment that puts access to their medications at risk.”
Concerns about access to new medicines were also raised by Richard Ingram, MD, FASCO, president of the Virginia Association of Hematology and Oncology. Ingram’s specifically referenced the “Upper Payment Limits“ (UPLS) in the bill, which are pricing mechanisms sometimes used by prescription drug affordability boards to cap what health plans and government programs pay for certain medicines.
Ingram said this “sounds simple and fair but can cause real harm in practice,” reported the Richmond Leader.
“The drug supply chain is complex and crowded with intermediaries, including pharmacy benefit managers who negotiate hidden rebates that rarely reach patients,” wrote in a Virginia Mercury op-ed. “A UPL that squeezes the front-line provider, while leaving the middle of the system opaque, risks punishing the wrong link in the chain.”
“We should be enacting policies that protect vital community hubs, not creating reimbursement caps that make their survival impossible,” wrote Ingram. “Many of the drugs under review will be cancer therapies. Real-world expertise matters from those who see patients every day as they undergo their treatment. Virginia can lead on affordability without gambling with access.”
