RAAP: VIRGINIA LEGISLATORS INTRODUCE EXPENSIVE EXPERIMENT

Prescription Drug Affordability Boards Proven to Be Failures

WASHINGTON, Jan. 13, 2026 /PRNewswire/ -- Virginia legislators need to look at the facts and stop playing politics with people's lives. The "buzzword policy proposal" of the last few years, Prescription Drug Affordability Boards (PDABs), has shown in states across the country that PDABs don't work! 

Last year, the Rare Access Action Project released a PDAB report, "Solving for Access and Affordability: PDABs are Not the Answer" verifying our prediction that PDABs cause much more harm than good. (https://www.rareaccessactionproject.org/wp-content/uploads/2025/08/RAAP-PDABs-Arent-Solving-for-Access-and-Affordability-July-202566.pdf)

With time, newly created and existing PDABs from other states have shown the inability of PDABs to achieve success. Specifically: 

• New Hampshire: PDAB repealed in 2025. Concerns cited included state expenditures vs. savings generated. 
• Oregon: In the 2025 legislative recommendations, the Oregon PDAB vice chair recommended repealing the program due to cost and access concerns. 
• Maryland: Discussions and comments from PDAB Board Members that an Upper Payment Limit (UPL) may not be as effective as once thought and have not generated savings.
• Colorado, Maine, Massachusetts, Minnesota, New Jersey, New York, Ohio, and Washington: No money saved for patients.

In Virginia, a UPL would set a limit on what purchasers and payers can pay for a specific medication. It's important to note a UPL only deals with what an insurance plan can pay for that medication, not the actual cost of acquiring and stocking it. This will create several access challenges for healthcare providers who administer complex drugs, pharmacies, patients who receive shipped medication from other states, and/or those that receive specialized care/treatment at facilities both in and out of state. 

Michael Eging, Executive Director of RAAP stated, "Over the past 3 years, RAAP has pointed out that PDABs are not necessarily equipped to foresee the unintended consequences of their actions, particularly for patients with rare diseases, providers, hospitals, health centers and community pharmacies. Nowhere is this more apparent than with the PDABs that are moving towards implementation of Upper Payment Limits (UPLs). While the return on investment for PDABs is questionable overall, the challenges of implementation are considerable and the pay-off for patients is limited at best – particularly as we consider the use of UPLs. We now have seen the failure of PDABs in states across the country and the time has come to start the conversation over policy proposals that will in fact achieve the desired result of lower prescription costs for rare disease patients."

"Even if we set aside the serious concerns that pharmacies won't stock UPL drugs—and that is a fundamental problem," Bill Sarraille, Select Counsel to RAAP, and a rare disease patient, said, "there is no reason to believe any 'savings' will benefit the patient." In Colorado, insurers have publicly cautioned that premiums may not be reduced by a UPL. The same risk applies equally to copays. "If we want to help patients," he said, "we can do so much better."

RAAP and other advocacy stakeholders have offered several solutions to reduce or stabilize the out-of-pocket costs patients pay for their therapies. These solutions have bipartisan support in states where they have passed or been considered. These solutions can include:

• Encouraging capped out-of-pocket copay alternatives in the insurance marketplace.
• Broadening access to Medicare Part B products for beneficiaries under age 65.
• PBM reforms that include delinking; as well as requirements for sharing rebates with patients and encouraging use of pass through PBMs.
• Copay accumulator, maximizer, and AFP reforms to protect patients from additional costs.
• Public/Private Risk pooling for at risk high-cost patients.

RAAP encourages Virginia legislators to take a moment and study the very real negative consequences that PDABs bring with them. RAAP strongly recommends the following:

• RAAP urges the legislature and Governor Spanberger to pause efforts to pass a PDAB bill, given the concerns and the problems other states have now encountered.
• RAAP strongly urges the legislature to send the PDAB bill to the Joint Commission on Healthcare to study how it would lower out-of-pocket costs and protect patients from identified access issues.

Eging concluded, "Unfortunately, members of the Virginia legislature have not listened to and worked with patients to examine the disastrous consequences of PDABs. Lawmakers need to take a step back. While their intentions are good, PDAB is not the answer. We encourage legislators and Governor Spanberger to do the right thing and pause this effort to study and determine effective solutions that can lower patient prescription drug costs, without causing access issues."

RAAP, the Rare Access Action Project, is a coalition of patient and life sciences stakeholders that explore creative policy solutions to address structural issues in access and coverage. Our priority is to help ensure rare disease patients have access to the care and treatments they need.

SOURCE Rare Access Action Project (RAAP)