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Bipartisan backers of a proposal to create a Virginia Prescription Drug Affordability Board vowed Tuesday to reintroduce legislation during the 2024 General Assembly session, saying they believe the new legislature will be more favorable to the idea than prior ones that struck it down.
As Virginia approaches the 2023 elections, all 140 seats in the House of Delegates and Senate are up for grabs, with a wave of retirements ushering in a field of new candidates.
“A lot of those older delegates and senators were set in their ways and had been influenced by lobbyists for the pharmaceutical companies,” said Sen. Bill Stanley, R-Franklin, who has pledged to carry legislation in the Senate to establish the board and is favored to win his strongly Republican Southside Virginia district this November. “Big Pharma has given a lot of donations to delegate and senator candidates over the years, and certainly that plays a part in this, unfortunately.”
But in 2024, he said, he expects to see “a bunch of new freethinking people” in the House and Senate.
“I have great hope that the new General Assembly in 2024 is going to be constituent oriented in its thinking and not lobbyist oriented in its thinking, and therefore we’re going to get a lot of great things that maybe we wouldn’t have been able to get done before, including this prescription board,” he said.
Proposals for Virginia to create a Prescription Drug Affordability Board that would have the power to review and in some cases set upper price limits on widely used prescription drugs were put forward in 2022 and 2023 by Sen. Chap Petersen, D-Fairfax, and Del. Karrie Delaney, D-Fairfax. Similar boards have been created in recent years in seven states, including Maryland.
Petersen — who unexpectedly lost his primary this June to political newcomer Saddam Azlan Salim — withdrew his legislation in 2022, but the idea gained bipartisan support last year, clearing the Democratic-controlled Senate with five Republican votes before dying in the Republican-led House.
Critical opposition to the proposal came from Republican Gov. Glenn Youngkin’s administration, which decried it as too “wide-reaching.”
“We don’t think a part-time board should regulate this industry,” Deputy Secretary of Health and Human Resources James Williams told a House subcommittee during a January hearing. “It’s a very sophisticated and complicated industry, and health insurers will tell you they spend a lot of time looking at the value of these medicines.”
Asked Tuesday whether the administration continues to oppose a Prescription Drug Affordability Board, Youngkin spokeswoman Macaulay Porter said “the governor will review the legislation if it comes to his desk.”
At a press conference held earlier in the day, Virginia AARP said a survey of 1,000 Virginia registered voters conducted in June by the Wason Center for Civic Leadership at Christopher Newport University found three-quarters supported the creation of an affordability board “to help reduce what people pay for drugs in Virginia” by evaluating drug costs and setting limits on how much certain payers like state agencies pay for prescriptions. Support was found among Democrats, Republicans and independents alike. Sixty percent of respondents also said they would be “more likely” to vote for a candidate “who supported legislation that would create a Prescription Drug Affordability Board (to help reduce the prices that people pay for drugs in Virginia).” Six percent said they would be “less likely” to vote for such a candidate.
“This survey should show every candidate running for the General Assembly this fall that supporting a Prescription Drug Affordability Board is a commonsense bipartisan way to win voters to their side,” said State AARP Director Jim Dau.
Delaney, who is running for a reliably blue Northern Virginia seat and plans to carry legislation in the House again next session, said the board “is going to be a tremendously important issue this election year and as we go into our legislative session next year.”
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Any proposals, however, will face steep resistance from the pharmaceutical and biotechnology industries, which have argued a board with review and price oversight powers will have a “chilling effect” on investment in Virginia’s drug research and development industry. They also say the proposal overlooks other parts of the medication supply chain that drive up costs, including middlemen.
“Virginians widely reject measures that put government bureaucrats between them and their doctors,” said Stami Williams, a spokesperson for the Pharmaceutical Research and Manufacturers of America, or PhRMA, the trade group for the pharmaceutical industry. “Instead of politically appointed boards, AARP and other Virginia legislators should be looking at solutions that will lower costs at the pharmacy counter without risking people’s access to medicine.”
Williams pointed to the findings of a different poll conducted by business intelligence company Morning Consult on behalf of PhRMA in Virginia that found 60% of respondents “oppose drug price setting policies, such as prescription drug affordability boards (PDAB), once they learn more information on the policies and are presented with tradeoffs.”
Tradeoffs listed were the potential of boards to “limit people’s access to newer prescription medicines,” “lead to less research and development of new medicines, including for cancer and rare diseases” and “put the government and unelected bureaucrats between patients and their medicines.”
On Tuesday, Stanley called the argument that an affordability board would dampen investment “malarkey.”
“It is the old corporate saying that has kept governments out of trying to regulate the prescription drug business in a financial way that is good for the consumer,” he said, comparing the industry to the state’s electric utilities, which are overseen by regulators who approve the companies’ profit levels.
“These drug companies have been getting an almost unreasonable amount of return,” said Stanley.
Delaney contended an affordability board would add necessary transparency to drug pricing that will still allow companies to charge high prices for medications if they are justified by research and development needs.
“Come to the table and let us know where the money is coming from, where it’s going and how we’re reaching these astronomical prices,” she said. “If there’s justification, the board will see it.”
Numerous studies, including a Kaiser Family Foundation analysis and a report from the U.S. Health and Human Services Administration, have shown that drug price increases have outstripped inflation in recent years. In Virginia, the Commonwealth Council on Aging last September reported that while average income in Virginia rose almost 17% between 2015 and 2019, annual prescription drug costs rose by more than 26% over the same period.
Dr. Rommaan Ahmad, a sports medicine and pain management physician from Alexandria who also serves as the Virginia lead for the Committee to Protect Health Care, said rising drug prices can also limit the tools doctors have at their disposal to treat patients with constrained resources.
“On the one hand, we’re trying to get away from things like opioids. But on the other hand, that’s still the cheapest treatment,” she said. “Almost anything we try seems to be much more expensive than that, so we’re sort of stuck in this weird loop where we’re trying to limit opioids and telling our patients not to take them, or cut back anyway, but at the same time we’re not really offering great alternatives because they’re too expensive.”
Stanley said in his Southside Virginia district, too many people are forced to choose between paying for prescription medication and paying for food or rent.
“We have a gap in Virginians that are not eligible for Medicaid but don’t have insurance that will defray or at least reduce the cost of that prescription drug in any meaningful way,” said Stanley. “A lot of times Republicans and conservatives might say, ‘Well, this is government interference in the free market system.’ I say no. Because we’re talking about … a matter of life and death.”
Stanley said he would “do whatever I can to make sure our Republican friends in both the House and the Senate get behind us.”
“Because if we don’t do this now, when will it get done?” he asked. “And if we don’t do it now, what will be the consequences to those Virginians who we have let down? That will be on us.”
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