A Cure For High Drug Costs in Virginia?

State lawmakers are weighing a new tool to curb high drug costs: a review board that would be able to set payment limits for some medications.

Del. Karrie Delaney, a Fairfax County Democrat, plans to push the idea this year. A similar proposal was introduced in the state Senate last year but did not pass. A Senate committee voted unanimously to defer the issue until 2023.

The proposal would create a Prescription Drug Affordability Board with the power to set upper payment limits for some expensive new drugs and existing ones with skyrocketing price tags.

“People need these medicines to live and to have a good quality of life,” Delaney says.

Curbing drug costs is one of AARP Virginia’s top priorities for this year’s legislative session, says Advocacy Director Jared Calfee.

“The price of prescription drugs is far outpacing inflation,” Calfee says. “Folks are struggling to afford them.”

The board would have five members—appointed by the governor and confirmed by the General Assembly—with clinical, health care and health economics expertise, but no industry ties.

Delaney says the board would ensure that experts are examining the factors driving drug prices.

The affordability board would focus on brand-name drugs whose wholesale costs have increased $3,000 or more over a 12-month period, or new medicines with a wholesale cost of $30,000 or more per year. It could set an upper payment limit on a drug after conducting an affordability review that examines a range of factors.

Drug industry opposition

Proponents say the board would review about 10 to 15 drugs annually for possible payment limits, likely affecting just a fraction of those on the market.

Between July 2021 and July 2022, prices for more than 1,200 drugs rose an average of 31.6 percent nationally (compared with 8.5 percent inflation overall), according to the U.S. Department of Health and Human Services. The cancer drug Revlimid, for example, jumped from $185,574 a year in 2015 to $267,583 in 2020, notes AARP’s Public Policy Institute.

The pharmaceutical industry opposes the proposal, arguing that a drug affordability board could hinder patients’ access to medications.

Maryland, Colorado and Washington have created similar boards, and a number of other states are considering the idea, Calfee notes.

He says the bill, which the Commonwealth Council on Aging also supports, could save the state money if drug spending decreases in its employee health insurance plans and the Medicaid program.

The federal Inflation Reduction Act, passed by Congress in 2022, will allow Medicare to negotiate lower prices for some drugs. But that doesn’t help those under 65 who face high costs but aren’t on Medicare. Many older Americans struggle with chronic conditions, such as diabetes and high blood pressure, that require expensive medications, says Rhena Hicks, executive director of Freedom Virginia, a nonprofit that advocates for economic security policies.

Hicks says it will be tough to pass the bill even though high drug prices cut across partisan divisions. She says it stalled last year because lawmakers wanted more time to study the idea.

Tamara Lytle is a writer living in Vienna, Virginia.

For more on prescription drug costs

• Prices of Hundreds of Drugs Outpace Inflation
• At Long Last, Prescription Drug Price Relief
• Can’t Afford Your Meds? Talk to Your Doctor