For an opposing view, see “Gov. Youngkin should sign the Prescription Drug Affordability Board bill” by one of the measure’s sponsors, state Sen. Bill Stanley, R-Franklin County.
Governor Youngkin must make a decision very soon whether to sign into law SB 274, the General Assembly’s bill creating a state-run Prescription Drug Affordability Board (PDAB). Once in place, this board would have the power to set upper list price limits on pharmaceuticals bought and sold within the commonwealth, but not what patients actually pay. As a physician who has treated thousands of Virginia families, I am urging the governor to veto this “sounds too good to be true” bill and work with legislators to craft a measure that will actually save Virginians money on their prescriptions.
Don’t get me wrong: We critically need action now to address the patient’s cost — not just the price — of prescription drugs. I’ve spent decades treating and working on behalf of children with rare and chronic diseases. I’ve seen families struggle to afford the medicines their kids need. However, the board’s stated goal is a complete misdiagnosis of the problem. It won’t help families and has significant potential to even create harm.
What the General Assembly misunderstood is that almost no patient pays the manufacturer’s list price for their prescription drugs. The complicated path from a drug’s list price to the patient’s cost is not addressed by SB 274. The bill assumes a lower list price will “trickle down” to a lower patient payment. Once a manufacturer sets a list price, it goes through a series of complex price negotiations within the supply chain before reaching the patient. Middlemen, known as pharmacy benefit managers (PBMs), are subcontractors hired by employers, health insurers and government agencies. PBMs determine a drug’s placement on formularies, whether there is a copay or coinsurance and how much, and what patients actually pay at the pharmacy counter. While the manufacturers work to ensure their drugs are more available than their competitors’ products, it is the PBMs, not the drug manufacturers, who ultimately determine whether a drug is available for Virginians, and if so, how much patients pay.
It’s a truly broken system, and this new government board doesn’t come even remotely close to addressing, much less doing anything to lower how much Virginians pay for their medications within the next few years.
In fact, Virginia patients and families may have much to fear if the governor signs this bill into law. A similar board created in Colorado began its work by targeting rare disease drugs for price controls. New medicines for rare diseases are, by definition, expensive. Yet these remarkable medications can make the difference between a normal life and a premature death.
If Virginia follows Colorado’s lead and empowers an unaccountable government board to set arbitrary upper limits on drug list prices without addressing the complex economics involved, many drugs could become unavailable within Virginia. It would create potential problems for drugs purchased by national companies elsewhere at different prices than they could be bought or sold within Virginia. It could make it difficult for physicians to purchase and administer medications that have saved and changed the lives of so many Virginians and their families.
PDABs are unproven, costly experiments that have many predictable — and therefore preventable, negative consequences.
As a physician and a patient, I’m urging the governor to do the right thing. Don’t sign a bill into law that cannot accomplish its stated goals. Please work with the General Assembly to develop legislation that will actually make prescription drugs more affordable by addressing the many reasons why they cost so much.
Dr. Harry L. Gewanter, FAAP, MACR, is a pediatric rheumatologist, current president of the Virginia Society of Rheumatology and board member of Let My Doctors Decide Action Network.