A Virginia oncologist said a provision in legislation to create a so-called “affordability board” in the state “could cause harm” and threaten patient access to cancer drugs.
That provision would allow for “Upper Payment Limits” (UPLS), 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.”
“The drug supply chain is complex and crowded with intermediaries, including pharmacy benefit managers who negotiate hidden rebates that rarely reach patients,” Richard Ingram, MD, FASCO, president of the Virginia Association of Hematology and Oncology, 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.”
His comments come as Virginia lawmakers consider Senate Bill 271, legislation that 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 EACH/PIC Coalition, a national network of patient advocacy organizations focused on drug access and affordability issues, also released a report that said UPLs may not address the factors that determine what patients ultimately pay for medicines.
“If patients are the goal, policymakers should focus on the barriers that actually determine whether people can access medicines,” the EACH/PIC Coalition said in a press release.
Patient advocacy groups have also weighed in on the legislation. The International Foundation for Autoimmune & Autoinflammatory Arthritis, a patient advocacy organization, urged Virginia lawmakers earlier this year to oppose a companion measure in the House of Delegates.
In a January post on X, the group warned that the proposal would create “an ineffective and costly Prescription Drug Affordability Board that has failed to generate any savings in other states.” The comments referenced House Bill 483, a House companion bill to SB 271 currently under consideration by Virginia lawmakers.
Debate over the policy has been ongoing in Richmond for several years. Former Virginia Gov. Glenn Youngkin vetoed legislation establishing a prescription drug affordability board in both 2024 and 2025, citing concerns about the potential impact on access to medicines and the broader healthcare market, according to veto messages released by his office.
