In a win for patients, the Virginia Governor vetoed legislation establishing a Prescription Drug Affordability Board (PDAB). Meanwhile, yesterday’s hearing on ERISA highlighted AFP and PBM abuses. (620 words, 3 minutes, 6 seconds)

Virginia Governor vetoes PDAB

A win for patient access, Virginia Gov. Glenn Youngkin vetoed legislation last week that would have established a Prescription Drug Affordability Board (PDAB), and state-imposed price controls, in America’s 12th most-populous state.

Remind me, what are PDABs? State Prescription Drug Affordability Boards aim to cap, control, and dictate the price of drugs that manufacturers can charge.

Why it matters: PDABs have become a more prevalent idea for states to consider, despite growing concerns—articulated most clearly by patients in Colorado—that punitive cuts in list prices could undermine access.

What they’re saying: “He rejected a proposal to establish a government price-control board because this policy is not only unproven to lower drug prices, it would potentially restrict the access and creation of needed medications and life-saving treatments for families across the Commonwealth,” said a Youngkin spokesperson.

Meanwhile, in other states: There are currently eight established PDABs in Colorado, Maine, Maryland, Minnesota, New Hampshire, New Jersey, Oregon, and Washington. As one of the nation’s first PDABs, Colorado’s PDAB is now reviewing whether a small group of drugs are “affordable” for patients, and then determining whether they qualify for an upper payment limit (UPL), Bio.News previously reported.

BIO’s take: “The veto of PDAB legislation in Virginia is a win for patients,” said Patrick Plues, BIO’s VP of State Government Affairs. “As we have seen across so many states, the PDAB concept is severely flawed and threatens access to medicines for patients while failing to impact out-of-pocket costs for them.”

What’s next: Expect legislative battles to continue, with 23 ongoing efforts in 18 states. (Notably, however, no state in this session has yet passed a PDAB bill into law.)

More reading: HealthHIV: Prescription Drug Affordability Boards (PDABs) and Upper Payment Limits (UPLs) Impact on Patients, Drug Pricing, and Innovation

Congressional hearing highlights AFP and PBM abuses that harm patients

During yesterday’s hearing marking 50 years of the Employee Retirement Income Security Act (ERISA), Members of Congress and witnesses called out abuses by alternative funding programs (AFPs) and pharmacy benefit managers (PBMs) that raise drug costs and reduce patient access.

AFPs, in a nutshell: AFPs remove specialty drugs from an insurer’s formulary of covered drugs, then make patients apply to drug makers’ charitable patient assistant programs (PAPs). AFPs get charity drugs for free and take a fee from insurance companies, who save money.

Why it matters: AFPs reduce insurance coverage for drugs, make patients wait for PAP approval to obtain drugs, and put drug access at risk. Meanwhile, PAP aid available for patients in true need is reduced.

“AFPs are taking advantage of employers,” said Rep. Rick Allen (R-GA), adding that insurers should explain the impact of AFPs to insured patients.

There was also mention of PBMs—the middlemen between insurers, pharmacies, and drug makers who drive up prices with opaque operations, including taking drug rebates and not sharing savings with patients. Rep. Allen noted the House passed the Lower Cost More Transparency Act to check PBM abuses.

“It is a fantastic bill,” said witness Russell DuBose of Phifer Inc., which manufactures outdoor windows and screens “There needs to be PBM reform, especially in regards to spread pricing and rebate passthrough.”

Join the BIOAction campaign to urge PBM reform.

President Biden’s Wednesday: Addressing the United Steelworkers in Pittsburgh in a week focused on campaigning in Pennsylvania, per The New York Times.

What’s Happening on Capitol Hill: Health and Human Services (HHS) Secretary Xavier Becerra will testify before a House Energy & Commerce Health Subcommittee hearing on the 2025 HHS budget. U.S. Trade Representative Katherine Tai will testify for a Senate Finance Committee hearing on “The President’s 2024 Trade Policy Agenda.” And BIO members from across the country are on Capitol Hill today urging members to pass the Orphan Cures Act and to restore immediate R&D expensing.