EACH-PIC COALITION URGES VIRGINIA GOVERNOR TO PUT PATIENTS FIRST
Price Caps Are the Wrong Tool to Reduce Patient Costs
March 12, 2026 – The Ensuring Access to Collaborative Health (EACH) and Patient Inclusion Council (PIC) Coalition urges Virginia Governor Abigail Spanberger to prioritize patients by vetoing legislation to set artificial price caps for drugs under state-regulated health plans.
This week, legislation was passed by the House and Senate (HB483/SB271) that would implement rates set by the Medicare Drug Price Negotiation Program as price caps for those drugs under state-regulated health plans. However, these price caps will not materially lower costs for patients and could negatively impact patients by making it more difficult to access selected medications in Virginia.
“While price caps are a great headline, the reality is that these bills will do very little to actually lower patient costs or resolve the real issues that are keeping Virginians from getting the medications they need,” said Mark Hobraczk, legislative lead for the EACH/PIC Coalition. “We urge Governor Spanberger to veto these bills and instead pursue health reforms that will actually help patients.”
The EACH/PIC Coalition shares the goal of lowering drug costs for patients and applauds Virginia for the early adoption of many positive health reforms, including banning copay accumulator/diversion programs and reforming many anti-competitive pharmacy benefit manager (PBM) practices. Lawmakers should continue their focus on patient-centered reforms by enacting legislation allowing patients to choose plans with capped copayments and strengthen provisions that “delink” PBM compensation from the price of the drug.
“Virginia has been at the forefront of meaningful health reforms, and we look forward to working with the sponsors of these bills, the governor, and other advocacy organizations to continue that proud tradition,” said Hobraczk. “These bills run counter to that cause, and we hope that the governor will act with leadership and vision towards real reforms.”
BACKGROUND
- According to the Pioneer Institute, “federal drug price controls—intended to reduce out-of-pocket costs for seniors—are instead making many prescription drugs more expensive for Medicare beneficiaries. … Average out-of-pocket costs for the nine drugs rose 32 percent, from $74.51 to $98.42”
- The results of EACH/PIC’s Patient-Reported Affordability and Unaffordability Survey reveal that price caps fail to address the “why” behind drug affordability. Open-ended responses from over 500 patients demonstrate that patient-reported affordability is not caused by the list price of a drug but is instead driven by health insurance barriers, income, cumulative costs, and evolving life situations. The data also revealed existing and often stark health inequities that will only be exacerbated by price caps, as people of color are far less likely to be prescribed or have access to the highest-cost brand-name or specialty medications.
- Research by Avalere Health found that “respondents anticipate that UPLs will impact formulary design, cost sharing, rebating, and pharmacy and provider reimbursement, all of which can impact patients’ access to medications.”
- “When asked which types of stakeholders may be most impacted by UPL effectuation, 80% of respondents selected patients—the highest out of all stakeholders listed”
- “60% of respondents expected changes to OOP costs and 50% expected increased copays or coinsurance on a UPL drug”
- “60% of respondents said those negative impacts on pharmacy reimbursement would decrease the likelihood of a pharmacy stocking a product with a UPL. Nearly three-fourths (73%) of payers surveyed agreed that this could lead to a shortage of the drug in the state with a UPL.”
- The Value of Care Coalition survey of rheumatologists and other specialty doctors shows that nearly all believe price caps will result in non-medical switching, where patients are forced on to inferior and often ineffective/harmful therapies due solely to an upper payment limit and not the prescribed product. More than half of rheumatologists would avoid prescribing a drug with an upper payment limit/price cap.
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The Ensuring Access through Collaborative Health (EACH) and Patient Inclusion Council (PIC) is a two-part coalition that unites patient organizations and allied groups (EACH), as well as patients and caregivers (PIC), to advocate for drug affordability policies that benefit patients.
Please contact Mark Hobraczk, legislative lead for the EACH/PIC Coalition, at mark@aiarthritis.org for any additional information.