Virginia lawmakers are considering a substitute amendment to SB271 that would extend the federal Medicare drug negotiation program’s “Maximum Fair Price” beyond Medicare and into parts of Virginia’s broader healthcare market.
The proposal is intended to address drug affordability. But for patients, the most important question is simple:
Will this actually lower what patients pay at the pharmacy counter without risking access to medicines?
Unfortunately, the SB271 substitute raises serious concerns.
Below are five reasons Virginia patients and policymakers should take a closer look before moving forward.
In simple terms, the SB271 substitute would allow Virginia to enforce federally negotiated drug prices across parts of the state’s healthcare market.
That does not automatically mean patients will pay less at the pharmacy counter.
The federal Medicare drug negotiation program itself does not guarantee lower out-of-pocket costs for patients. Insurers and pharmacy benefit managers are not required to pass negotiated savings directly to patients.
What these policies guarantee is government price caps — not guaranteed patient savings.
At the same time, extending those caps beyond Medicare could create uncertainty about how certain medicines are supplied, covered, or reimbursed within the state.
Patients deserve policies that lower their costs without putting access to treatments at risk.
The central problem is simple: there is no guarantee patients will pay less.
Even under the federal Medicare negotiation program, negotiated prices do not automatically reduce what patients pay out of pocket.
Savings can remain within the healthcare system rather than reaching patients directly.
If the goal is affordability, policies should focus on lowering costs at the pharmacy counter.
The federal negotiation program was created specifically for Medicare.
SB271 would extend those federally negotiated prices into Virginia’s broader healthcare market.
Expanding federal price controls beyond the program they were designed for could reshape how medicines are priced and reimbursed across the state.
Major policy changes like this deserve careful review.
The first drugs selected for federal negotiation are commonly used to treat conditions such as:
These are medicines heavily used by older Americans and patients with chronic illness.
Policies that alter how these medicines are priced or reimbursed should be evaluated carefully to ensure they do not create new barriers to access.
SB271 would make Virginia one of the first states to extend federal Medicare price controls into its broader healthcare market.
That effectively turns the Commonwealth into a policy experiment.
Healthcare markets are complex, and policies that extend federal pricing rules beyond their original scope can have unintended consequences.
Virginia patients should not be placed in the middle of that uncertainty.
The substitute focuses on drugs included in the first round of federal Medicare negotiations.
Yet fewer than two percent of Virginians outside Medicare would likely be affected.
Meanwhile, many of the largest drivers of healthcare costs for patients remain untouched, including:
Virginia patients deserve solutions that address the broader drivers of healthcare costs, not policies focused on a small subset of drugs. Help all Virginians
Before moving forward, lawmakers should ask a few key questions:
These are important questions that deserve thoughtful consideration before implementing a policy that could reshape drug pricing across the Commonwealth.
If lawmakers truly want to lower prescription costs for patients at the pharmacy counter, they should focus on policies that guarantee that outcome.
Price controls do not guarantee lower out-of-pocket costs for patients. As the federal Medicare drug negotiation program demonstrates, negotiated prices can change how money moves within the healthcare system without ensuring that patients actually pay less for their medicines.
Real patient affordability requires policies that directly address what patients pay — including how insurance benefits are designed, how rebates are handled, and whether savings are passed through to patients at the pharmacy counter.
Virginia patients deserve solutions that guarantee lower costs for patients, not policies that impose price ceilings while leaving patients’ out-of-pocket costs unchanged.
Patients Rising believes affordability and access must go hand in hand.
Patients need policies that reduce out-of-pocket costs while ensuring continued access to the medicines their doctors prescribe.
Healthcare policy should always be judged by a simple test:
Does it make it easier for patients to get the treatment they need?