Get the Facts.

MFP Reference Pricing Doesn’t Help Virginia patients.

The Virginia legislature is considering two bills with new language that implements upper payment limits (UPLs) on prescription drugs in the Commonwealth based on Medicare’s maximum fair price set in Washington.

These price caps apply to health plan reimbursements for certain drugs, but don’t automatically change what patients pay at the pharmacy counter or change how plans design their benefits.

Read the VCC Blog: MFP Reference Pricing Fails Patients, Too

Virginians are hesitant about government price-setting…for good reason.  Recent polling shows that, when told about the tradeoffs of upper payment limits, the majority of Virginians don’t support them.

Contact members of the Virginia Senate today and ask them to oppose the substitute language for HB 483:

Click Here: Virginia Senate Contact List

Get the facts:

PATIENTS

The EACH / PIC patient-led survey makes clear: affordability is not just about the price of a single drug – it’s about the total burden of care.

– Even 20% of respondents paying $0–$10/month said their medications were still unaffordable, citing other financial pressures and cumulative costs.
– 77% reported additional out-of-pocket medical costs – for doctor visits, imaging, labs, and assistive devices – that compound the strain.
– When patients said a drug was “unaffordable,” 100% who discontinued it cited insurance barriers (denials, step therapy, prior authorization) – not just cost alone.

DOCTORS

A Value of Care Coalition survey of specialists found:

– 100% feared upper payment limits would increase administrative work and cut into patient care.
– 96% expressed concern that UPLs will lead to non-medical switching—forcing patients off effective medications for reasons unrelated to health.

PHARMACISTS

The National Community Pharmacists Association found in a September 2025 survey that 1 in 5 independent pharmacies would not stock drugs subjected to Medicare’s maximum fair price due to reimbursement concerns, and another two-thirds were considering the same.

HEALTH PLANS

According to research conducted by Avalere for the Partnership to Fight Chronic Disease, upper payment limits raise patient costs and decrease access:

– 50% of health plans expect increased copays or coinsurance on drugs with upper payment limits.
– 57% anticipate increasing premiums if upper payment limits are implemented.
– 77% of payers believed effectuation of upper payment limits would disrupt patient access to prescription drugs.
– Payers noted increased use of prior authorization and other utilization management techniques in the event of UPL effectuation.

RESEARCHERS

Experience with federal drug price controls, Medicare’s Maximum Fair Price (MFP) program, which these bills mandate as the upper payment limit in Virginia, is already showing negative patient impacts:

– An analysis from the Pioneer Institute shows Patient costs for drugs subjected to federal price controls have seen an average 32% increase in out-of-pocket costs.
– According to the Schaeffer Institute at USC, health plans are implementing sharp increases in annual deductibles and shifting benefit design from flat copays toward coinsurance, forcing patients to pay a percentage of the list price instead of a predictable dollar amount.