While some states continue to struggle with the operations of Prescription Drug Affordability Boards (PDABs), others are saying “no” to upper payment limits altogether. This year, the governors of Virginia and Nevada vetoed legislation that would have either established a PDAB or imposed price caps—delivering a clear message that upper payment limits do more harm than good.
Virginia & Nevada Take a Stand
Virginia Governor Glenn Youngkin put it pointedly, noting the proposed PDAB “risks limiting patient access to essential medication by prioritizing costs over medical necessity.” His veto message emphasized that decisions under this model would be based on price alone, not the expertise of doctors or the specific needs of patients.
These concerns are echoed by patient and provider groups nationwide. A board focused primarily on cost rather than outcomes or real-world clinical decision-making opens the door to dangerous consequences like delayed treatment, denied access and even increased patient costs.
Nevada Governor Joe Lombardo reached a similar conclusion, writing that he supports “efforts to reduce prescription drug costs,” but the price cap proposal could mean life-saving medications “simply won’t be available.” He also warned of rising costs for Nevadans and potential challenges pharmacies face in stocking price-capped drugs.
Seeing the Struggles Elsewhere
These governors aren’t guessing—they’re watching. Virginia’s veto message directly cited Maryland and Colorado as states in which PDABs “will limit access to life-saving pharmaceuticals and harm patients’ health, without producing the savings promised.”
In Maryland, stakeholders have raised alarm over short discussions, dismissive attitudes, and a lack of meaningful accountability in the existing board’s deliberations. Pharmacies are reporting they may not stock drugs subject to upper payment limits, while patients face mounting uncertainty over whether prescribed medications will remain available.
The experience in these states shows the risks aren’t hypothetical, and policymakers are wise to learn from mistakes made to date.
Affordability Without Access Isn’t a Solution
The vetoes in Virginia and Nevada aren’t a rejection of the affordability issue. Far from it. They’re a call to be smarter about the path forward. As Governor Youngkin put it, driving down the cost of medications “will require full transparency … not price controls.”
That warning is resonating. Lawmakers across the country are watching how these policies play out, and reevaluating whether PDABs and upper payment limits actually deliver savings for patients.
As more state leaders speak out, one point becomes clear: efforts to improve affordability must not undermine access. Good intentions don’t justify bad outcomes. Patients deserve solutions that tackle costs and protect their access to the care they need.