Get the Facts.

Governor Spanberger Stands with Virginia Patients

When doctors listen, patient outcomes improve. And when leaders listen, our families benefit too.

Governor Spanberger is fighting for evidence-based strategies to lower the cost of health care for Virginia families while preserving access to the innovative medicines Virginians rely on. She heard concerns from patients and health care providers on SB 271 and HB 483. That’s why she sent reasonable amendments to the legislature for those bill, requiring further study showing evidence of effectiveness of upper payment limits before implementing them in Virginia.

Unfortunately, the legislature returned the bills to the Governor without acting on her recommendations. As passed, SB 271 and HB 483 would implement Medicare-based government-imposed prices on certain prescription medications. These untested policies risk higher costs for patients and decreased access to innovative treatments Virginians rely on.

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

Get the facts on upper payment limits and Medicare Reference Pricing:

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.