The State Access to Innovative Medicines (SAIM) Coalition recently submitted a formal letter of support to the Virginia Senate Commerce and Labor Committee in favor of Senate Bill 161, sponsored by Sen. Russet Perry. The legislation aims to improve prescription drug affordability and predictability for patients in the individual and small group health insurance markets.
During the committee hearing, Carolyn Sheridan, Associate Director of State Policy for the National Organization for Rare Disorders (NORD), provided testimony on behalf of the SAIM Coalition, highlighting the significant challenges patients, particularly those with chronic and rare conditions, face due to high and unpredictable out-of-pocket prescription drug costs.
In its submitted comments, SAIM emphasized that SB 161 directly addresses these concerns by requiring insurers in the individual and small group markets to offer health plans with clear caps on prescription drug cost-sharing. Under the bill, cost-sharing would be limited to $100 per 30-day supply for silver, gold, and platinum plans, and $150 per 30-day supply for bronze plans. Importantly, these limits would apply at any point in the benefit design, including before and after a deductible is met, ensuring patients are protected from high upfront costs.
SAIM noted that this approach closely aligns with the Coalition’s core policy principles, which seek to:
- Ensure the out-of-pocket cost for any one prescription is affordable by limiting what a patient must pay to fill a single prescription;
- Eliminate the shock of high upfront deductibles by applying cost-sharing limits both before and after deductibles are reached; and
- Increase consumer choice in the insurance marketplace by ensuring access to plans with predictable and affordable prescription drug costs.
The coalition also highlighted a key provision of SB 161 requiring that at least 50 percent of plans offered by each carrier comply with these cost-sharing limits. According to SAIM, this requirement would significantly increase transparency and affordability in Virginia’s health insurance marketplace, allowing patients to better predict, plan for, and budget their prescription drug expenses while making more informed decisions when selecting coverage.
During committee consideration, Sen. Perry amended the bill’s effective date, moving implementation from 2027 to 2028. Ultimately, the committee chose to hold the bill until next week to allow time for additional fiscal clarification from the Virginia Bureau of Insurance (BOI).
SAIM remains engaged in the legislative process and looks forward to continued discussions as SB 161 advances, reaffirming its commitment to policies that improve patient access to affordable, innovative medicines.
