Virginia and Hawaii Introduce PDAB Legislation

February 12, 2026

EGWP marketplace medicaid Medicare

Gov. Abigail Spanberger (D) is expected to sign legislation that would establish a Prescription Drug Affordability Board (PDAB). Numerous versions of this bill have been introduced in Virginia for the past five years but have either stalled in the legislature or been vetoed by Spanberger’s Republican predecessor.

The proposed legislation would create a PDAB panel responsible for conducting data analyses, developing policy recommendations, and identifying implementation barriers related to strategies to improve prescription drug affordability and enhance price transparency for prescription drugs across public and private payers. The panel would be required to submit an annual report detailing drug pricing trends and offering policy recommendations to improve affordability. Additionally, the bill establishes that manufacturers are prohibited from accepting payment at an amount higher than the referenced drug price set by the Medicare Drug Price Negotiation Program, if a drug has one.

Unlike other state PDAB legislation, the measure also includes a few PBM requirements, such as a minimum dispensing fee of $10.65 per script. The dispensing fee mandate has gotten the attention of the Department of Human Resource Management (DHRM) which has jurisdiction over the state’s employee health plan. DHRM estimates that applying the higher dispensing fee would increase pharmacy claim costs to the state health plan by over $6.5 million annually.

Solutions

AHIP Shares Update on Plan Progress to Simplify Prior Authorization

AHIP shared progress on the voluntary, multi-year commitments made by AHIP, BCBSA, and leading health plans (including Cigna Healthcare) to streamline and simplify prior authorization. Health plans serving nearly 270 million Americans are participating in this initiative. The 2026 commitments took effect on Jan. 1 and include: reducing the scope of claims subject to prior […]
read more >

February 12, 2026

EGWP marketplace medicaid Medicare

legislation

DOL Issues Proposed Rule on Improving Transparency into PBM Fees

Pursuant to President Trump’s Executive Order “Lowering Drug Prices by Once Again Putting Americans First,” the Department of Labor’s (DOL’s) Employee Benefits Security Administration (EBSA) issued a proposed rule that would require providers of PBM services and affiliated entities of brokerage and consulting services to disclose direct and indirect compensation to their self-funded ERISA fiduciary […]
read more >

February 12, 2026

EGWP marketplace medicaid Medicare

legislation

CMS Releases 2027 Advance MA and Part D Rate Notice

On Jan. 26, the Centers for Medicare & Medicaid Services (CMS) released the CY2027 Medicare Advantage (MA) and Part D Advance Notice which provides preliminary estimates of payment changes in county benchmarks and proposes additional policies for the upcoming contract year. CMS projects a net average year-over-year payment increase of 0.09% (essentially flat) – a […]
read more >

February 12, 2026

Medicare

You may also like