Opinion: Board needs to protect patients with affordable drug access

Oncologist warns against unintended consequences of price controls on cancer drugs

Mar. 13, 2026 at 5:22pm

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A medical oncologist in Winchester, Virginia, argues that while lawmakers in Richmond should enact policies to make prescription drugs more affordable, they must be careful not to create reimbursement caps that could force community oncology clinics to stop offering certain life-saving cancer treatments, pushing patients into more expensive hospital settings and threatening access to care, especially in rural and underserved areas.

Why it matters

The financial burden of cancer treatment can be as overwhelming as the disease itself, and lawmakers in Virginia are considering creating a Prescription Drug Affordability Board (PDAB) to help alleviate this burden. However, the oncologist warns that one provision of the PDAB, upper payment limits (UPLs) on drug prices, could have unintended consequences that actually reduce patient access to affordable care in their local communities.

The details

The oncologist explains that in community oncology, clinics must purchase high-cost cancer medications upfront, sometimes tens of thousands of dollars per dose, and then store, prepare, and administer them with trained staff. If a UPL is set below what a practice pays to acquire a drug or below the cost of providing it, clinics will be forced to stop offering certain treatments, send patients to larger hospital systems, stop accepting certain insurance, or close entirely. This could push patients into more expensive hospital settings and threaten access to care, especially in rural areas where the local clinic may be the only option.

  • The Virginia General Assembly is currently considering creating a Prescription Drug Affordability Board (PDAB).

The players

Richard Ingram, MD, FASCO

A full-time practicing medical oncologist in Winchester, Virginia, and the president of the Virginia Association of Hematology and Oncology and a member of the Community Oncology Alliance Board of Directors.

Virginia General Assembly

The state legislature of Virginia, which is considering creating a Prescription Drug Affordability Board (PDAB).

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What they’re saying

“Drug prices are unsustainable, and patients are paying the price in real, painful ways.”

— Richard Ingram, MD, FASCO, Medical Oncologist

“If lawmakers move forward with a drug affordability board, they must include rigorous guardrails: modeling scenarios where UPLs might fall below acquisition costs to prevent clinic closures; evaluating likely shifts to higher-cost hospital settings to ensure the policy actually saves money; building robust exception and appeals processes for life-saving therapies; phasing implementation with real-world monitoring to catch access issues early; and including independent community oncologists in the decision-making process to provide real-world expertise.”

— Richard Ingram, MD, FASCO, Medical Oncologist

What’s next

The Virginia General Assembly is expected to vote on the proposal to create a Prescription Drug Affordability Board in the coming legislative session.

The takeaway

While lawmakers in Virginia aim to make prescription drugs more affordable, they must be careful not to implement policies like upper payment limits that could inadvertently reduce patient access to life-saving cancer treatments, especially in rural and underserved areas where community oncology clinics play a vital role.