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Bill > SB1359
VA SB1359
VA SB1359Health carriers and pharmacy benefits managers; prohibited conduct, civil penalty.
summary
Introduced
01/13/2025
01/13/2025
In Committee
01/13/2025
01/13/2025
Crossed Over
Passed
Dead
02/22/2025
02/22/2025
Introduced Session
2025 Regular Session
Bill Summary
Prohibited conduct by health carriers and pharmacy benefits managers; civil penalty; enforcement. Prohibits any carrier, pharmacy benefits manager, or representative of a pharmacy benefits manager from (i) requiring that a covered individual purchase pharmacy services exclusively through a mail-order pharmacy or retail pharmacy affiliated with a pharmacy benefits manager or (ii) prohibiting or limiting a covered individual from selecting a pharmacy or pharmacist of his choice that has agreed to participate in the health benefit plan according to the terms of the plan. The bill adds a civil penalty of $5,000 for a violation of prohibited conduct by health carriers and pharmacy benefits managers and adds that the State Corporation Commission has authority to investigate any such violations.
AI Summary
This bill adds a new section to Virginia's legal code that regulates how health carriers and pharmacy benefits managers (PBMs) handle prescription drug services. The bill requires that covered individuals (patients) be allowed to fill mail-order prescriptions at any network participating retail pharmacy if that pharmacy agrees to accept equivalent reimbursement rates to mail-order pharmacies. It prohibits PBMs and carriers from imposing different copayments, fees, or other conditions on patients who choose to use a retail community pharmacy versus a mail-order pharmacy. The bill also mandates that PBMs disclose to carriers if they retain different rebate amounts or additional compensation for drugs dispensed through their own mail-order pharmacies compared to retail pharmacies. The new regulations will apply to contracts with PBMs that are entered into, amended, extended, or renewed on or after January 1, 2026. Additionally, the bill establishes a civil penalty of $5,000 for violations and gives the State Corporation Commission authority to investigate such violations, with the goal of ensuring patient choice and preventing discriminatory practices in pharmacy services.
Committee Categories
Business and Industry
Sponsors (2)
Last Action
Failed to report (defeated) in Commerce and Labor (5-Y 9-N 1-A) (on 01/27/2025)
Official Document
bill text
bill summary
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bill summary
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bill summary
| Document Type | Source Location |
|---|---|
| State Bill Page | https://lis.virginia.gov/bill-details/20251/SB1359 |
| BillText | https://lis.virginia.gov/bill-details/20251/SB1359/text/SB1359SC1 |
| Fiscal Note/Analysis - Fiscal Impact Statement from State Corporation Commission (SB1359) | https://lis.blob.core.windows.net/files/1023336.PDF |
| BillText | https://lis.virginia.gov/bill-details/20251/SB1359/text/SB1359 |
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