Bill > HB481

This bill mandates that health insurance carriers, referred to as "carriers," cannot deny or make an "adverse determination" (a decision to deny, reduce, or terminate a requested benefit) for a prior authorization request for prescription drugs or health care services unless that denial has been reviewed and approved by a licensed physician, or if a physician is unavailable, by a licensed pharmacist for prescription drugs, or a licensed dentist for dental services, or a licensed mental health provider for mental health services. Prior authorization is the process where a carrier approves certain medical services or prescription drugs before they are provided to a patient. This change aims to ensure that medical professionals are involved in the decision-making process for denying essential treatments or medications, providing an additional layer of review beyond administrative staff.

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https://lis.virginia.gov/bill-details/20261/HB481