summary
Introduced
01/13/2026
01/13/2026
In Committee
02/18/2026
02/18/2026
Crossed Over
02/16/2026
02/16/2026
Passed
Dead
Introduced Session
2026 Regular Regular Session
Bill Summary
Pharmacy benefits managers; requirements; scope; report. Requires a pharmacy benefits manager to use the pass-through pricing model and prohibits a pharmacy benefits manager from deriving income from pharmacy benefits management services provided to a carrier except for income derived from a pharmacy benefits management fee. The bill prohibits a pharmacy benefits manager from (i) reversing and or resubmitting the claim of a pharmacist or pharmacy without meeting certain requirements, (ii) reducing any payment to a pharmacist or pharmacy to an effective rate of reimbursement, or (iii) retroactively denying or reducing a claim or aggregate of claims except under certain circumstances. The bill applies all of the requirements for pharmacy benefits managers to the state employee health plan and certain reporting requirements to the state pharmacy benefits manager. The bill requires the State Corporation Commission (the Commission) to annually prepare a report based on certain information that examines the overall impact of prescription drug costs on health care premiums in the Commonwealth. Additionally, the bill requires the Commission to examine the practice of carriers or pharmacy benefits managers requiring or inducing covered individuals to utilize pharmacy services at an affiliated pharmacy. The Commission is required to report its findings and recommendations to the General Assembly by December 1, 2026.
AI Summary
This bill mandates that pharmacy benefit managers (PBMs), which are companies that manage prescription drug benefits on behalf of health insurers or employers, must adopt a "pass-through pricing model," meaning they can only earn income from fees for their services and cannot profit from the difference between what they pay pharmacies and what they charge health plans. It also prohibits PBMs from unfairly reversing or resubmitting pharmacy claims, reducing payments to pharmacies to an unreasonably low rate, or retroactively denying or reducing payments except under specific circumstances like fraud or if services weren't rendered. These requirements are extended to the state employee health plan, and the State Corporation Commission (the Commission) is tasked with producing an annual report on the impact of prescription drug costs on healthcare premiums and investigating whether health plans or PBMs unfairly steer individuals towards affiliated pharmacies, with findings and recommendations due to the General Assembly by December 1, 2026.
Committee Categories
Budget and Finance, Business and Industry
Sponsors (31)
Katrina Callsen (D)*,
Kimberly Adams (D),
Jessica Anderson (D),
Bonita Anthony (D),
Elizabeth Bennett-Parker (D),
Gretchen Bulova (D),
Kacey Carnegie (D),
Stacey Carroll (D),
Nadarius Clark (D),
Nicole Cole (D),
Rae Cousins (D),
Lindsey Dougherty (D),
Mark Downey (D),
Lily Franklin (D),
Margaret Franklin (D),
Elizabeth Guzmán (D),
Phil Hernandez (D),
Karen Keys-Gamarra (D),
Amy Laufer (D),
Fernando Martinez (D),
Adele McClure (D),
Leslie Chambers Mehta (D),
May Nivar (D),
Marcia Price (D),
Sam Rasoul (D),
Charlie Schmidt (D),
Shelly Simonds (D),
Virgil Thornton (D),
Kathy Tran (D),
Howard Wachsmann (R),
Rodney Willett (D),
Last Action
Referred to Committee on Commerce and Labor (on 02/18/2026)
Official Document
bill text
bill summary
Loading...
bill summary
Loading...
bill summary
| Document Type | Source Location |
|---|---|
| State Bill Page | https://lis.virginia.gov/bill-details/20261/HB830 |
| BillText | https://lis.virginia.gov/bill-details/20261/HB830/text/HB830H2 |
| BillText | https://lis.virginia.gov/bill-details/20261/HB830/text/HB830HC4 |
| BillText | https://lis.virginia.gov/bill-details/20261/HB830/text/HB830HC3 |
| Fiscal Note/Analysis - Fiscal Impact Statement from State Corporation Commission (HB830) | https://lis.blob.core.windows.net/files/1136484.PDF |
| BillText | https://lis.virginia.gov/bill-details/20261/HB830/text/HB830H1 |
| BillText | https://lis.virginia.gov/bill-details/20261/HB830/text/HB830HC2 |
| Fiscal Note/Analysis - Fiscal Impact Statement from State Corporation Commission (HB830) | https://lis.blob.core.windows.net/files/1115646.PDF |
| BillText | https://lis.virginia.gov/bill-details/20261/HB830/text/HB830HC1 |
| BillText | https://lis.virginia.gov/bill-details/20261/HB830/text/HB830 |
Loading...