Bill

Bill > HB736


VA HB736

VA HB736
Health insurance; required provisions regarding prior authorization for prescription drugs.


summary

Introduced
01/13/2026
In Committee
02/18/2026
Crossed Over
02/16/2026
Passed
Dead

Introduced Session

Potential new amendment
2026 Regular Regular Session

Bill Summary

Health insurance; carrier contracts; required provisions regarding prior authorization for prescription drugs. Amends existing required provisions for health carrier contracts related to prior authorizations for prescription drugs. Current law requires that if prior authorization is approved for prescription drugs and such prescription drugs have been scheduled, provided, or delivered to the patient consistent with the authorization, health carriers may not revoke, limit, condition, modify, or restrict that authorization except in certain circumstances. The bill requires this limitation on carriers to apply for the duration of the authorization, which the bill requires to be a minimum of six months for initial authorizations and a minimum of 12 months for continued authorizations. The bill adds circumstances under which a prior authorization may be revoked, limited, conditioned, modified, or restricted by a carrier, including (i) a final action by the U.S. Food and Drug Administration, other regulatory agencies, or the manufacturer communicating a patient efficacy issue that would affect the authorization and (ii) when additional safety and efficacy monitoring is clinically appropriate or recommended by the U.S. Food and Drug Administration, other regulatory agencies, or the manufacturer.

AI Summary

This bill amends existing laws regarding health insurance, specifically focusing on prior authorization for prescription drugs, which is the process health carriers use to approve certain drug benefits before they are provided to a patient. The key change is that once a prior authorization is approved and the prescription drugs are dispensed to the patient, health carriers can no longer revoke, limit, condition, modify, or restrict that authorization for a minimum of six months for initial approvals and a minimum of 12 months for continued approvals, unless specific exceptions apply. These exceptions now include situations where there's a final action from the U.S. Food and Drug Administration (FDA) or other regulatory bodies, or the manufacturer, indicating a patient efficacy issue or recommending additional safety monitoring for the drug. The bill aims to provide greater stability and predictability for patients and providers regarding prescription drug coverage.

Committee Categories

Budget and Finance, Business and Industry

Sponsors (2)

Last Action

Referred to Committee on Commerce and Labor (on 02/18/2026)

bill text


bill summary

Loading...

bill summary

Loading...

bill summary

Document Type Source Location
State Bill Page https://lis.virginia.gov/bill-details/20261/HB736
Fiscal Note/Analysis - Fiscal Impact Statement from Department of Planning and Budget (HB736) https://lis.blob.core.windows.net/files/1156873.PDF
BillText https://lis.virginia.gov/bill-details/20261/HB736/text/HB736E
Labor and Commerce Amendment https://lis.virginia.gov/bill-details/20261/HB736/text/HB736AH1
Subcommittee #1 Subcommittee Amendment https://lis.virginia.gov/bill-details/20261/HB736/text/HB736AHC1
BillText https://lis.virginia.gov/bill-details/20261/HB736/text/HB736
Loading...