Bill > HB1109

This bill requires managed care organizations (MCOs), which are private companies that contract with the state to manage healthcare services for Medicaid beneficiaries, and pharmacy benefits managers (PBMs), companies that manage prescription drug benefits on behalf of health insurers, to follow standardized rules for collecting and reporting financial data to the Department of Medical Assistance Services (DMAS) and the Centers for Medicare and Medicaid Services (CMS). This data must include a detailed breakdown of all costs associated with prescription drugs, including expenditures and any rebates received, to ensure transparency. MCOs will also need to undergo an independent audit of their reporting practices every two years to verify accuracy, and DMAS will establish a compliance unit to oversee this process and can impose penalties, such as fines up to $10,000, suspension from administering medical assistance services, or mandatory corrective action plans, on MCOs and PBMs that fail to comply with these new reporting requirements.

Budget and Finance, Health and Social Services

https://lis.virginia.gov/bill-details/20261/HB1109