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VA SB669
VA SB669Pharmacy benefits managers; requirements, application of law, report, delayed effective date.
summary
Introduced
01/14/2026
01/14/2026
In Committee
02/19/2026
02/19/2026
Crossed Over
02/27/2026
02/27/2026
Passed
Dead
Introduced Session
2026 Regular Regular Session
Bill Summary
Pharmacy benefits managers; requirements; scope; report. Requires all health insurance carriers to use the pass-through pricing model and may limit 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 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. Certain provisions of the bill have a delayed enactment date of July 1, 2027.
AI Summary
This bill mandates that all health insurance carriers must adopt a pass-through pricing model, meaning they cannot profit from the difference between what they pay for prescription drugs and what they charge patients, and limits a pharmacy benefits manager (PBM), which is a company that manages prescription drug benefits on behalf of health insurers, from earning income beyond a set fee for services provided to a carrier. It also prohibits PBMs from reversing or resubmitting a pharmacist's claim without proper notification and reconciliation, reducing payments to an unfairly low rate, or retroactively denying claims except under specific circumstances like fraud or if the service wasn't properly rendered. Furthermore, the bill requires the State Corporation Commission to annually report on the impact of prescription drug costs on healthcare premiums and to investigate whether carriers or PBMs are pressuring individuals to use affiliated pharmacies, with findings and recommendations due to the General Assembly by December 1, 2026, though some provisions will not take effect until July 1, 2027.
Committee Categories
Budget and Finance, Business and Industry
Sponsors (2)
Last Action
House substitute agreed to by Senate (38-Y 0-N 0-A) (on 02/27/2026)
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/20261/SB669 |
| BillText | https://lis.virginia.gov/bill-details/20261/SB669/text/SB669H2 |
| BillText | https://lis.virginia.gov/bill-details/20261/SB669/text/SB669H1 |
| Fiscal Note/Analysis - Fiscal Impact Statement from State Corporation Commission (SB669) | https://lis.blob.core.windows.net/files/1136485.PDF |
| BillText | https://lis.virginia.gov/bill-details/20261/SB669/text/SB669S1 |
| BillText | https://lis.virginia.gov/bill-details/20261/SB669/text/SB669SC1 |
| BillText | https://lis.virginia.gov/bill-details/20261/SB669/text/SB669 |
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