# Virginia HB481: Prior authorization; requiring physician review for denial. Virginia HB481, Prior authorization; requiring physician review for denial., is a 2026 Regular Session House bill sponsored by Patrick A. Hope (Democratic); status signed, last action 2026-04-13 (Fiscal Impact Statement from State Corporation Commission (HB481)); PRIA reads it as touching household money (as of 2026-10-12). - Canonical: https://policyrisk.com/state-bill/VA-HB481-2026 - As of: 2026-10-12 - Plain-text twin of the page above; the HTML and this file carry the same facts. ## Facts - Bill: Virginia HB481 - State: Virginia - Session: 2026 Regular Session - Title: Prior authorization; requiring physician review for denial. - Status: signed - Chamber: House - Introduced: 2026-01-12 - Last action: 2026-04-13, Fiscal Impact Statement from State Corporation Commission (HB481) - Sponsor: Patrick A. Hope (Democratic) - Cosponsors: 0 - Touches household money: yes - Roll calls: 9 (317 yes, 1 no in all) - Economic provisions PRIA read: 10 ## Summary Prior authorization; requiring physician review for denial. Prohibits a health insurance carrier from making an adverse determination of a prior authorization request (i) for prescription drugs unless such denial has been reviewed and approved by a licensed physician or, if a licensed physician is not available, by a licensed pharmacist or (ii) for health care services unless such adverse determination has been reviewed and approved by (a) a licensed physician; (b) in the case of mental health services, a licensed mental health provider if a licensed physician is unavailable; or (c) in the case of dental services, a licensed dentist if a licensed physician is unavailable. ## Bill overview: provisions PRIA read - Clinical review before patients' coverage denials: benefit, medium. Insurers cannot deny a prior approval request for prescription drugs or health care without a licensed physician reviewing and approving the denial. If no physician is available, a licensed pharmacist can review and approve a drug denial. For mental health services, a licensed mental health provide… - Fewer approval barriers for addiction treatment: benefit, medium. Virginia insurers cannot require prior approval for at least one covered drug used in medication-assisted treatment for substance-use disorder. The prescription must follow FDA-labeled dosage limits and Board of Medicine regulations. The law does not require coverage of an otherwise excluded drug.… - Mental health patients keep drug approvals: benefit, medium. Virginia insurers cannot require repeated approval for previously approved, covered drugs treating disorders listed in the latest Diagnostic and Statistical Manual. Prescriptions must continue for at least three months and stay within FDA-labeled dosage limits. Prescribers must review effectiveness… - Online drug approvals show patients' costs: benefit, medium. Beginning July 1, 2025, Virginia insurers must offer online drug approval tools using NCPDP SCRIPT and Real Time Benefit standards. The tools show patient-specific out-of-pocket costs and lower-cost medicine options when available. Requests meeting the insurer's criteria must receive automatic appr… - Patients keep drug approvals through changes: benefit, medium. A new Virginia insurer must honor a previous drug approval for at least the first 90 days of drug coverage. The prescriber must provide proof of the earlier approval or coverage; the new plan's coverage terms and continued-approval exceptions still apply. When patients switch plans within the same… - Patients' approved care gains stronger protections: benefit, medium. Virginia insurers generally cannot change or limit approved care once it is scheduled or provided as authorized. Drug protection also applies after delivery, with exceptions for fraud, misrepresentation, specified regulatory or manufacturer actions, harmful interactions, or newly listed generics or… - Public approval rules protect patients' claims: benefit, medium. The earlier Virginia drug rules require one website location for covered-drug lists, approval requirements, procedures, and forms, updated within seven days of approved changes. Beginning January 1, 2027, insurers must publicly post services, codes, procedures, forms, and each requirement's effecti… - Clearer drug requests for patients' prescribers: benefit, low. Virginia insurers must accept drug approval requests by phone, fax, or electronic submission. Electronic routes include prescribing systems, electronic health records, and health information exchanges using NCPDP SCRIPT standards. Insurers must track every request and give prescribers identifying i… - Some health plans exclude patient protections: cost, low. The health care prior approval section does not cover certain health maintenance organizations using a multispecialty physician group. The group's doctors must be both employees and shareholders. The plan must arrange physician care through those doctors or contracted community providers. Patients… - New deadlines for patients' coverage decisions: mixed, medium. Before January 1, 2027, urgent Virginia drug requests require a response within 24 hours, including weekends, using phone or another insurer-directed method. Complete requests and completed answers to requests for more information require responses within two business days. These drug rules cover p… ## Sponsors and cosponsors - Sponsor: Patrick A. Hope (Democratic), House ## Roll call votes | Date | Chamber | Motion | Result | Yes | No | Other | | --- | --- | --- | --- | --- | --- | --- | | 2026-03-10 | House | Senate substitute agreed to by House | pass | 98 | 1 | | | 2026-03-05 | Senate | Commerce and Labor Substitute agreed to | pass | 0 | 0 | | | 2026-03-05 | Senate | Passed Senate with substitute Block Vote | pass | 39 | 0 | | | 2026-03-04 | Senate | Constitutional reading dispensed Block Vote (on 2nd reading) | pass | 39 | 0 | | | 2026-03-04 | Senate | Passed by for the day Block Vote (Voice Vote) | pass | 0 | 0 | | | 2026-03-02 | Senate | Reported from Commerce and Labor with substitute | pass | 13 | 0 | | | 2026-02-04 | House | Read third time and passed House | pass | 97 | 0 | | | 2026-01-29 | House | Reported from Labor and Commerce with substitute | pass | 22 | 0 | | | 2026-01-27 | House | Subcommittee recommends reporting with substitute | pass | 9 | 0 | | ## Actions (37) - 2026-04-13: Fiscal Impact Statement from State Corporation Commission (HB481) (House) - 2026-04-13: Acts of Assembly Chapter text (CHAP0925) (Governor) - 2026-04-13: Approved by Governor-Chapter 925 (effective 7/1/2026) (Governor) - 2026-03-31: Governor's Action Deadline 11:59 p.m., April 13, 2026 (Governor) - 2026-03-31: Enrolled Bill communicated to Governor on March 31, 2026 (House) - 2026-03-31: Signed by Speaker (House) - 2026-03-30: Bill text as passed House and Senate (HB481ER) (House) - 2026-03-30: Enrolled (House) - 2026-03-30: Signed by President (Senate) - 2026-03-10: Senate substitute agreed to by House (98-Y 1-N 0-A) (House) - 2026-03-09: Passed by for the day (House) - 2026-03-05: Fiscal Impact Statement from State Corporation Commission (HB481) (House) - 2026-03-05: Passed Senate with substitute Block Vote (39-Y 0-N 0-A) (Senate) - 2026-03-05: Commerce and Labor Substitute agreed to (Senate) - 2026-03-05: Engrossed by Senate - committee substitute (Senate) - 2026-03-05: Read third time (Senate) - 2026-03-04: Passed by for the day Block Vote (Voice Vote) (Senate) - 2026-03-04: Constitutional reading dispensed Block Vote (on 2nd reading) (39-Y 0-N 0-A) (Senate) - 2026-03-04: Rules suspended (Senate) - 2026-03-03: Committee substitute printed 26108765D-S1 (Senate) - 2026-03-02: Senate committee offered (Senate) - 2026-03-02: Reported from Commerce and Labor with substitute (13-Y 0-N) (Senate) - 2026-02-05: Referred to Committee on Commerce and Labor (Senate) - 2026-02-05: Constitutional reading dispensed (on 1st reading) (Senate) - 2026-02-04: Read third time and passed House (97-Y 0-N 0-A) (House) - 2026-02-03: Engrossed by House - committee substitute (House) - 2026-02-03: committee substitute agreed to (House) - 2026-02-03: Read second time (House) - 2026-02-03: Moved from Uncontested Calendar to Regular Calendar (House) - 2026-02-02: Read first time (House) - 2026-01-29: Committee substitute printed 26106401D-H1 (House) - 2026-01-29: Reported from Labor and Commerce with substitute (22-Y 0-N) (House) - 2026-01-27: House subcommittee offered (House) - 2026-01-27: Subcommittee recommends reporting with substitute (9-Y 0-N) (House) - 2026-01-19: Assigned HCL sub: Subcommittee #1 (House) - 2026-01-12: Referred to Committee on Labor and Commerce (House) - 2026-01-12: Prefiled and ordered printed; Offered 01-14-2026 26105194D (House) ## Bill text - Chaptered, 2026-04-13: [HTML](https://lis.blob.core.windows.net/files/1224611.HTML), [PDF](https://lis.blob.core.windows.net/files/1224610.PDF) - Enrolled, 2026-03-30: [HTML](https://lis.blob.core.windows.net/files/1210690.HTML), [PDF](https://lis.blob.core.windows.net/files/1210689.PDF) - Substitute, 2026-03-03: [HTML](https://lis.blob.core.windows.net/files/1190072.HTML), [PDF](https://lis.blob.core.windows.net/files/1190071.PDF) - Substitute, 2026-03-02: [HTML](https://lis.blob.core.windows.net/files/1189409.HTML), [PDF](https://lis.blob.core.windows.net/files/1189408.PDF) - Substitute, 2026-01-29: [HTML](https://lis.blob.core.windows.net/files/1103522.HTML), [PDF](https://lis.blob.core.windows.net/files/1103521.PDF) - Substitute, 2026-01-28: [HTML](https://lis.blob.core.windows.net/files/1098967.HTML), [PDF](https://lis.blob.core.windows.net/files/1098966.PDF) - Substitute, 2026-01-27: [HTML](https://lis.blob.core.windows.net/files/1098343.HTML), [PDF](https://lis.blob.core.windows.net/files/1098342.PDF) - Introduced, 2026-01-12: [HTML](https://lis.blob.core.windows.net/files/1084611.HTML), [PDF](https://lis.blob.core.windows.net/files/1084610.PDF) ## Related bills - HB5: Employment; paid sick leave, civil penalties. (signed) - SB199: Employment; paid sick leave, civil penalties. (signed) - HB95: Va. Residential Landlord and Tenant Act; landlord remedies, noncompliance with rental agreement. (signed) - HB1393: Electric utilities; pilot program for energy assistance and weatherization for certain individuals. (signed) - HB834: Virginia Residential Landlord and Tenant Act; fire or casualty damage, termination by landlord. (signed) - HB675: Protection of employees; coercion or threat based on immigration status, civil penalty. (signed) ## Sources - [Chaptered (HTML)](https://lis.blob.core.windows.net/files/1224611.HTML) - [Chaptered (PDF)](https://lis.blob.core.windows.net/files/1224610.PDF) - [Enrolled (HTML)](https://lis.blob.core.windows.net/files/1210690.HTML) - [Enrolled (PDF)](https://lis.blob.core.windows.net/files/1210689.PDF) - [Substitute (HTML)](https://lis.blob.core.windows.net/files/1190072.HTML) - [Substitute (PDF)](https://lis.blob.core.windows.net/files/1190071.PDF) - [Substitute (HTML)](https://lis.blob.core.windows.net/files/1189409.HTML) - [Substitute (PDF)](https://lis.blob.core.windows.net/files/1189408.PDF) - [Substitute (HTML)](https://lis.blob.core.windows.net/files/1103522.HTML) - [Substitute (PDF)](https://lis.blob.core.windows.net/files/1103521.PDF) - [Substitute (HTML)](https://lis.blob.core.windows.net/files/1098967.HTML) - [Substitute (PDF)](https://lis.blob.core.windows.net/files/1098966.PDF) - [Substitute (HTML)](https://lis.blob.core.windows.net/files/1098343.HTML) - [Substitute (PDF)](https://lis.blob.core.windows.net/files/1098342.PDF) - [Introduced (HTML)](https://lis.blob.core.windows.net/files/1084611.HTML) - [Introduced (PDF)](https://lis.blob.core.windows.net/files/1084610.PDF) ## Related - [HB5: Employment; paid sick leave, civil penalties.](https://policyrisk.com/state-bill/VA-HB5-2026) - [SB199: Employment; paid sick leave, civil penalties.](https://policyrisk.com/state-bill/VA-SB199-2026) - [HB95: Va. Residential Landlord and Tenant Act; landlord remedies, noncompliance with…](https://policyrisk.com/state-bill/VA-HB95-2026) - [HB1393: Electric utilities; pilot program for energy assistance and weatherization for…](https://policyrisk.com/state-bill/VA-HB1393-2026) - [HB834: Virginia Residential Landlord and Tenant Act; fire or casualty damage, terminat…](https://policyrisk.com/state-bill/VA-HB834-2026) - [HB675: Protection of employees; coercion or threat based on immigration status, civil…](https://policyrisk.com/state-bill/VA-HB675-2026) - [Virginia bills](https://policyrisk.com/states/virginia/bills) - [Virginia state hub](https://policyrisk.com/states/virginia) - [All state legislation](https://policyrisk.com/state-bills) Source: PRIA, https://policyrisk.com/state-bill/VA-HB481-2026 (as of 2026-10-12).