VirginiaHB6252026 Regular SessionHouseWALLET

Health insurance; limit on cost-sharing payments for prescription drugs under certain plans.

Sponsored By: Jen Kiggans - to resign 12/31 (Republican)

Became Law

Summary

Health insurance; limit on cost-sharing payments for prescription drugs under certain plans. Requires each carrier that offers a health plan in either the individual or small group market to ensure that at least one health plan in each of the bronze, silver, gold, and platinum levels of coverage in each rating area in the individual and small group market conform with the following: (i) a plan that offers a platinum level of coverage shall limit a person's cost-sharing payment for prescription drugs covered under the plan to an amount that does not exceed $150 per 30-day supply of the prescription drug; (ii) a plan that offers a gold level of coverage shall limit a person's cost-sharing payment for prescription drugs covered under the plan to an amount that does not exceed $200 per 30-day supply of the prescription drug; (iii) a plan that offers a silver level of coverage shall limit a person's cost-sharing payment for prescription drugs covered under the plan to an amount that does not exceed $250 per 30-day supply of the prescription drug; and (iv) a plan that offers a bronze level of coverage shall limit a person's cost-sharing payment for prescription drugs covered under the plan to an amount that does not exceed $300 per 30-day supply of the prescription drug. The bill requires that any plans offered to meet its requirements are (a) clearly and appropriately named to aid the consumer or plan sponsor in the plan selection process and (b) marketed in the same manner as other plans offered by the carrier. The bill's provisions apply to any individual or group accident and sickness insurance policy, any individual or group accident and sickness subscription contract, and any health care plan for health care services delivered, issued for delivery, or renewed in the Commonwealth on or after January 1, 2028. This bill is identical to SB 161.

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Bill Overview

Analyzed Economic Effects

2 provisions identified: 1 benefits, 0 costs, 1 mixed.

Drug cost caps in individual and small-group plans

Starting January 1, 2028, carriers in Virginia must offer at least one capped plan in each metal level in every rating area for the individual and small-group markets. These plans cap what you pay at the pharmacy per 30-day fill: platinum $150, gold $200, silver $250, bronze $300. The caps apply even before you meet the deductible. These plans must have clear names, be marketed the same as others, and they do not count against plan-option limits. The rules apply when your policy is delivered, issued for delivery, or renewed on or after that date.

HSA plans: caps start after deductible

If your plan is HSA-qualified, the drug cost caps do not apply to the deductible until you meet the federal minimum deductible. After you meet it, the caps apply. This preserves your plan’s HSA eligibility. The rule applies to plans delivered, issued, or renewed on or after January 1, 2028.

Sponsors & Cosponsors

Sponsor

  • Jen Kiggans - to resign 12/31

    Republican • Senate

Cosponsors

There are no cosponsors for this bill.

Roll Call Votes

All Roll Calls

Yes: 320 • No: 187

Senate vote 3/11/2026

Conference report agreed to by Senate

Yes: 39 • No: 0

House vote 3/10/2026

Conference report agreed to by House

Yes: 63 • No: 33

Senate vote 3/4/2026

Senate insisted on amendment Block Vote

Yes: 40 • No: 0

House vote 3/2/2026

Senate substitute rejected by House

Yes: 2 • No: 97

Senate vote 2/26/2026

Commerce and Labor Substitute agreed to

Yes: 0 • No: 0

Senate vote 2/26/2026

Passed Senate with substitute

Yes: 37 • No: 3

Senate vote 2/25/2026

Passed by for the day Block Vote (Voice Vote)

Yes: 0 • No: 0

Senate vote 2/25/2026

Constitutional reading dispensed Block Vote (on 2nd reading)

Yes: 40 • No: 0

Senate vote 2/23/2026

Reported from Commerce and Labor with substitute

Yes: 11 • No: 4

House vote 2/11/2026

Read third time and passed House

Yes: 63 • No: 35

House vote 2/5/2026

Reported from Labor and Commerce with amendment(s)

Yes: 15 • No: 7

House vote 2/3/2026

Subcommittee failed to recommend reporting

Yes: 4 • No: 5 • Other: 1

House vote 2/3/2026

Reconsidered by Labor and Commerce (Voice Vote)

Yes: 0 • No: 0

House vote 2/3/2026

Subcommittee recommends reporting with amendment(s)

Yes: 6 • No: 3 • Other: 1

Actions Timeline

  1. Fiscal Impact Statement from State Corporation Commission (HB625)

    4/13/2026House
  2. Acts of Assembly Chapter text (CHAP0641)

    4/13/2026Governor
  3. Approved by Governor-Chapter 641 (effective 7/1/2026)

    4/13/2026Governor
  4. Governor's Action Deadline 11:59 p.m., April 13, 2026

    3/31/2026Governor
  5. Enrolled Bill communicated to Governor on March 31, 2026

    3/31/2026House
  6. Signed by Speaker

    3/31/2026House
  7. Bill text as passed House and Senate (HB625ER)

    3/30/2026House
  8. Enrolled

    3/30/2026House
  9. Signed by President

    3/30/2026Senate
  10. Conference report agreed to by Senate (39-Y 0-N 0-A)

    3/11/2026Senate
  11. Conference report agreed to by House (63-Y 33-N 0-A)

    3/10/2026House
  12. Conference Report released

    3/10/2026
  13. House Conferees: Henson, Ward, McLaughlin

    3/9/2026House
  14. Conferees appointed by House

    3/9/2026House
  15. Senate Conferees: Perry, Rouse, Stanley

    3/6/2026Senate
  16. Conferees appointed by Senate

    3/6/2026Senate
  17. House acceded to request

    3/5/2026House
  18. Senate insisted on amendment Block Vote (40-Y 0-N 0-A)

    3/4/2026Senate
  19. Fiscal Impact Statement from State Corporation Commission (HB625)

    3/4/2026House
  20. Senate requested conference committee

    3/4/2026Senate
  21. Senate substitute rejected by House (2-Y 97-N 0-A)

    3/2/2026House
  22. Passed Senate with substitute (37-Y 3-N 0-A)

    2/26/2026Senate
  23. Commerce and Labor Substitute agreed to

    2/26/2026Senate
  24. Engrossed by Senate - committee substitute

    2/26/2026Senate
  25. Read third time

    2/26/2026Senate

Bill Text

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