VirginiaHB7362026 Regular SessionHouseWALLET

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

Sponsored By: Michelle Lopes Maldonado (Democratic)

Signed by Governor

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.

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Bill Overview

Analyzed Economic Effects

6 provisions identified: 6 benefits, 0 costs, 0 mixed.

Drug approvals follow patients switching insurers

For covered Virginia provider contracts entered into, changed, or renewed beginning January 1, 2027, new insurers must honor prior drug approvals. This protection lasts at least the first 90 days of prescription drug coverage under the new plan. The prescriber or their designee must provide the prior approval record or written or electronic proof of previous coverage. The new plan’s coverage terms still apply. Exceptions include fraud, availability changes, required safety monitoring, harmful drug interactions, and adding a generic or biosimilar to the drug list.

Easier medicine access for addiction treatment

For covered Virginia provider contracts entered into, changed, or renewed beginning January 1, 2027, insurers must remove an addiction-treatment approval barrier. At least one covered drug for medication-assisted substance use treatment must not require prior approval. The prescribed dose must stay within FDA-labeled limits. Prescribing must also follow Board of Medicine rules. This does not remove approval requirements for every addiction-treatment medicine.

Faster drug approval answers for patients

These Virginia rules apply to provider contracts entered into, changed, or renewed on or after January 1, 2027. Insurers must answer urgent drug approval requests within 24 hours, including weekends, when submitted by phone or another insurer-directed method. Completed standard requests get an approval, denial, or request for more information within two business days. After receiving completed extra information, insurers must approve or deny within two business days. Denials must explain why, and responses must include tracking information. Insurers must accept phone, fax, and electronic requests, using NCPDP SCRIPT standards for prescribing, health-record, and health-information exchange systems. Requests for extra information must identify information required by the form and needed for the decision. Insurers must post drug lists, approval requirements, procedures, and forms together online and update them within seven days of approved changes. These rules exclude Medicare, Medicaid, CHIP, federal employee plans, TRICARE and its supplements, Medicare supplements, workers’ compensation, dental, and optometric plans. They also exclude accident-only, credit, disability, long-term care coverage, and HMOs meeting specified system-linking and internal-processing requirements. The Virginia Commission cannot decide individual disputes under this section.

Fewer repeat approvals for mental health medicines

For covered Virginia provider contracts entered into, changed, or renewed beginning January 1, 2027, qualifying mental health medicines need no repeat approval. The drug must have prior insurer approval and at least three months of continuous prescribing. It must remain covered and stay within FDA-labeled doses. The treated disorder must appear in the latest Diagnostic and Statistical Manual of Mental Disorders. Each year, the prescriber must review effectiveness, health changes, and reasons the medicine may be unsafe. Insurers can still require initial approval for a medicine outside their drug list.

Longer lasting drug approvals for patients

For covered Virginia provider contracts entered into, changed, or renewed beginning January 1, 2027, initial drug approvals last at least six months. Continued approvals last at least 12 months when the drug is scheduled, provided, or delivered as approved. Insurers generally cannot cancel, shorten, or add restrictions during that period. Exceptions cover fraud or misrepresentation, regulatory or manufacturer actions changing availability, required safety monitoring, harmful drug interactions, and adding a generic or biosimilar to the drug list. Existing approvals also continue after non-opioid dosage changes within FDA-labeled limits. They continue after switching plans with the same insurer when the new plan covers the drug. Protection after removal from the drug list is subject to the law’s ongoing mental health treatment rules: covered treatment, FDA-labeled doses, at least three months of continuous prescribing, and annual prescriber review. These protections do not require benefits outside the plan’s coverage or drugs scheduled or delivered after coverage ends.

Patients get real-time prescription cost information

Beginning July 1, 2025, covered insurers must maintain online drug approval systems linked to compatible prescribing and electronic health-record systems. These links must use NCPDP SCRIPT and Real Time Benefit standards. Systems must approve requests meeting insurer criteria when no extra information or clinical review is needed. They must show real-time patient costs, including copayments and deductibles, and lower-cost covered medicine choices when prescribing. Participating providers must make their systems able to access these tools; regulators can grant hardship waivers for a set period. Insurers cannot charge providers for access or access provider data without consent, except data about the enrollee. The law sets July 1, 2024, as the deadline for requested vendor contact details, provided to providers or posted online. The amended contract rules apply to contracts entered into, changed, or renewed on or after January 1, 2027.

Sponsors & Cosponsors

Sponsor

  • Michelle Lopes Maldonado

    Democratic • House

Cosponsors

There are no cosponsors for this bill.

Roll Call Votes

All Roll Calls

Yes: 248 • No: 0

Senate vote • 3/5/2026

Passed Senate Block Vote

Yes: 39 • No: 0

Senate vote • 3/4/2026

Constitutional reading dispensed Block Vote (on 2nd reading)

Yes: 39 • No: 0

Senate vote • 3/4/2026

Passed by for the day Block Vote (Voice Vote)

Yes: 0 • No: 0

Senate vote • 3/2/2026

Reported from Commerce and Labor

Yes: 13 • No: 0

House vote • 2/17/2026

Read third time and passed House Block Vote

Yes: 97 • No: 0

House vote • 2/13/2026

Reported from Appropriations

Yes: 22 • No: 0

House vote • 2/13/2026

Subcommittee recommends reporting

Yes: 7 • No: 0

House vote • 2/5/2026

Reported from Labor and Commerce with amendment(s) and referred to Appropriations

Yes: 22 • No: 0

House vote • 2/3/2026

Subcommittee recommends reporting with amendment(s) and referring to Appropriations

Yes: 9 • No: 0

Actions Timeline

  1. Acts of Assembly Chapter text (CHAP0213)

    4/6/2026Governor
  2. Approved by Governor-Chapter 213 (effective 7/1/2026)

    4/6/2026Governor
  3. Governor's Action Deadline 11:59 p.m., April 13, 2026

    3/14/2026Governor
  4. Enrolled Bill communicated to Governor on March 14, 2026

    3/14/2026House
  5. Bill text as passed House and Senate (HB736ER)

    3/12/2026House
  6. Enrolled

    3/12/2026House
  7. Fiscal Impact Statement from Department of Planning and Budget (HB736)

    3/12/2026House
  8. Signed by President

    3/12/2026Senate
  9. Signed by Speaker

    3/12/2026House
  10. Passed Senate Block Vote (39-Y 0-N 0-A)

    3/5/2026Senate
  11. Read third time

    3/5/2026Senate
  12. Passed by for the day Block Vote (Voice Vote)

    3/4/2026Senate
  13. Constitutional reading dispensed Block Vote (on 2nd reading) (39-Y 0-N 0-A)

    3/4/2026Senate
  14. Rules suspended

    3/4/2026Senate
  15. Reported from Commerce and Labor (13-Y 0-N)

    3/2/2026Senate
  16. Referred to Committee on Commerce and Labor

    2/18/2026Senate
  17. Constitutional reading dispensed (on 1st reading)

    2/18/2026Senate
  18. Read third time and passed House Block Vote (97-Y 0-N 0-A)

    2/17/2026House
  19. Fiscal Impact Statement from Department of Planning and Budget (HB736)

    2/17/2026House
  20. Engrossed by House as amended

    2/16/2026House
  21. committee amendments agreed to

    2/16/2026House
  22. Read second time

    2/16/2026House
  23. Read first time

    2/15/2026House
  24. Subcommittee recommends reporting (7-Y 0-N)

    2/13/2026House
  25. Reported from Appropriations (22-Y 0-N)

    2/13/2026House

Bill Text

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