VirginiaHB7362026 Regular SessionHouseWALLET

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

Sponsored By: Michelle Lopes Maldonado (Democratic)

Became Law

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

5 provisions identified: 3 benefits, 1 costs, 1 mixed.

Some plans are exempt from protections

Beginning January 1, 2027, these prior authorization protections do not apply to Medicare, Medicaid, CHIP, federal employee plans, TRICARE, many supplemental or specialty plans, workers’ compensation, dental and vision plans, and some HMOs that meet strict conditions (including processing at least 85% of drug approvals interoperably). If you are in these plans, these rules do not apply. The Commission cannot decide individual disputes under this section; you must use other legal or administrative paths.

Easier access to mental health and addiction meds

Beginning January 1, 2027, at least one covered medication for substance use disorder is available without prior authorization if the dose follows FDA limits and the prescription follows Board of Medicine rules. For mental health drugs listed in the DSM, no new approval is required if the drug is covered, the dose follows FDA limits, it has been prescribed for at least three months, and the prescriber reviews it yearly. If you already have approval and the plan later drops the drug from the formulary, the approval still stands when those conditions are met. Plans may still require approval for drugs that were not on the formulary at the first prescription.

Faster, clearer drug prior authorizations

Beginning January 1, 2027, insurers must accept prior authorization requests by phone, fax, and from e‑prescribing/EHR systems that use the NCPDP SCRIPT standard. Urgent requests get a response within 24 hours (including weekends). Fully completed requests get a response in two business days; properly completed supplements also get a decision in two business days. Denials must state the reasons within the same time limits. Insurers must use a tracking system and share the tracking ID with the prescriber. They must post the drug formulary, which drugs need approval, the approval steps, and forms in one place online and update it within seven days of approved changes. If extra health‑record information is needed, the insurer must name the exact records. These rules apply to contracts dated January 1, 2016 or later.

Keep approved prescriptions through plan changes

Beginning January 1, 2027, an approved prior authorization lasts at least six months for an initial approval and at least 12 months for a continued approval. Insurers cannot revoke or change an approval during that time unless there is fraud, new FDA or manufacturer safety actions, needed safety monitoring, harmful drug interactions, or when a generic or biosimilar is added. If you switch plans within the same insurer, your approval stays valid when the new plan covers the drug. If you move to a new insurer, the new plan must honor a prior approval from your last plan for at least the first 90 days when your prescriber sends proof. If a non‑opioid drug dose changes within FDA labeling, the prior authorization still stands.

Real-time drug costs and online approvals

By July 1, 2025, insurers must run an online prior authorization system that links to e‑prescribing and EHRs, accepts electronic requests, can auto‑approve simple requests, and shows your real‑time out‑of‑pocket price and lower‑cost options. Insurers cannot charge providers to use it and cannot access provider data beyond enrollee information without consent. By July 1, 2024, insurers must post contact information for any third‑party vendor they use. By July 1, 2025, participating providers must enable their e‑prescribing/EHR systems to use the insurer’s online approvals and real‑time benefits at prescribing; a temporary hardship waiver is available.

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

Passed by for the day Block Vote (Voice Vote)

Yes: 0 • No: 0

Senate vote 3/4/2026

Constitutional reading dispensed Block Vote (on 2nd reading)

Yes: 39 • 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 • Other: 1

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 • Other: 1

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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