VirginiaHB8302026 Regular SessionHouseWALLET

Pharmacy benefits managers; requirements, application of law, report, delayed effective date.

Sponsored By: Katrina Callsen (Democratic)

Became Law

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 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, 2027. Certain provisions of the bill have a delayed effective date of July 1, 2027. This bill is identical to SB 669.

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Bill Overview

Analyzed Economic Effects

6 provisions identified: 5 benefits, 0 costs, 1 mixed.

Stronger payment protections for pharmacies

Starting July 1, 2027, PBMs and insurers must treat independent pharmacies fairly. They cannot pay you less than they pay their own affiliates for the same drug and service, counting rebates and fees. They cannot cut your pay with DIR‑style or “effective rate” reconciliations unless your contract clearly allows it. They cannot charge claim‑adjudication fees beyond a reasonable first submission, and they cannot charge for electronic claims. They cannot retaliate when you assert your rights. They cannot reverse and resubmit claims without written notice, just cause, and an attempt to reconcile, and not more than one year after acceptance. They cannot retroactively deny or cut claims except for fraud, duplicate payment, or services not properly given. If your non‑affiliate contract ends, they still must pay already‑approved claims, unless tied to a fraud investigation. They also cannot block your network spot over accreditation if your pharmacist meets the standard.

Fair 340B rules and patient choice

Starting July 1, 2027, insurers and PBMs cannot treat 340B covered entities or contract pharmacies worse just because of 340B status. They may still identify a 340B claim, and drugs costing over $250,000 per patient per year are not covered by this protection. Plans also cannot limit your pharmacy choice based on a pharmacy being a covered entity or contract pharmacy.

No false ads by insurers or pharmacy benefit managers

Starting July 1, 2027, insurers and PBMs cannot publish ads, offers, or claims that are untrue. This protects patients and pharmacies from misleading statements on coverage, price, or access.

End spread pricing and pass rebates

Starting July 1, 2027, spread pricing is banned. Carriers must use pass‑through pricing, and if a plan sponsor asks, they must offer a contract that limits PBM pay to stated service fees. If a PBM negotiates manufacturer rebates, it must pass 100% to the health plan to lower premiums and cost‑sharing, or to the patient at checkout to lower copays, deductibles, or coinsurance. The State Corporation Commission can inspect these compensation arrangements, with confidentiality protections.

Networks must exclude mail order pharmacies

Starting July 1, 2027, insurers cannot count mail‑order or PBM‑affiliated pharmacies when proving a network has enough access. This makes network checks reflect local, in‑person pharmacy access.

Who these pharmacy rules cover

Starting July 1, 2027, the state employee health plan must follow these PBM and carrier rules. Self‑insured ERISA plans, Medicaid, Medicare Part D, and CHIP are not covered by this law.

Sponsors & Cosponsors

Sponsor

  • Katrina Callsen

    Democratic • House

Cosponsors

There are no cosponsors for this bill.

Roll Call Votes

All Roll Calls

Yes: 363 • No: 0

House vote 3/11/2026

Senate substitute agreed to by House

Yes: 98 • No: 0

Senate vote 3/10/2026

Passed Senate with substitute Block Vote

Yes: 40 • No: 0

Senate vote 3/10/2026

Commerce and Labor Substitute agreed to

Yes: 0 • No: 0

Senate vote 3/9/2026

Passed by for the day Block Vote (Voice Vote)

Yes: 0 • No: 0

Senate vote 3/9/2026

Constitutional reading dispensed Block Vote (on 2nd reading)

Yes: 40 • No: 0

Senate vote 3/6/2026

Reported from Finance and Appropriations

Yes: 14 • No: 0

Senate vote 3/2/2026

Reported from Commerce and Labor with substitute and rereferred to Finance and Appropriations

Yes: 14 • 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 with substitute

Yes: 22 • No: 0

House vote 2/13/2026

Subcommittee recommends reporting with substitute

Yes: 7 • No: 0 • Other: 1

House vote 2/5/2026

Reported from Labor and Commerce with substitute and referred to Appropriations

Yes: 22 • No: 0

House vote 2/3/2026

Subcommittee recommends reporting with substitute and referring to Appropriations

Yes: 9 • No: 0 • Other: 1

Actions Timeline

  1. Acts of Assembly Chapter text (CHAP0678)

    4/13/2026Governor
  2. Approved by Governor-Chapter 678 (Effective 7/1/2027)

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

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

    3/31/2026House
  5. Signed by Speaker

    3/31/2026House
  6. Bill text as passed House and Senate (HB830ER)

    3/30/2026House
  7. Enrolled

    3/30/2026House
  8. Signed by President

    3/30/2026Senate
  9. Fiscal Impact Statement from State Corporation Commission (HB830)

    3/12/2026House
  10. Senate substitute agreed to by House (98-Y 0-N 0-A)

    3/11/2026House
  11. Passed Senate with substitute Block Vote (40-Y 0-N 0-A)

    3/10/2026Senate
  12. Commerce and Labor Substitute agreed to

    3/10/2026Senate
  13. Engrossed by Senate - committee substitute

    3/10/2026Senate
  14. Read third time

    3/10/2026Senate
  15. Passed by for the day Block Vote (Voice Vote)

    3/9/2026Senate
  16. Constitutional reading dispensed Block Vote (on 2nd reading) (40-Y 0-N 0-A)

    3/9/2026Senate
  17. Passed by for the day

    3/9/2026Senate
  18. Rules suspended

    3/9/2026Senate
  19. Reported from Finance and Appropriations (14-Y 0-N)

    3/6/2026Senate
  20. Committee substitute printed 26108906D-S1

    3/3/2026Senate
  21. Reported from Commerce and Labor with substitute and rereferred to Finance and Appropriations (14-Y 0-N)

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

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

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

    2/17/2026House
  25. Engrossed by House - committee substitute

    2/16/2026House

Bill Text

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