VirginiaHB8302026 Regular SessionHouseWALLET

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

Sponsored By: Katrina Callsen (Democratic)

Signed by Governor

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

8 provisions identified: 7 benefits, 1 costs, 0 mixed.

Stronger protections for patients choosing pharmacies

Beginning July 1, 2027, insurers and drug benefit managers cannot interfere with covered patients’ pharmacy or provider choices based on protected status. This includes status as a manager’s affiliate, covered entity, or contract pharmacy. They cannot block pharmacy network participation based on accreditation or certification standards that the pharmacist meets. Insurers cannot count mail-order pharmacies or manager affiliates when checking whether a network has enough pharmacies. Insurers, managers, and their representatives also cannot cause or knowingly allow false ads, promotions, statements, or offers.

Pharmacy protections cover state employee plans

Beginning July 1, 2027, Virginia’s pharmacy benefit manager rules apply to claims under the state employee health plan. Participants and beneficiaries receive the article’s protections for those claims. The law does not specify individual savings.

Equal treatment for discount drug pharmacies

Beginning July 1, 2027, insurers and drug benefit managers cannot impose different terms because of covered-entity or contract-pharmacy status. They also cannot do so because a pharmacy dispenses drugs covered by the 340B discount program. This protection does not cover drugs with an estimated annual cost above $250,000 per patient. Insurers and managers may still identify a 340B reimbursement request.

Fairer payments and fees for pharmacies

Beginning July 1, 2027, insurers and drug benefit managers cannot charge pharmacies claim-processing fees except reasonable initial submission fees. Electronic claim-processing fees are banned. Pharmacies cannot receive less than a manager’s affiliate for the same services. Payments are compared per unit using the same generic product identifier or code, including rebates, fees, costs, and other payments. Pharmacies also gain protection against retaliation for using their legal rights. Banned retaliation includes ending or refusing to renew contracts, increasing audits without cause, or delaying money owed.

Stronger payment protections for pharmacy claims

Beginning July 1, 2027, insurers and drug benefit managers cannot reduce pharmacy payments unless the provider agreement allows the reduction. Reversing and resubmitting a claim requires prior written notice and either just cause or an attempt to settle the issue first. They must act within one year after the claim was first approved. Later denials or reductions are allowed only for fraudulent claims, services already paid for, or services not properly provided. Ending a contract does not cancel payment owed for approved claims to a pharmacy that is not a manager affiliate. Payment may still be withheld in connection with an insurance-fraud investigation.

New pricing rules for prescription benefits

Beginning July 1, 2027, Virginia insurers must use pass-through pricing and cannot use spread pricing, directly or through drug benefit managers. When a plan sponsor asks, insurers must offer a contract limiting manager income to service fees listed in the agreement. When a contract assigns rebate negotiations to a manager or affiliate, it must pass on 100% of manufacturer rebates received. Rebates go to the health plan for cost-sharing or premium offsets, or to patients to lower cost-sharing at the pharmacy. The law does not set a household savings amount.

State reviews drug managers’ pay practices

Beginning July 1, 2027, covered drug benefit manager compensation arrangements must be open to Virginia State Corporation Commission inspection. Confidentiality protections apply to that review. The Commission also must study practices that require or encourage covered patients to use manager affiliates. It must report findings and recommendations to the General Assembly by December 1, 2027.

Some health plans exclude pharmacy protections

Beginning July 1, 2027, the pharmacy benefit manager article does not apply to Children’s Health Insurance Program claims. Medicaid, Medicare Part D, and self-funded arrangements governed by federal ERISA law are also outside its scope. These exclusions do not establish a cost increase or a change in pharmacy access.

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

Subcommittee recommends reporting with substitute

Yes: 7 • No: 0

House vote • 2/13/2026

Reported from Appropriations with substitute

Yes: 22 • No: 0

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

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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