VirginiaSB1612026 Regular SessionSenateWALLET

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

Sponsored By: Russet Perry (Democratic)

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 HB 625.

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Bill Overview

Analyzed Economic Effects

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

Insurers must offer capped-cost plans

Beginning January 1, 2028, insurers that sell individual or small-group coverage must offer at least one plan per metal level with the drug caps in every rating area. These plans are clearly named and marketed like other plans so you can find them. They do not count against any plan-option limits.

Lower drug costs in individual and small-group plans

Beginning January 1, 2028, some individual and small-group plans cap what you pay at the pharmacy for a 30-day supply. Caps are: platinum $150, gold $200, silver $250, bronze $300. The cap applies each time you fill a 30-day supply, before and after any deductible. These caps apply only in plans that meet the law.

HSA plans keep status, caps delayed

If applying the drug caps would make a plan lose HSA-qualified high-deductible status, the caps start only after you meet the federal minimum deductible. This preserves your ability to use an HSA. This rule applies starting January 1, 2028.

Sponsors & Cosponsors

Sponsor

  • Russet Perry

    Democratic • Senate

Cosponsors

There are no cosponsors for this bill.

Roll Call Votes

All Roll Calls

Yes: 302 • No: 125

House vote 3/10/2026

Conference report agreed to by House

Yes: 63 • No: 33

Senate vote 3/9/2026

Conference report agreed to by Senate

Yes: 38 • No: 2

Senate vote 3/3/2026

Senate acceded to request Block Vote

Yes: 40 • No: 0

Senate vote 2/26/2026

House substitute rejected by Senate

Yes: 0 • No: 40

House vote 2/24/2026

Passed House with substitute

Yes: 64 • No: 34

House vote 2/19/2026

Reported from Labor and Commerce with substitute

Yes: 14 • No: 6

Senate vote 2/6/2026

Read third time and passed Senate

Yes: 34 • No: 6

Senate vote 2/5/2026

Commerce and Labor Amendment agreed to

Yes: 0 • No: 0

Senate vote 2/4/2026

Constitutional reading dispensed Block Vote (on 1st reading)

Yes: 40 • No: 0

Senate vote 2/4/2026

Passed by for the day Block Vote (Voice Vote)

Yes: 0 • No: 0

Senate vote 2/2/2026

Reported from Commerce and Labor with amendment

Yes: 9 • No: 4

Actions Timeline

  1. Acts of Assembly Chapter text (CHAP0642)

    4/13/2026Governor
  2. Approved by Governor-Chapter 642 (effective 7/1/2026)

    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

    3/31/2026Senate
  5. Signed by Speaker

    3/31/2026House
  6. Bill text as passed Senate and House (SB161ER)

    3/30/2026Senate
  7. Enrolled

    3/30/2026Senate
  8. Signed by President

    3/30/2026Senate
  9. Conference report agreed to by House (63-Y 33-N 0-A)

    3/10/2026House
  10. Conference report agreed to by Senate (38-Y 2-N 0-A)

    3/9/2026Senate
  11. Conference Report released

    3/6/2026
  12. House Conferees: Henson, Ward, McLaughlin

    3/5/2026House
  13. Conferees appointed by House

    3/5/2026House
  14. Fiscal Impact Statement from State Corporation Commission (SB161)

    3/3/2026Senate
  15. Senate acceded to request Block Vote (40-Y 0-N 0-A)

    3/3/2026Senate
  16. Senate Conferees: Perry, Rouse, Stanley

    3/3/2026Senate
  17. Conferees appointed by Senate

    3/3/2026Senate
  18. House requested conference committee

    2/27/2026House
  19. House insisted on substitute

    2/27/2026House
  20. House substitute rejected by Senate (0-Y 40-N 0-A)

    2/26/2026Senate
  21. Passed House with substitute (64-Y 34-N 0-A)

    2/24/2026House
  22. Engrossed by House - committee substitute

    2/24/2026House
  23. committee substitute agreed to

    2/24/2026House
  24. Read third time

    2/24/2026House
  25. Read second time

    2/23/2026House

Bill Text

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