VirginiaSB6692026 Regular SessionSenateWALLET

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

Sponsored By: Aaron R. Rouse (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 incorporates SB 410 and SB 413 and is identical to HB 830.

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Bill Overview

Analyzed Economic Effects

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

Drug rebates must lower patient costs

Beginning July 1, 2027, pharmacy benefit managers must pass along 100% of manufacturer rebates received under delegated rebate-negotiation agreements. This also applies when an affiliated company handles the negotiations. Rebates must go to the insurer or health plan for premium and cost-sharing reductions, or directly to patients at checkout. At checkout, rebates reduce deductibles, copayments, coinsurance, or other patient charges. The law sets no dollar amount and does not guarantee every patient a checkout discount.

Stronger rules for pharmacy network access

Beginning July 1, 2027, insurers cannot count mail-order pharmacies or pharmacy benefit manager affiliates when measuring whether networks provide enough access. This applies to access requirements in Virginia law or contracts. Insurers cannot exclude a pharmacy based on accreditation or certification requirements when its pharmacist meets the applicable standards. Network participation restrictions based purely on pharmacy benefit manager affiliation are also prohibited. The law does not set a new minimum network size.

Fairer treatment for discount-program pharmacies

Beginning July 1, 2027, insurers and pharmacy benefit managers cannot impose different terms because providers or contract pharmacies participate in the 340B drug discount program. This includes different payment terms, requirements, or exclusions based on that status or dispensing 340B drugs. The equal-treatment rule does not cover drugs with estimated annual costs above $250,000 per patient. Insurers can still identify reimbursement requests involving 340B drugs. They cannot interfere with a covered patient's choice of pharmacy or provider because of its covered-entity or contract-pharmacy status.

Pharmacy protections cover state employee plans

Beginning July 1, 2027, Virginia's pharmacy benefit management rules apply to claims under the state employee health plan. Members receive the article's applicable pricing, pharmacy choice, and other protections for those claims. The law does not set an individual savings amount.

Clearer pricing rules for pharmacy benefits

Beginning July 1, 2027, Virginia bans spread pricing and false advertising by insurers and their pharmacy benefit managers. Insurers must use pass-through pricing, with that pricing stated in their agreements. When a plan sponsor requests it, insurers must offer at least one contract limiting pharmacy benefit management income to stated service fees. The Virginia State Corporation Commission can inspect compensation arrangements, with confidentiality protections. The Commission must examine insurer and pharmacy benefit manager practices and report findings and recommendations to lawmakers by December 1, 2027.

Limits on pharmacy claim payment disputes

Beginning July 1, 2027, reversing and resubmitting pharmacy claims requires prior written notice and either just cause or an earlier attempt to resolve the claim. This must happen within one year after the claim was first approved. Claims cannot be denied or reduced later except for fraud, prior payment, or services not properly provided. Ending a non-affiliated pharmacy's contract does not erase approved amounts owed, though payments tied to an insurance fraud investigation can be withheld. Insurers and pharmacy benefit managers cannot punish pharmacies for using their legal rights through contract termination, renewal denial, increased audits without cause, or delayed payment.

Stronger payment protections for pharmacies

Beginning July 1, 2027, insurers and their pharmacy benefit managers cannot charge pharmacies claim-review fees beyond a reasonable initial-submission fee. Electronic claim processing fees are banned. Pharmacies cannot receive less per unit than a pharmacy benefit manager pays its affiliate for the same services. That comparison uses the same generic product identifier or code and includes rebates, fees, costs, and other payments. Payment reductions, including adjustments made later, must be authorized by the pharmacy's provider agreement.

Some health plans fall outside protections

Beginning July 1, 2027, Children's Health Insurance Program claims fall outside Virginia's pharmacy benefit management rules. The article also excludes self-insured employer plans governed by federal ERISA law, Medicaid, and Medicare Part D. These exclusions concern the article's protections, not whether people keep their health coverage. The law states no direct cost increase for these households.

Sponsors & Cosponsors

Sponsor

  • Aaron R. Rouse

    Democratic • Senate

Cosponsors

There are no cosponsors for this bill.

Roll Call Votes

All Roll Calls

Yes: 266 • No: 0

Senate vote • 2/27/2026

House substitute agreed to by Senate

Yes: 38 • No: 0

House vote • 2/25/2026

Passed House with substitute

Yes: 98 • No: 0

House vote • 2/19/2026

Reported from Labor and Commerce with substitute

Yes: 20 • No: 0

Senate vote • 2/6/2026

Read third time and passed Senate Block Vote

Yes: 40 • No: 0

Senate vote • 2/5/2026

Commerce and Labor Substitute agreed to

Yes: 0 • No: 0

Senate vote • 2/4/2026

Passed by for the day Block Vote (Voice Vote)

Yes: 0 • No: 0

Senate vote • 2/4/2026

Constitutional reading dispensed Block Vote (on 1st reading)

Yes: 40 • No: 0

Senate vote • 2/3/2026

Reported from Finance and Appropriations

Yes: 15 • No: 0

Senate vote • 1/26/2026

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

Yes: 15 • No: 0

Actions Timeline

  1. Acts of Assembly Chapter text (CHAP0036)

    3/31/2026Governor
  2. Approved by Governor-Chapter 36 (Effective 7/1/2027)

    3/31/2026Governor
  3. Fiscal Impact Statement from State Corporation Commission (SB669)

    3/12/2026Senate
  4. Governor's Action Deadline 11:59 p.m., April 13, 2026

    3/10/2026Governor
  5. Enrolled Bill communicated to Governor on March 10, 2026

    3/10/2026Senate
  6. Bill text as passed Senate and House (SB669ER)

    3/4/2026Senate
  7. Enrolled

    3/4/2026Senate
  8. Signed by President

    3/4/2026Senate
  9. Signed by Speaker

    3/4/2026House
  10. House substitute agreed to by Senate (38-Y 0-N 0-A)

    2/27/2026Senate
  11. Passed House with substitute (98-Y 0-N 0-A)

    2/25/2026House
  12. Engrossed by House - floor substitute

    2/25/2026House
  13. Delegate Callsen Floor substitute agreed to

    2/25/2026House
  14. committee substitute rejected

    2/25/2026House
  15. Read third time

    2/25/2026House
  16. Floor Offered

    2/25/2026House
  17. Floor substitute printed 26108552D-H2 (Callsen)

    2/25/2026House
  18. Passed by for the day

    2/24/2026House
  19. Moved from Uncontested Calendar to Regular Calendar

    2/24/2026House
  20. Read second time

    2/23/2026House
  21. Committee substitute printed 26108250D-H1

    2/19/2026House
  22. Reported from Labor and Commerce with substitute (20-Y 0-N)

    2/19/2026House
  23. Referred to Committee on Labor and Commerce

    2/12/2026House
  24. Read first time

    2/12/2026House
  25. Placed on Calendar

    2/12/2026House

Bill Text

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