VirginiaSB6692026 Regular SessionSenateWALLET

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

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

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Bill Overview

Analyzed Economic Effects

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

Transparent drug pricing and full rebates

Beginning July 1, 2027, carriers and PBMs must use pass‑through pricing and cannot use spread pricing. If your employer or plan sponsor asks, they must offer a fee‑only PBM contract with clear, listed fees. When a PBM negotiates drug rebates, 100% of each rebate must go to the plan to lower premiums or cost‑sharing, or to you at the counter. The State Corporation Commission can inspect these compensation agreements under confidentiality rules. Carriers remain responsible for following these rules even when they use a PBM.

Fair pay and billing for pharmacies

Beginning July 1, 2027, carriers and PBMs cannot charge claim fees beyond one reasonable fee for the first submission, and cannot charge to process a claim electronically. They must pay pharmacies at least what PBM affiliates get for the same drug, counting rebates and fees. They cannot reverse and resubmit a paid claim without written notice, just cause, reconciliation efforts, or after one year. They cannot cut payments later through reconciliations or DIR‑style fees unless the contract clearly allows it, and cannot retro‑deny claims except for fraud, duplicate payment, or services not rendered. Ending a contract does not cancel payment owed on already adjudicated claims, unless money is held for a fraud probe. Carriers and PBMs also cannot retaliate against a pharmacy for using rights under this law.

Who these PBM rules cover

Beginning July 1, 2027, these PBM rules apply to the Virginia state employee health plan. They do not apply to ERISA self‑funded employer plans, Medicaid, Medicare Part D, or CHIP. People in those plans do not get these state PBM protections.

Stronger pharmacy choice and access

Beginning July 1, 2027, plans cannot count mail‑order pharmacies or PBM affiliates when proving network adequacy. Your plan or PBM cannot block your choice of pharmacy because it is a 340B or contract pharmacy. Carriers and PBMs also cannot use untrue ads or offers.

No unfair 340B or accreditation limits

Beginning July 1, 2027, carriers and PBMs cannot treat 340B covered entities or contract pharmacies worse than other pharmacies. This rule does not apply to drugs costing more than $250,000 per patient per year, and plans may require pharmacies to identify 340B claims. If a pharmacist meets accreditation or certification, a plan cannot exclude the pharmacy from the network for accreditation reasons.

Study of PBM steering to affiliates

The State Corporation Commission must examine whether carriers or PBMs steer people to PBM‑affiliated pharmacies. The Commission must report findings and recommendations to the General Assembly by December 1, 2027.

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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