RichmondSunlight

HB560

2023 House

HB560

Failed

Health insurance; retail community pharmacies.

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Summary

Health insurance; retail community pharmacies. Requires a carrier to administer its health benefit plans in a manner consistent with certain requirements and to include such requirements in its provider contracts addressing the provision of pharmacy benefits management. The bill provides that (i) a covered individual is permitted to fill any mail order-covered prescription, at the covered individual's option, at any mail order pharmacy or network participating retail community pharmacy under certain conditions; (ii) the carrier or pharmacy benefits manager is prohibited from imposing a differential copayment, additional fee, rebate, bonus, or other condition on any covered individual who elects to fill his prescription at an in-network retail community pharmacy that is not similarly imposed on covered individuals electing to fill a prescription from a mail order pharmacy; and (iii) the pharmacy benefits manager is required to expressly disclose to the carrier in the contract if the pharmacy benefits manager retains all or a greater portion of a drug manufacturer's rebate amount or any additional direct or indirect remuneration from any third party for drugs dispensed through the pharmacy benefits manager-owned mail order pharmacy than the pharmacy benefits manager does for drugs dispensed through a retail community pharmacy. The bill also removes the exemption for a self-insured or self-funded employee welfare benefit plan under provisions regulating pharmacy benefits managers.

Full Text

HOUSE BILL NO. 560
Offered January 12, 2022
Prefiled January 11, 2022
A BILL to amend and reenact § 38.2-3470 of the Code of Virginia and to amend the Code of Virginia by adding a section numbered 38.2-3407.15:7, relating to health insurance; retail community pharmacies; pharmacy benefits managers; employee welfare benefit plans.
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Patrons-- O'Quinn and Wachsmann
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Referred to Committee on Health, Welfare and Institutions
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Be it enacted by the General Assembly of Virginia:

1. That § 38.2-3470 of the Code of Virginia is amended and reenacted and that the Code of Virginia is amended by adding a section numbered 38.2-3407.15:7 as follows:

§ 38.2-3470. Scope of article.

This article shall not apply with respect to claims under coverages issued pursuant to Title XIX of the Social Security Act, 42 U.S.C. § 1396 et seq. (Medicaid) or prescription drug coverages issued pursuant to Part D of Title XVIII of the Social Security Act, 42 U.S.C. § 1395 et seq. (Medicare Part D).

Bill Details

Status
failed committee
Outcome
failed
Introduced
2022-12-12
Patron
Del. Israel O'Quinn (R-Bristol)
Party
R
District
44
Committee
n/a
Copatrons
1
Words
731
Citation
https://www.richmondsunlight.com/bill/2023/hb560/

Status History

status: Left in Health, Welfare and Institutions
translation: failed committee
date: 11/22/2022
date_raw: 2022-11-22
lis_vote_id: H12V0008
vote_count:
status: Continued to 2023 in Health, Welfare and Institutions
translation:
date: 02/10/2022
date_raw: 2022-02-10
lis_vote_id: H12C0085
vote_count:
status: Subcommittee recommends continuing to 2023
translation:
date: 02/08/2022
date_raw: 2022-02-08
lis_vote_id: H1203C0035
vote_count:
status: Assigned HWI sub: Subcommittee #3
translation: in subcommittee
date: 01/26/2022
date_raw: 2022-01-26
lis_vote_id:
vote_count:
status: Referred to Committee on Health, Welfare and Institutions
translation: in committee
date: 01/11/2022
date_raw: 2022-01-11
lis_vote_id:
vote_count:
status: Prefiled and ordered printed; offered 01/12/22 22101659D
translation: introduced
date: 01/11/2022
date_raw: 2022-01-11
lis_vote_id:
vote_count:

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]