SB 1359 Virginia Senate · 2025 Regular Session

Health carriers and pharmacy benefits managers; prohibited conduct, civil penalty.

Summary

Prohibited conduct by health carriers and pharmacy benefits managers; civil penalty; enforcement. Prohibits any carrier, pharmacy benefits manager, or representative of a pharmacy benefits manager from (i) requiring that a covered individual purchase pharmacy services exclusively through a mail-order pharmacy or retail pharmacy affiliated with a pharmacy benefits manager or (ii) prohibiting or limiting a covered individual from selecting a pharmacy or pharmacist of his choice that has agreed to participate in the health benefit plan according to the terms of the plan. The bill adds a civil penalty of $5,000 for a violation of prohibited conduct by health carriers and pharmacy benefits managers and adds that the State Corporation Commission has authority to investigate any such violations.

Issues: ✓ Healthcare

Bill status died 1 of 4 stages cleared

Introduction

Jan 2025

Committee Review

Floor Vote

Governor

Introduced Jan 13, 2025 Last action Jan 27, 2025

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What changed between versions

Introduced → Commerce and Labor Substitute · 5 edits

MODERATE

The bill was amended from an original version that modified existing sections to a substitute version that adds a completely new section (38.2-3407.7:1) to the Code of Virginia. The new section establishes specific requirements for health carriers regarding access to retail community pharmacies, including provisions about prescription filling options, copayment consistency, and rebate disclosure between pharmacy benefits managers and carriers.

Scope change

The bill's scope changed from amending existing sections 38.2-3467 and 38.2-3469 to adding a new section 38.2-3407.7:1, which shifts the focus from prohibited conduct to specific operational requirements for pharmacy access.

REQUIREMENT

Added new section 38.2-3407.7:1 requiring carriers to allow covered individuals to fill prescriptions at retail community pharmacies if those pharmacies agree to accept reimbursement at rates equivalent to mail order pharmacies.

Added requirement that pharmacy benefits managers or carriers cannot impose differential copayments, fees, rebates, or bonuses on individuals who choose retail community pharmacies over mail order pharmacies.

Added requirement that pharmacy benefits managers must disclose to carriers if they retain more rebate amounts from drugs dispensed through PBM-owned mail order pharmacies compared to retail community pharmacies.

TIMELINE

New section applies to contracts entered into, amended, extended, or renewed on or after January 1, 2026, establishing a future effective date for these requirements.

SCOPE

Removed the original amendments to sections 38.2-3467 and 38.2-3469 that addressed prohibited conduct by carriers and pharmacy benefits managers.

Floor votes

How they voted

No floor votes recorded yet.

Full legislative history

Actions timeline

Total actions

Key actions

Committee

Jan 27, 2025

Committee

Failed to report (defeated) in Commerce and Labor (5-Y 9-N 1-A)

upper

Jan 13, 2025

Committee

Referred to Committee on Commerce and Labor

upper

1 primary · 1 co-sponsor