Healthcare

Health insurance; prohibited restrictions on in-network referrals. Prohibits a health insurance carrier from prohibiting an in-network provider, as defined in the bill, from referring any enrollee or specimen to any in-network clinical laboratory or in-network pathology service provider under the terms of such insurance unless such referral would constitute a violation of certain laws. This bill is identical to SB 745.

Therapeutic interchange and adaptation. Authorizes pharmacists to perform therapeutic interchanges by substituting a drug with another drug in the same therapeutic class when such substitution lowers the cost or is cost-neutral to the patient or the prescribed drug is in a drug shortage and the substitution conforms to Board of Pharmacy regulations. The bill directs the Board of Pharmacy to determine which therapeutic classes of drugs shall be eligible for therapeutic interchange and which classes shall be prohibited. The bill also authorizes pharmacists to adapt prescriptions by changing the dosage form or quantity of a medication or by completing missing information on a prescription when there is evidence to support such change.

Medicare supplement policies; regulations establishing minimum standards; work group; report. Amends provisions related to the State Corporation Commission's issuance of regulations to establish minimum standards regarding Medicare supplement policies to include minimum standards for the disclosure of methodology used in coverage decisions. The bill directs the Bureau of Insurance to convene a work group to review and make recommendations related to minimum standards regarding Medicare supplement policies, implementation of risk adjustment mechanisms, ways to eliminate waste and abuse from overpayments, methodologies used in coverage decisions, ways to improve care under such policies, and the effectiveness and utilization of existing consumer protections related to Medicare supplement policies and to submit a report of its findings and recommendations by December 1, 2026.

Sickle Cell Coordinated Access Network established. Directs the State Health Commissioner, in coordination with the Virginia Commonwealth University Health Systems Authority, to establish and maintain the Sickle Cell Coordinated Access Network to provide health care providers in the Commonwealth with real-time consultation and support from sickle cell specialists. The bill has a delayed effective date of July 1, 2027. This bill is identical to HB 1391.

Medical cannabis; administration to terminally ill patients; report. Directs the Department of Health to promulgate regulations specifying that hospital staff may store, dispense, and administer cannabis oil when a patient has valid certification and exempts such staff from criminal penalties for possession of cannabis oil. The bill directs the Department of Health to convene a work group to discuss the implementation process for providing cannabis products to patients in medical care facilities and report on its discussion to the Chairs of the House Committee on Health and Human Services and the Senate Committee on Education and Health by November 1, 2026. This bill incorporates HB 486. This bill is identical to SB 332.

Workers' compensation; employer's offset in event of recovery. Amends provisions related to an employer's offset for recovery in certain actions brought under the Virginia Workers' Compensation Act. The bill requires that lifetime medical award benefits and ongoing indemnity award benefits shall remain in full force and effect if the claimant is under such an award at the time that recovery is effected, subject to the employer offset provisions. Under the bill, an employer's credit shall be applied as a continuing, pro rata reduction to benefits otherwise payable under an existing award until the employer's required credit is exhausted. The bill also removes language limiting an employee's entitlement to compensation and expenses for medical, surgical, and hospital attention and funeral expenses.

Medical cannabis program; product labels; delivery. Changes the requirements for what is included on medical cannabis product labels affixed by pharmaceutical processors to include (i) the total milligrams of tetrahydrocannabinol (THC) and cannabidiol (CBD) included in the edible cannabis product or topical cannabis product, both defined in the bill; (ii) the number of milligrams of THC and CBD in each serving of the edible cannabis product or topical cannabis product; and (iii) the total percentage of THC and CBD included in the inhalable cannabis product, defined in the bill. Under current law, the product label of any medical cannabis product is required to include the total percentage and milligrams of THC and CBD included in the product and the number of milligrams of THC and CBD in each serving.The bill also allows a pharmaceutical processor or cannabis dispensing facility to dispense or deliver cannabis products in person to a patient or such patient's registered agent, parent, or legal guardian at any residence, including a temporary residence or business. However, the bill prohibits dispensing or delivering cannabis products to (a) any military base, child day center, school, or correctional facility; (b) the State Capitol; or (c) any public gathering places, including sporting events, festivals, fairs, races, concerts, and terminals of public transportation companies. The bill also specifies that all transportation or delivery of usable cannabis, botanical cannabis, cannabis oil, or cannabis products, whether by an employee or delivery agent, shall comply with all relevant laws and regulations and provides that the Board of Directors of the Virginia Cannabis Control Authority may suspend or revoke the privileges of any employee or delivery agent to transport or deliver such products for failure to comply. The bill also provides that the 12-month stability testing period for medical cannabis products begins on the date the cannabis product is tested, rather than the date of product registration approval and that any medical cannabis product with an expiration date exceeding 12 months shall be supported by stability testing measured from the testing date, rather than the date of product registration approval. The bill contains technical amendments.

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 is identical to SB 669.

Commissioner of Health; feasibility of a statewide maternal health safety initiative; work group; reports. Directs the Commissioner of Health to convene a work group of relevant stakeholders, described in the bill, to evaluate the feasibility of a statewide maternal health safety initiative. The bill directs the Commissioner to submit an interim report of the work group by November 1, 2026, and a final report with the work group's recommendations no later than July 1, 2027, to the House Committee on Health and Human Services, the Senate Committee on Education and Health, and the Commission on Women's Health.

Health insurance; ethics and fairness in carrier business practices; downcoded claims. Prohibits a carrier, intermediary, administrator, or representative of a carrier from downcoding a claim unless the decision to downcode is determined by a person or electronic system that reflects correct coding standards and considers all relevant patient data from the billing provider in making the determination. The bill requires a carrier, intermediary, administrator, or representative that downcodes a claim to provide certain notice to the provider. The bill requires that all downcoding dispute decisions are reviewed and adjudicated by a natural person.