Healthcare

Medical malpractice information disclosures; report. Requires insurers who issue medical malpractice liability insurance polices covering health care providers in the Commonwealth to disclose, for the preceding calendar year, information regarding (i) premiums; (ii) claims activity; (iii) claim payments and litigation costs; and (iv) insurer financial condition. The bill further requires every hospital or health system licensed in the Commonwealth that maintains self-insurance, captive insurance, risk retention arrangements, or other retained financial risk for medical malpractice liability to disclose information regarding (a) the numbers of physicians and health care providers covered under the malpractice liability program; (b) claims activity; (c) malpractice expenditures; and (d) the total malpractice liability expenditures for the reporting year. The bill further requires such insurers, hospitals, and health care systems to provide a list of verdicts during the reporting year in medical malpractice actions in which the jury verdict exceeded the medical malpractice limitation on recovery. The bill provides that such disclosures and information be submitted to the Chairs of the House and Senate Committees for Courts of Justice and to the ranking Delegate and Senator of the minority party serving on such Committees on or before September 1, 2026, for the 2025 calendar year and on or before March 31 of each year thereafter for the preceding calendar year.

Collaborative agreements; practitioners; diagnosis. Removes registered nurses from the list of practitioners whose diagnoses may form the basis of drug therapy conducted pursuant to a collaborative agreement between a practitioner and a pharmacist.

Firefighters Cancer Screening Grant Program and Fund established. Creates the Firefighters Cancer Screening Grant Program and Fund to award grants to localities for costs incurred in providing certain cancer detection tests to firefighters. The bill provides that in any year that the amount of funds in the Firefighters Cancer Screening Fund reduces to zero and the Fund does not receive a separate appropriation, the Grant Program and Fund shall expire.

State pharmacy benefits manager; contractual provisions; report. Requires the Department of Medical Assistance Services' contract with the state pharmacy benefits manager to (i) require that that ingredient-cost reimbursement is based on the national average drug acquisition cost, or if unavailable, the wholesale acquisition cost minus a discount set by the Department, plus a professional dispensing fee, determined by the Department; (ii) require real-time or near real-time transparency in drug costs, rebates collected and paid, dispensing fees paid, administrative fees, and all other charges, fees, costs, and holdbacks, claim denials appeals, and network participation; (iii) prohibit the state pharmacy benefits manager from steering Medicaid recipients to affiliated pharmacies through differential cost-sharing, restrictive network design, or the mandatory use of a mail order pharmacy provider; (iv) require the state pharmacy benefits manager to (a) meet network adequacy standards established by the Department; (b) allow any willing pharmacy to participate in the pharmacy network; (c) verify that all contracted pharmacies are actively accepting Medicaid recipients; (d) submit annual reports containing certain information; (e) disclose to the Department pricing and maximum acquisition cost methodologies; and (f) allow invoice-based or national average drug acquisition cost-based appeals and require an adjustment of rates network-wide when an appeal is upheld; and (v) include enforcement mechanisms and monetary penalties for noncompliance. Additionally, the bill requires Department to annually calculate the savings generated by the use of the state pharmacy benefits manager and to annually increase its dispensing fee by the amount of such savings. The bill requires the Department to annually (1) publish and make available on its website its annual and total savings achieved, the annual and total amount applied to dispensing fees increases, and the updated dispensing fees and (2) report to the General Assembly on the state pharmacy benefits manager's compliance, national average drug acquisition cost compliance, pharmacy reimbursement trends, network adequacy compliance, and dispensing fee sufficiency.