Virginia 2023 Regular Session

Virginia House Bill HB560

Introduced
1/11/22  

Caption

Health insurance; retail community pharmacies.

Impact

The implications of HB 560 on state law primarily concern the relationship between pharmacy benefits managers (PBMs) and retail pharmacies. The bill requires PBMs to treat retail pharmacies more equitably in terms of reimbursement and prohibiting differential treatment in cost-sharing arrangements. This change is expected to foster a more competitive environment within the pharmaceutical supply chain, ultimately benefiting consumers by ensuring they have better access to their necessary medications through local pharmacies.

Summary

House Bill 560 focuses on health insurance regulations concerning retail community pharmacies. The bill aims to enhance the accessibility of prescriptions by ensuring that covered individuals can fill their mail order prescriptions at any in-network retail pharmacy, given that the pharmacy agrees to accept the same reimbursement rates as mail-order pharmacies. This effort is intended to promote greater consumer choice and streamline access to medications, while reducing potential out-of-pocket costs for patients.

Contention

Despite its consumer-friendly intentions, HB 560 has sparked debates among stakeholders, particularly between retail pharmacies and PBMs. Supporters of the bill argue that it empowers consumers and fosters local business viability, while some may view it as an attempt to impose additional regulations on PBMs which they believe could lead to higher costs for health plans. The bill's provisions prevent PBMs from retaining excessive profits from rebates linked to mail-order pharmacy transactions, which some PBMs argue could create financial strain in their services and business models.

Companion Bills

VA HB560

Carry Over Health insurance; retail community pharmacies.

Previously Filed As

VA HB560

Health insurance; retail community pharmacies.

VA HB943

Health insurance; retail community pharmacies.

VA HB943

Health insurance; retail community pharmacies.

VA SB1338

Health insurance; pharmacy benefits managers, employee welfare benefit plans.

VA HB2491

Health insurance; pharmacy benefits managers, employee welfare benefit plans.

VA HB1162

Health insurance; discrimination prohibited against covered entities and contract pharmacies.

VA HB1782

Health insurance; ensuring fairness in cost-sharing.

VA SB1425

Health insurance; ensuring fairness in cost-sharing.

VA SB1078

Health insurance; cost-sharing, pharmacy benefits managers, compensation and duties, civil penalty.

VA HB2773

Health insurance; cost-sharing, pharmacy benefits managers, compensation and duties, civil penalty.

Similar Bills

CA AB913

Pharmacy benefit managers.

CA SB362

Chain community pharmacies: quotas.

LA HB432

Provides for the regulation of pharmacy services administrative organizations (OR +$88,000 SG EX See Note)

MS HB1125

Pharmacy services; prohibit insurers and PBMs from requiring persons to obtain exclusively through pharmacies that they own.

LA HB387

Provides for the regulation of pharmacy services administrative organizations

CA AB401

Pharmacy: remote dispensing site pharmacy: telepharmacy: shared clinic office space.

CA AB690

Pharmacies: relocation: remote dispensing site pharmacy: pharmacy technician: qualifications.

MS HB1119

Pharmacy benefit managers; revise provisions related to.