Virginia House Bill HB1782

Virginia 2023 Regular Session

• Introduced: 1/10/23
• Refer: 1/10/23

Caption

Health insurance; ensuring fairness in cost-sharing.

Impact

The impact of HB1782 extends to state regulations concerning pharmacy benefits managers and health carriers. If enacted, it will require carriers and PBMs to offer the option of extending point-of-sale rebates to enrollees transparently. This change aims to enhance cost transparency and reduce out-of-pocket expenses for individuals reliant on prescription drugs. Additionally, by ensuring that a greater share of rebates is passed directly to consumers, the bill seeks to alleviate some financial burdens and promote higher-value health care services for Virginians.

Summary

House Bill 1782 addresses the issue of fairness in cost-sharing related to health insurance and prescription drug coverage. It proposes significant amendments to existing Virginia laws regarding the calculation of an enrollee's cost-sharing for prescription drugs. Specifically, the bill mandates that the defined cost-sharing for each prescription drug must be calculated at the point of sale based on a price that is reduced by at least 80% of all rebates received or anticipated from the dispensing or administration of the drug. This is aimed at ensuring that enrollees benefit directly from the rebates negotiated by pharmacy benefits managers (PBMs).

Conclusion

Overall, HB1782 seeks to amend the landscape of health insurance relating to prescription drugs in Virginia, with the aim of promoting fairness in cost-sharing for enrollees. The bill is expected to engage various stakeholders from health care sectors and consumer advocacy groups, potentially igniting discussions on the balance between consumer protections and the operational realities of health plan management.

Contention

While supporters may argue that HB1782 is a step towards consumer protection and fairness, potential points of contention include concerns from pharmacy benefits managers and health carriers about the feasibility and implications of mandated rebate distributions. Critics may suggest that this could lead to increased costs for PBMs and disrupt existing pricing models. Furthermore, the confidentiality provisions stipulated in the bill regarding rebate information may raise concerns among stakeholders about transparency and accountability in pharmacy benefit management.