Virginia 2022 Regular Session

Virginia House Bill HB560

Introduced

1/11/22

Refer

1/11/22

Caption

Health insurance; retail community pharmacies.

Impact

The implementation of HB 560 is expected to have significant effects on the pharmaceutical and health insurance landscape in Virginia. By mandating carriers to uphold fair reimbursement practices, the bill seeks to diminish the discrepancies that often disadvantage community pharmacies compared to larger mail order counterparts. This could lead to increased viability for retail pharmacies, which often serve as essential points of contact for healthcare in local communities, helping to maintain competition in the pharmaceutical sector.

Summary

House Bill 560 proposes amendments to the Code of Virginia concerning health insurance and access to retail community pharmacies. The bill seeks to enhance patients' options by allowing individuals to fill prescriptions at both mail order pharmacies and retail community pharmacies, provided that the latter agree to reimbursement rates equivalent to those of mail order pharmacies. This change aims to promote competition and accessibility in healthcare by ensuring that pharmacy benefits managers (PBMs) and carriers cannot impose unfair conditions on patients who prefer using local pharmacies.

Contention

Despite its potential benefits, HB 560 also invites some contention. Critics may argue that the bill could inadvertently exacerbate tension between mail order and retail pharmacies, particularly if reimbursement rates are not standardized effectively across all platforms. Additionally, concerns regarding the administration and enforcement of these new requirements by pharmacy benefit managers could arise, as differences in operational structures may lead to inconsistent implementation across the state. As the discussions around this bill evolve, the balance between patient choice and business interests will remain at the forefront.