2025 SESSION
INTRODUCED
25102445D
HOUSE BILL NO. 1670
Offered January 8, 2025
Prefiled January 3, 2025
A BILL to amend the Code of Virginia by adding a section numbered 38.2-3407.15:8, relating to health insurance; cost-sharing for epinephrine injectors.
PatronJones
Committee Referral Pending
Be it enacted by the General Assembly of Virginia:
1. That the Code of Virginia is amended by adding a section numbered 38.2-3407.15:8 as follows:
38.2-3407.15:8. Limit on cost-sharing payments for epinephrine injectors.
A. As used in this section:
"Carrier" has the same meaning ascribed thereto in subsection A of 38.2-3407.15.
"Cost-sharing payment" means the total amount a covered person is required to pay at the point of sale in order to receive a prescription drug or device that is covered under the covered person's health plan.
"Covered person" means a policyholder, subscriber, participant, or other individual covered by a health plan.
"Health plan" means any health benefit plan, as defined in 38.2-3438, that provides coverage for epinephrine injectors.
"Pharmacy benefits manager" means an entity that engages in the administration or management of prescription drug benefits provided by a carrier for the benefit of its covered persons.
"Provider contract" has the same meaning ascribed thereto in subsection A of 38.2-3407.15.
B. Every health plan offered by a carrier shall set the cost-sharing payment that a covered person is required to pay for a two-pack of covered epinephrine injectors at an amount not to exceed $60, regardless of the type of epinephrine injector.
C. Nothing in this section shall prevent a carrier from setting a covered person's cost-sharing payment for a two-pack of covered epinephrine injectors at an amount that is less than the maximum amount permitted pursuant to subsection B.
D. No provider contract between a carrier or its pharmacy benefits manager and a pharmacy or its contracting agent shall contain a provision (i) authorizing the carrier's pharmacy benefits manager or the pharmacy to charge, (ii) requiring the pharmacy to collect, or (iii) requiring a covered person to make a cost-sharing payment for a covered pack of epinephrine injectors in an amount that exceeds the amount of cost-sharing payment for the covered pack of epinephrine injectors established by the carrier pursuant to subsection B.
E. This section shall apply with respect to health plans and provider contracts entered into, amended, extended, or renewed on or after January 1, 2026.