CHAPTER 256
An Act to direct the Bureau of Insurance to study step therapy protocols for health benefit plans; report.
[H 2258]
Approved March 21, 2025
Be it enacted by the General Assembly of Virginia:
1. 1. The Bureau of Insurance of the State Corporation Commission (the Bureau) shall study the step therapy protocols for health benefit plans developed pursuant to 38.2-3407.9:05 of the Code of Virginia by conducting a data call of health carriers that ascertains (i) the aggregate number of step therapy exception requests, acceptances, denials, appeals, and reversals; (ii) the percentages of reversals of step therapy exception request denials; (iii) the time frame for responses, reconsiderations, and final decisions regarding step therapy exception requests; (iv) the number of step therapy protocols that are introduced, revised, or removed each quarter; and (v) data on the specialties of step therapy protocols, such as those used specifically for oncology, rheumatology, ophthalmology, orthopedics, or neurosurgery. The Bureau shall submit an executive summary of the study and a report of its findings and recommendations to the Governor and General Assembly no later than November 1, 2026. The executive summary and report shall be submitted as provided in the procedures of the Division of Legislative Automated Systems for the processing of legislative documents and reports no later than the first day of the 2027 Regular Session of the General Assembly and shall be posted on the General Assembly's website.