Health insurance; cost-sharing, pharmacy benefits managers, compensation and duties, civil penalty.
The proposed legislation will modify existing laws governing PBMs, detailing their obligations towards enrollees and health plans. By enforcing transparency, the bill aims to address issues of spread pricing — a practice where there is a substantial difference between what a PBM charges a health plan and what it reimburses a pharmacy. This could potentially reduce the costs associated with prescription drugs and improve access to medications for consumers throughout Virginia. The bill also stipulates that the Commission will adopt specific regulations to define these obligations and ensure compliance among PBMs.
House Bill 2773 aims to amend sections of the Code of Virginia related to health insurance and pharmacy benefits managers (PBMs). Specifically, it introduces regulations that promote fairness in cost-sharing for prescription drugs, ensuring that enrollees have transparency in the pricing process. The bill mandates that an enrollee’s defined cost-sharing at the point of sale should account for at least 80 percent of all known rebates associated with the drug, thereby reducing the burden on consumers at the point of purchase. Furthermore, the bill seeks to maintain the confidentiality of rebate information as trade secrets, ensuring no public disclosures can compromise competitive pricing strategies.
While supporters of HB2773 argue that it enhances consumer protection and promotes fair pricing practices in the pharmaceutical industry, there may be contention regarding the regulation of established PBMs, which could view the bill as overreach. Some stakeholders could express concerns about how stringent regulations might impact their business models, particularly those relying on rebate structures. Balancing the need for transparency without stifling operational efficiencies will be a key point of discussion as this bill progresses through the legislative process.