OFFERED FOR CONSIDERATION 1/27/2025
SENATE BILL NO. 1359
AMENDMENT IN THE NATURE OF A SUBSTITUTE
(Proposed by the Senate Committee on Commerce and Labor
on ________________)
(Patron Prior to SubstituteSenator Srinivasan)
A BILL to amend the Code of Virginia by adding a section numbered 38.2-3407.7:1, relating to health insurance; retail community pharmacies; pharmacy benefits managers.
Be it enacted by the General Assembly of Virginia:
1. That the Code of Virginia is amended by adding a section numbered 38.2-3407.7:1 as follows:
38.2-3407.7:1. Access to retail community pharmacies.
A. As used in this section:
"Carrier" has the same meaning as provided in 38.2-3407.15.
"Covered individual" has the same meaning as provided in 38.2-3465.
"Health benefit plan" has the same meaning as provided in 38.2-3438.
"Mail order pharmacy" has the same meaning as provided in 38.2-3465.
"Pharmacy benefits management" has the same meaning as provided in 38.2-3465.
"Pharmacy benefits manager" or "PBM" has the same meaning as provided in 38.2-3465.
"Retail community pharmacy" has the same meaning as provided in 38.2-3465.
B. Each carrier shall, as applicable, (i) administer its health benefit plans in a manner consistent with the following requirements and (ii) include such requirements in each provider contract addressing the provision of pharmacy benefits management that the carrier or the carrier's pharmacy benefits manager enters into with a pharmacy or the pharmacy's contracting agent:
1. Each covered individual shall be permitted to fill any mail order-covered prescription, at the covered individual's option, at any mail order pharmacy or network participating retail community pharmacy if the network participating retail community pharmacy agrees to accept reimbursement at a rate that is equivalent to that of the mail order pharmacy;
2. The PBM or carrier shall not impose a differential copayment, additional fee, rebate, bonus, or other condition or benefit on any covered individual who elects to fill his prescription at an in-network retail community pharmacy that is not similarly imposed, charged, or remunerated at all pharmacies under contract with the PBM or carrier in the Commonwealth; and
3. The PBM shall expressly disclose to the carrier in the contract if the PBM retains all or a greater portion of a drug manufacturer's rebate amount or any additional direct or indirect remuneration from any third party for drugs dispensed through the PBM-owned mail order pharmacy than the PBM does for drugs dispensed through a retail community pharmacy.
C. This section shall apply with respect to contracts with a PBM entered into, amended, extended, or renewed on or after January 1, 2026.