A BILL to amend and reenact §§ 38.2-3407.7, 38.2-4209.1, and 38.2-4312.1 of the Code of Virginia, relating to pharmacy freedom of choice; specialty pharmacy benefits.
HB1172 would amend Virginia’s pharmacy “freedom of choice” laws to expressly cover specialty pharmacy benefits in addition to ordinary prescription drug benefits. The bill applies to insurers, corporations offering preferred provider subscription contracts, and health maintenance organizations, and it generally bars them or their pharmacy benefits managers from steering patients to a particular pharmacy, imposing unequal copays or penalties, or reducing reimbursement in ways that would influence a patient’s pharmacy choice. It also requires these entities to allow pharmacies to submit reimbursement agreements electronically or by phone and to respond to pharmacy requests for provider agreements within 60 days.
The bill preserves existing exceptions and clarifies several limits. It does not prevent plans from using a single exclusive mail-order pharmacy for drugs delivered by mail or common carrier, and it does not apply to pharmacy services provided by a pharmacy wholly owned or exclusively operated by an HMO. It also states that the State Corporation Commission would have no jurisdiction to adjudicate disputes arising under these provisions, leaving enforcement and controversy resolution outside that forum.
HB1172 would revise three sections of the Code of Virginia—§§ 38.2-3407.7, 38.2-4209.1, and 38.2-4312.1—to extend pharmacy access protections to specialty pharmacy benefits and to reinforce existing pharmacy choice rules across insurers, subscription contracts, and HMOs. The practical effect would be to limit pharmacy benefit manager practices that restrict network access, impose differential cost-sharing, or otherwise discourage use of nonpreferred pharmacies, while preserving mail-order and certain vertically integrated plan-pharmacy arrangements. Affected parties include insurers, HMOs, pharmacy benefits managers, pharmacies, and covered patients who use specialty medications or other prescription benefits.
The bill appears to have been introduced as a consumer-access measure, with its text emphasizing patient choice, equal treatment of pharmacies, and prompt processing of provider agreements. There is no recorded committee testimony or vote history in the provided materials, and the bill was left in the House Labor and Commerce Committee, suggesting it did not advance. Based on the bill’s structure, the likely general sentiment among supporters would be favorable toward broader pharmacy access and anti-steering protections, while opponents would likely focus on plan administration and network-management concerns.
The main points of contention are likely to be whether specialty pharmacy benefits should be subject to the same freedom-of-choice rules as standard pharmacy benefits, and how much flexibility insurers and pharmacy benefits managers should retain to manage networks and reimbursement. Another likely issue is the bill’s restriction on conditions that could influence pharmacy selection, which may be viewed by insurers and PBMs as limiting cost-control tools. The exceptions for exclusive mail-order arrangements and for pharmacies owned or operated by the HMO suggest an effort to balance consumer choice with plan design, but those carveouts could also be a source of debate over whether the bill is broad enough or too restrictive.