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 health insurance; pharmacies; freedom of choice; delivery of prescription drugs; penalties.
HB1390 is a health insurance and pharmacy access bill that expands and clarifies Virginia’s “freedom of choice” rules for prescription drug benefits across insurers, corporations offering preferred provider subscription contracts, and health maintenance organizations. It generally prohibits these entities and their pharmacy benefits managers from steering patients to a particular pharmacy, imposing unequal copays or fees, or using penalties or reimbursement practices that discourage use of a pharmacy chosen by the patient. The bill expressly includes specialty pharmacy services and recognizes pharmacies broadly, including physician practices, hospital outpatient infusion centers, and other clinical settings that dispense or administer drugs.
The bill also requires insurers and pharmacy benefits managers to accept and promptly process a pharmacy’s reimbursement agreement or provider agreement, and it sets timelines for responding to pharmacy requests for participation. It preserves the ability of plans to use a single mail-order pharmacy for drugs delivered to a covered person’s address, and it exempts certain wholly owned or exclusively operated pharmacies in the HMO context. The measure further bars retaliation against pharmacies or dispensing practitioners for exercising the rights created by the statute and removes the Commission’s jurisdiction to adjudicate disputes arising under these provisions.
HB1390 would amend §§ 38.2-3407.7, 38.2-4209.1, and 38.2-4312.1 of the Code of Virginia, strengthening existing pharmacy freedom-of-choice protections in the insurance, corporation, and HMO contexts. It would affect insurers, pharmacy benefits managers, health maintenance organizations, pharmacies, dispensing practitioners, and patients receiving pharmacy benefits by limiting network steering, point-of-service payment requirements, and other practices that could influence pharmacy selection. The bill also creates procedural obligations for prompt processing of pharmacy participation agreements and preserves a mail-order pharmacy exception.
The available context suggests the bill was generally treated as a consumer- and provider-protection measure, with no recorded floor votes or committee transcript opposition in the provided materials. Its continuation to the next session in Appropriations indicates it advanced procedurally but did not complete final action in the session. Overall, the bill appears to have been framed as a pharmacy access and anti-steering proposal rather than a controversial restructuring of coverage rules.
The main points of contention likely concern the bill’s limits on insurer and pharmacy benefits manager contracting and network management practices, especially provisions barring steering to specific pharmacies, restricting penalties, and requiring prompt acceptance of provider agreements. Insurers and PBMs may view these requirements as constraining their ability to manage costs and design pharmacy networks, while pharmacies and patient advocates would likely support the freedom-of-choice protections and anti-retaliation language. The bill’s explicit preservation of a single mail-order pharmacy option and its exemption for certain owned or operated pharmacies suggest an attempt to balance access protections with plan administration flexibility.