An Act to amend the Code of Virginia by adding a section numbered 38.2-3407.5:3, relating to health insurance; coverage for early refills of prescription eye drops.
HB490 adds a new section to the Virginia Code requiring health carriers that cover outpatient prescription drugs to cover early refills of prescription eye drops under specified conditions. Coverage must be provided when the eye drops are a covered benefit, enough time has passed that at least 85 percent of the prescription would have been used if taken as directed, and the prescriber states that additional quantities are medically necessary and do not exceed that amount.
The bill also prohibits insurers, corporations, and health maintenance organizations from imposing extra copayments, coinsurance, fees, or other conditions on an early refill of prescription eye drops that are not applied equally to other covered persons in the same benefit category and cost-sharing level. It does not require a plan to add eye-drop coverage if the plan does not already cover prescription drugs, and it excludes certain policy types, including short-term travel, accident-only, limited or specified disease policies, Medicare-related contracts, and short-term nonrenewable policies of six months or less. The new requirements apply to policies delivered, issued for delivery, or renewed in Virginia on and after January 1, 2027.
HB490 amends Virginia insurance law by creating a specific prescription-drug coverage mandate for early refills of prescription eye drops. It affects health carriers, insurers, health maintenance organizations, and covered persons under health benefit plans that already include outpatient prescription drug coverage, while leaving untouched plans that do not cover prescription drugs and several categories of exempt policies. The bill establishes a uniform standard for when early refills must be covered and limits the ability of carriers to apply additional cost-sharing or administrative barriers.
The available record shows no committee transcripts or recorded votes, so there is no documented debate or split vote history to indicate opposition or support. Based on the enacted text, the bill appears to be a targeted consumer-coverage measure aimed at improving access to medically necessary eye-drop refills, with a narrow and technical insurance mandate rather than a broad policy change.
Because there are no committee discussions or votes in the provided record, no specific points of contention are documented. Potential areas of concern inherent in the bill’s design include the 85 percent utilization threshold, the requirement for prescriber certification of medical necessity, and the exclusion of certain policy types and government-related coverage. Any disagreement would likely center on insurer administrative burden, cost-sharing consistency, and whether the mandate should extend to additional plan types.