A BILL to amend the Code of Virginia by adding a section numbered 38.2-3407.9:06, relating to health insurance; coverage for non-opioid prescription drugs.
HB516 would add a new section to the Virginia Code requiring health insurers, subscription contracts, and health maintenance organizations that cover prescription drugs to treat FDA-approved non-opioid pain medications at least as favorably as covered opioid pain medications. Specifically, the bill prohibits insurers from imposing more restrictive cost-sharing, prior authorization, step therapy, or other coverage limits on covered non-opioid drugs than they impose on covered opioid drugs for pain treatment or management.
The bill applies to individual and group health insurance policies, subscription contracts, and HMO health plans delivered, issued for delivery, or renewed in Virginia on and after January 1, 2027. It is framed as a coverage parity measure for pain medications and would affect how prescription drug benefits are designed and administered by carriers operating in the Commonwealth.
HB516 would amend Virginia insurance law by creating a new mandate for prescription drug coverage parity between covered non-opioid pain medications and covered opioid pain medications. It would constrain insurers, health service corporations, and HMOs from using stricter utilization management or cost-sharing tools for non-opioid pain drugs than for opioid alternatives, potentially affecting formularies, prior authorization policies, step therapy protocols, and member out-of-pocket costs. The bill would apply prospectively to policies and plans renewed or issued on or after January 1, 2027.
Based on the available record, the bill appears to have been introduced as a consumer- and public-health-oriented measure with no recorded committee debate or votes in the provided materials. Its framing suggests support for expanding access to non-opioid pain treatment and reducing barriers to those medications, but the absence of transcripts or vote history means there is no documented public sentiment in the supplied context beyond the bill’s introduction and referral to committee.
No specific points of contention are documented in the provided committee transcripts or vote history, because none are available. Potential areas of dispute, based on the bill text, would likely involve insurer concerns about mandated coverage design, utilization management flexibility, and cost impacts, versus patient advocates and sponsors favoring easier access to non-opioid alternatives and reduced reliance on opioids. However, those positions are not explicitly recorded in the supplied materials.