Health insurance; carrier business practices, prior authorization provisions. (HB1942)

Introduced By

Del. Greg Habeeb (R-Salem) with support from 16 copatrons, whose average partisan position is:

Those copatrons are Del. Jeff Campbell (R-Marion), Del. Scott Garrett (R-Lynchburg), Del. Tag Greason (R-Potomac Falls), Del. Gordon Helsel (R-Poquoson), Del. Jay Leftwich (R-Chesapeake), Del. Alfonso Lopez (D-Arlington), Del. John O'Bannon (R-Richmond), Del. Chris Peace (R-Mechanicsville), Del. Brenda Pogge (R-Williamsburg), Del. Margaret Ransone (R-Kinsale), Del. Tom Rust (R-Herndon), Del. Chris Stolle (R-Virginia Beach), Del. Lee Ware (R-Powhatan), Del. Tony Wilt (R-Harrisonburg), Del. Joseph Yost (R-Blacksburg), Sen. Todd E. Pillion (R-Abingdon)


Passed Committee
Passed House
Passed Senate
Signed by Governor
Became Law


Health insurance; prior authorization for drug benefits. Requires health insurance provider contracts under which a carrier has the right or obligation to require prior authorization for a drug benefit contain specific provisions that, among other things, (i) accept universal prior authorization forms; (ii) permit the electronic submission of prior authorization requests using certain electronic submission formats; (iii) address when prior authorization may be required for chronic disease management drug benefits and mental health drug benefits; (iv) require that prior authorization approved by another carrier be honored for the initial 90 days of an insured's prescription drug benefit coverage upon the carrier's receipt from the prescriber of a record demonstrating the previous carrier's prior authorization approval; (v) address when prior authorization requests are deemed to be approved; (vi) require that, if a prior authorization request is approved by the carrier, the prior authorization approval be valid for not less than one year; (vii) limit when prior authorization may be required for generic drug benefits; (viii) require that a tracking number be assigned by the carrier to all prior authorization requests and that the tracking number be provided electronically to the prescriber upon the carrier's receipt of the prior authorization request; and (ix) require that the carrier's prescription drug formularies, all drug benefits subject to prior authorization by the carrier, all of the carrier's prior authorization procedures, and all prior authorization request forms accepted by the carrier be centrally located on the carrier's website and that such postings be updated by the carrier within seven days of approved changes. These requirements do not apply when the carrier has evidence of fraud, waste, or abuse by the insured or the prescriber. The measure also requires certain entities to develop, and annually update, universal prior authorization forms and to provide the forms to the State Corporation Commission. The State Corporation Commission is required to make the universal prior authorization forms available on or before January 1, 2016, and to make revised universal prior authorization forms available annually thereafter. Read the Bill »


Bill Has Passed


01/13/2015Prefiled and ordered printed; offered 01/14/15 15103414D
01/13/2015Referred to Committee on Commerce and Labor
01/22/2015Assigned C & L sub: Subcommittee #2
01/23/2015Impact statement from SCC (HB1942)
02/05/2015Reported from Commerce and Labor with substitute (22-Y 0-N) (see vote tally)
02/05/2015Committee substitute printed 15104573D-H1
02/07/2015Read first time
02/09/2015Read second time
02/09/2015Committee substitute agreed to 15104573D-H1
02/09/2015Engrossed by House - committee substitute HB1942H1
02/10/2015Read third time and passed House BLOCK VOTE (100-Y 0-N)
02/10/2015VOTE: BLOCK VOTE PASSAGE (100-Y 0-N) (see vote tally)
02/11/2015Constitutional reading dispensed
02/11/2015Referred to Committee on Commerce and Labor
02/16/2015Reported from Commerce and Labor (15-Y 0-N) (see vote tally)
02/18/2015Constitutional reading dispensed (38-Y 0-N) (see vote tally)
02/19/2015Read third time
02/19/2015Passed Senate (38-Y 0-N) (see vote tally)
02/24/2015Bill text as passed House and Senate (HB1942ER)
02/25/2015Impact statement from DPB (HB1942ER)
02/25/2015Signed by Speaker
02/26/2015G Governor's Action Deadline Midnight, Monday, March 30, 2015
02/26/2015Signed by President
02/26/2015Enrolled Bill communicated to Governor on 2/26/15
02/26/2015G Governor's Action Deadline Midnight, Sunday, March 29, 2015
03/23/2015G Approved by Governor-Chapter 515 (effective 7/1/15)
03/23/2015G Acts of Assembly Chapter text (CHAP0515)


This bill was discussed on the floor of the General Assembly. Below is all of the video that we have of that discussion, 1 clip in all, totaling 40 seconds.