Health insurance; carrier contracts, carrier provision of certain prescription drug information. (SB428)

Introduced By

Sen. Siobhan Dunnavant (R-Henrico)


Passed Committee
Passed House
Passed Senate
Signed by Governor
Became Law


Health insurance; carrier disclosure of certain information. Requires each health insurance carrier, beginning July 1, 2025, to establish and maintain an online process that (i) links directly to e-prescribing systems and electronic health record systems that utilize the National Council for Prescription Drug Programs SCRIPT standard; (ii) can accept electronic prior authorization requests from a provider; (iii) can approve electronic prior authorization requests for which no additional information is needed by the carrier to process the prior authorization request, no clinical review is required, and that meet the carrier's criteria for approval; and (iv) otherwise meets the requirements of the relevant Code of Virginia section. The bill prohibits a carrier from (a) imposing a charge or fee on a participating health care provider for accessing the required online process required or (b) accessing, absent provider consent, provider data via the online process other than for the enrollee. The bill requires participating health care providers, beginning July 1, 2025, to ensure that any e-prescribing system or electronic health record system owned by or contracted for the provider to maintain an enrollee's health record has the ability to access the electronic prior authorization process established by a carrier and real-time cost information data for a covered prescription drug made available by a carrier. The bill provides that a provider may request a waiver of compliance for undue hardship for a period not to exceed 12 months. The bill requires any carrier or its pharmacy benefits manager to provide real-time cost information data to enrollees and contracted providers for a covered prescription drug, including any cost-sharing requirement or prior authorization requirements, and to ensure that the data is accurate. The bill requires that such cost information data is available to the provider in a format that a provider can access and understand such as through the provider's e-prescribing system or electronic health record system for which the carrier or pharmacy benefits manager or its designated subcontractor has adopted that utilizes the National Council for Prescription Drug Programs SCRIPT standard from which the provider makes the request. The bill requires the State Corporation Commission's Bureau of Insurance (the Bureau) to, in coordination with the Secretary of Health and Human Resources, establish a work group to evaluate and make recommendations to modify the process for prior authorization for drug benefits in order to maximize efficiency and minimize delays that include a single standardized process and any recommendations for necessary statutory or regulatory changes. The bill requires the work group to include relevant stakeholders, including representatives from the Virginia Association of Health Plans, the Medical Society of Virginia, the National Council for Prescription Drug Programs, the Virginia Pharmacists Association, and the Virginia Hospital and Healthcare Association, and other parties with an interest in the underlying technology. The bill requires the work group to report its findings and recommendations to the Chairmen of the Senate Committee on Commerce and Labor and the House Committee on Commerce and Energy by November 1, 2022. The provisions of the bill other than the requirement for the Bureau to establish the work group will not become effective unless reenacted by the 2023 Session of the General Assembly. This bill is identical to HB 360. Read the Bill »


Bill Has Passed


01/11/2022Prefiled and ordered printed; offered 01/12/22 22101437D
01/11/2022Referred to Committee on Commerce and Labor
01/31/2022Impact statement from DPB (SB428)
01/31/2022Senate committee, floor amendments and substitutes offered
02/07/2022Senate committee, floor amendments and substitutes offered
02/07/2022Reported from Commerce and Labor with substitute (15-Y 0-N) (see vote tally)
02/07/2022Committee substitute printed 22106220D-S1
02/08/2022Constitutional reading dispensed (40-Y 0-N) (see vote tally)
02/09/2022Read second time
02/09/2022Reading of substitute waived
02/09/2022Committee substitute agreed to 22106220D-S1
02/09/2022Engrossed by Senate - committee substitute SB428S1
02/10/2022Read third time and passed Senate (40-Y 0-N) (see vote tally)
02/11/2022Impact statement from DPB (SB428S1)
02/21/2022Placed on Calendar
02/21/2022Read first time
02/21/2022Referred to Committee on Health, Welfare and Institutions
02/24/2022House committee, floor amendments and substitutes offered
02/24/2022Reported from Health, Welfare and Institutions with amendment(s) (22-Y 0-N) (see vote tally)
02/28/2022Read second time
03/01/2022Read third time
03/01/2022Committee amendments agreed to
03/01/2022Engrossed by House as amended
03/01/2022Passed House with amendments BLOCK VOTE (100-Y 0-N)
03/01/2022VOTE: Block Vote Passage (100-Y 0-N) (see vote tally)
03/03/2022House amendments agreed to by Senate (40-Y 0-N) (see vote tally)
03/08/2022Bill text as passed Senate and House (SB428ER)
03/08/2022Signed by President
03/08/2022Signed by Speaker
03/09/2022Impact statement from DPB (SB428ER)
03/22/2022Enrolled Bill Communicated to Governor on March 22, 2022
03/22/2022G Governor's Action Deadline 11:59 p.m., April 11, 2022
04/08/2022G Approved by Governor-Chapter 285 (effective - see bill)
04/08/2022G Acts of Assembly Chapter text (CHAP0285)

Duplicate Bills

The following bills are identical to this one: HB360.