Virginia House Bill 1041 (Prior Session Legislation)

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Spectrum: Partisan Bill (Republican 2-0)
Status: Introduced on January 10 2024 - 25% progression
Action: 2024-02-08 - Continued to 2025 in Labor and Commerce by voice vote
Pending: House Labor and Commerce Committee
Text: Latest bill text (Prefiled) [HTML]

Health insurance; cost-sharing; pharmacy benefits managers' compensation and duties: civil penalty. Amends provisions related to rebates provided by carriers and health benefit plans to health plan enrollees by defining "defined cost-sharing," "price protection rebates," and "pharmacy benefits management services." The bill requires that an enrollee's defined cost-sharing for each prescription drug be calculated at the point of sale based on a price that is reduced by an amount equal to at least 80 percent of all rebates received or expected to be received in connection with the dispensing or administration of the prescription drug. Health insurance; cost-sharing; pharmacy benefits managers' compensation and duties: civil penalty. Amends provisions related to rebates provided by carriers and health benefit plans to health plan enrollees by defining "defined cost-sharing," "price protection rebates," and "pharmacy benefits management services." The bill requires that an enrollee's defined cost-sharing for each prescription drug be calculated at the point of sale based on a price that is reduced by an amount equal to at least 80 percent of all rebates received or expected to be received in connection with the dispensing or administration of the prescription drug. The bill prohibits a pharmacy benefits manager from deriving income from pharmacy benefits management services provided to a carrier or health benefit plan except for income derived from a pharmacy benefits management fee. The bill requires the amount of any pharmacy benefits management fees to be set forth in the agreement between the pharmacy benefits manager and the carrier or health benefit plan and that such fee not be based on the acquisition cost or any other price metric of a drug; the amount of savings, rebates, or other fees charged, realized, or collected by or generated based on the activity of the pharmacy benefits manager; or the amount of premiums, deductibles, or other cost-sharing or fees charged, realized, or collected by the pharmacy benefits manager from enrollees or other persons on behalf of an enrollee. The bill requires a pharmacy benefits manager to annually certify to the State Corporation Commission that it has met certain requirements. The bill establishes a pharmacy benefits manager duty, which includes the duties of care and good faith and fair dealing, owed to any enrollee, provider, or health benefit plan that receives pharmacy benefits management services from the pharmacy benefits manager or that furnishes, covers, receives, or is administered a unit of a prescription drug for which the pharmacy benefits manager has provided pharmacy benefits management services. The bill requires the Commission to define by regulation the scope of such duty and provides for a private cause of action for any person aggrieved by the breach of such duty.

Health insurance; cost-sharing, pharmacy benefits managers' compensation and duties, civil penalty.

Del. Israel O'Quinn [R]

Del. Chris Runion [R]

Date	Chamber	Action
2024-02-08	House	Continued to 2025 in Labor and Commerce by voice vote
2024-02-06	House	Subcommittee recommends continuing to 2025 by voice vote
2024-01-23	House	Assigned L & C sub: Subcommittee #1
2024-01-10	House	Referred to Committee on Labor and Commerce
2024-01-10	House	Prefiled and ordered printed; offered 01/10/24 24104998D

Chapter	Article	Section	Citation Type	Statute Text
38	2	3407.22	(n/a)	See Bill Text
38	2	3465	(n/a)	See Bill Text
38	2	3466	(n/a)	See Bill Text
38	2	3467	(n/a)	See Bill Text
38	2	3467.1	(n/a)	See Bill Text
38	2	3467.2	(n/a)	See Bill Text

Type	Source
Summary	https://lis.virginia.gov/cgi-bin/legp604.exe?241+sum+HB1041
Text	https://lis.virginia.gov/cgi-bin/legp604.exe?241+ful+HB1041+hil
Supplement	https://lis.virginia.gov/cgi-bin/legp604.exe?241+oth+HB1041F122+PDF