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ACROSS SESSIONS
- Subject Index: Since 1995
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Developed and maintained by the Division of Legislative Automated Systems.
1995 SESSION
LD1585320Be it enacted by the General Assembly of Virginia:
1. That §§ 38.2-3407.7, 38.2-4209.1, and 38.2-4312.1 of the Code of Virginia are amended and reenacted as follows:
§ 38.2-3407.7. Pharmacies; freedom of choice.
A. Notwithstanding any provision of § 38.2-3407 to the contrary, no insurer
proposing to issue preferred provider policies or contracts shall prohibit
any person receiving pharmacy benefits furnished thereunder from selecting,
without limitation, the pharmacy of his choice to furnish such benefits. This
right of selection extends to and includes pharmacies that are nonpreferred
providers and that agree have previously notified the
insurer, by facsimile or otherwise, of their agreement to accept
reimbursement for their services at rates applicable to pharmacies that are
preferred providers, including any copayment consistently imposed by the
insurer, as payment in full. Each insurer shall permit prompt electronic or
telephonic transmittal of the reimbursement agreement by the pharmacy and
ensure prompt verification to the pharmacy of the terms of reimbursement. In
no event shall any person receiving a covered pharmacy benefit from a
nonpreferred provider which has submitted a reimbursement agreement be
responsible for amounts that may be charged by the nonpreferred provider in
excess of the copayment and the insurer's reimbursement applicable to all
of its preferred pharmacy providers.
B. No such insurer shall impose upon any person receiving pharmaceutical benefits furnished under any such policy or contract:
1. Any copayment, fee or condition that is not equally imposed upon all individuals in the same benefit category, class or copayment level, whether or not such benefits are furnished by pharmacists who are nonpreferred providers;
2. Any monetary penalty that would affect or influence any such person's choice of pharmacy; or
3. Any reduction in allowable reimbursement for pharmacy services related to utilization of pharmacists who are nonpreferred providers.
C. For purposes of this section, a prohibited condition or penalty shall include, without limitation: (i) denying immediate access to electronic claims filing to a pharmacy which is a nonpreferred provider and which has complied with subsection D below; or (ii) requiring a person receiving pharmacy benefits to make payment at point of service except to the extent such conditions and penalties are similarly imposed on preferred providers.
D. Any pharmacy which wishes to be covered by this section shall, if requested to do so in writing by an insurer, within thirty days of the pharmacy's receipt of the request, execute and deliver to the insurer the direct service agreement or preferred provider agreement which the insurer requires all of its preferred providers of pharmacy benefits to execute. Any pharmacy which fails to timely execute and deliver such agreement shall not be covered by this section with respect to that insurer unless and until the pharmacy executes and delivers the agreement.
C. E. The Commission shall have no jurisdiction to
adjudicate controversies arising out of this section.
§ 38.2-4209.1. Pharmacies; freedom of choice.
A. Notwithstanding any provision of § 38.2-4209, no corporation providing
preferred provider subscription contracts shall prohibit any person receiving
pharmaceutical benefits thereunder from selecting, without limitation, the
pharmacy of his choice to furnish such benefits. This right of selection
extends to and includes pharmacies that are nonpreferred providers and that
agree have previously notified the corporation, by facsimile
or otherwise, of their agreement to accept reimbursement for their
services at rates applicable to pharmacies that are preferred providers,
including any copayment consistently imposed by the corporation, as payment
in full. Each corporation shall permit prompt electronic or telephonic
transmittal of the reimbursement agreement by the pharmacy and ensure payment
verification to the pharmacy of the terms of reimbursement. In no event
shall any person receiving a covered pharmacy benefit from a nonpreferred
provider which has submitted a reimbursement agreement be responsible for
amounts that may be charged by the nonpreferred provider in excess of the
copayment and the corporation's reimbursement applicable to all of its
preferred pharmacy providers.
B. No such corporation shall impose upon any person receiving pharmaceutical benefits furnished under any such contract:
1. Any copayment, fee or condition that is not equally imposed upon all individuals in the same benefit category, class or copayment level, whether or not such benefits are furnished by pharmacists who are nonpreferred providers;
2. Any monetary penalty that would affect or influence any such person's choice of pharmacy; or
3. Any reduction in allowable reimbursement for pharmacy services related to utilization of pharmacists who are nonpreferred providers.
C. For purposes of this section, a prohibited condition or penalty shall include, without limitation: (i) denying immediate access to electronic claims filing to a pharmacy which is a nonpreferred provider and which has complied with subsection D below or (ii) requiring a person receiving pharmacy benefits to make payment at point of service, except to the extent such conditions and penalties are similarly imposed on preferred providers.
D. Any pharmacy which wishes to be covered by this section shall, if requested to do so in writing by a corporation, within thirty days of the pharmacy's receipt of the request, execute and deliver to the corporation the direct service agreement or preferred provider agreement which the corporation requires all of its preferred providers of pharmacy benefits to execute. Any pharmacy which fails to timely execute and deliver such agreement shall not be covered by this section with respect to that corporation unless and until the pharmacy executes and delivers the agreement.
C. E. The Commission shall have no jurisdiction to
adjudicate controversies arising out of this section.
§ 38.2-4312.1. Pharmacies; freedom of choice.
A. Notwithstanding any other provision in this chapter, no health
maintenance organization providing health care plans shall prohibit any
person receiving pharmaceutical benefits thereunder from selecting, without
limitation, the pharmacy of his choice to furnish such benefits. This right
of selection extends to and includes pharmacies that are not participating
providers under any such health care plan and that agree have
previously notified the health maintenance organization, by facsimile or
otherwise, of their agreement to accept reimbursement for their
services at rates applicable to pharmacies that are participating
providers, including any copayment consistently imposed by the plan, as
payment in full. Each health maintenance organization shall permit prompt
electronic or telephonic transmittal of the reimbursement agreement by the
pharmacy and ensure prompt verification to the pharmacy of the terms of
reimbursement. In no event shall any person receiving a covered pharmacy
benefit from a nonparticipating provider which has submitted a reimbursement
agreement be responsible for amounts that may be charged by the
nonparticipating provider in excess of the copayment and the health
maintenance organization's reimbursement applicable to all of its
participating pharmacy providers.
B. No such health maintenance organization shall impose upon any person receiving pharmaceutical benefits furnished under any such health care plan:
1. Any copayment, fee or condition that is not equally imposed upon all individuals in the same benefit category, class or copayment level, whether or not such benefits are furnished by pharmacists who are not participating providers;
2. Any monetary penalty that would affect or influence any such person's choice of pharmacy; or
3. Any reduction in allowable reimbursement for pharmacy services related to utilization of pharmacists who are not participating providers.
C. For purposes of this section, a prohibited condition or penalty shall include, without limitation: (i) denying immediate access to electronic claims filing to a pharmacy which is a nonparticipating provider and which has complied with subsection E below or (ii) requiring a person receiving pharmacy benefits to make payment at point of service, except to the extent such conditions and penalties are similarly imposed on participating providers.
C. D. The provisions of this section are not
applicable to any pharmaceutical benefit covered by a health care
plan whose terms require exclusive utilization of pharmacies
when those benefits are obtained from a pharmacy wholly
owned and operated by, or exclusively operated for, the health
maintenance organization providing the health care plan.
E. Any pharmacy which wishes to be covered by this section shall, if requested to do so in writing by a health maintenance organization, within thirty days of the pharmacy's receipt of the request, execute and deliver to the health maintenance organization the direct service agreement or participating provider agreement which the health maintenance organization requires all of its participating providers of pharmacy benefits to execute. Any pharmacy which fails to timely execute and deliver such agreement shall not be covered by this section with respect to that health maintenance organization unless and until the pharmacy executes and delivers the agreement.
D. F. The Commission shall have no jurisdiction to
adjudicate controversies arising out of this section.
2. That §§ 38.2-3407.8, 38.2-4209.2, and 38.2-4312.2 of the Code of Virginia are repealed.
3. That the Joint Commission on Health Care shall conduct a three-year study of ancillary medical services insofar as the availability and quality of the same are affected by managed care, and shall include its findings thereon in its 1996, 1997 and 1998 reports to the Governor and the General Assembly.