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2020 SESSION

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20103662D
HOUSE BILL NO. 1659 Offered January 17, 2020 A BILL to amend the Code of Virginia by adding a section numbered 38.2-3407.15:5, relating to health insurance; carrier contracts with pharmacy benefits managers; pharmacy reimbursement. ---------- Patron-- Head ---------- Referred to Committee on Labor and Commerce ----------

Be it enacted by the General Assembly of Virginia:

1. That the Code of Virginia is amended by adding a section numbered 38.2-3407.15:5 as follows:

§ 38.2-3407.15:5. Carrier contracts with pharmacy benefits managers; required provisions.

A. As used in this section:

"Carrier" has the same meaning ascribed thereto in subsection A of § 38.2-3407.15.

"Covered individual" means an individual receiving prescription medication coverage or reimbursement provided by a pharmacy benefits manager or a carrier under a health benefit plan.

"Pharmacy benefits management" means the administration or management of prescription drug benefits provided by a carrier for the benefit of covered individuals.

"Pharmacy benefits manager" means a person that performs pharmacy benefits management.

"Pharmacy benefits manager affiliate" means a pharmacy or pharmacist that directly or indirectly, through one or more intermediaries, owns or controls, is owned or controlled by, or is under common ownership or control with a pharmacy benefits manager.

B. No carrier shall enter into, amend, renew, or extend a contract with a pharmacy benefits manager unless such contract contains provisions prohibiting the pharmacy benefits manager or a representative of the pharmacy benefits manager from reimbursing a pharmacy or pharmacist an amount less than the amount that the pharmacy benefits manager reimburses a pharmacy benefits manager affiliate for providing the same pharmacist services, calculated on a per-unit basis using the same product identifier or code number and reflecting all drug manufacturer's rebates, direct and indirect administrative fees, and costs and any remuneration.

C. The provisions of this section shall apply to any contract between a carrier and a pharmacy benefits manager entered into, amended, renewed, or extended on and after July 1, 2021.