VA HB 631
Status unknownState pharmacy benefits manager; contractual provisions, report.
Virginia · 2026 Regular Session · lower
Quick answers
Did VA HB 631 pass?
The current status of VA HB 631 is not known from the official record. Latest recorded action (2026-02-18): Left in Committee Appropriations
What is VA HB 631 about?
State pharmacy benefits manager; contractual provisions; report. Requires the Department of Medical Assistance Services' contract with the state pharmacy benefits manager to (i) require that that ingredient-cost reimbursement is based on the national average drug acquisition cost, or if unavailable, the wholesale acquisition cost minus a discount set by the Department, plus a professional dispensing fee, determined by the Department; (ii) require real-time or near real-time transparency in drug costs, rebates collected and paid, dispensing fees paid, administrative fees, and all other charges, fees, costs, and holdbacks, claim denials appeals, and network participation; (iii) prohibit the state pharmacy benefits manager from steering Medicaid recipients to affiliated pharmacies through differential cost-sharing, restrictive network design, or the mandatory use of a mail order pharmacy provider; (iv) require the state pharmacy benefits manager to (a) meet network adequacy standards established by the Department; (b) allow any willing pharmacy to participate in the pharmacy network; (c) verify that all contracted pharmacies are actively accepting Medicaid recipients; (d) submit annual reports containing certain information; (e) disclose to the Department pricing and maximum acquisition cost methodologies; and (f) allow invoice-based or national average drug acquisition cost-based appeals and require an adjustment of rates network-wide when an appeal is upheld; and (v) include enforcement mechanisms and monetary penalties for noncompliance. Additionally, the bill requires Department to annually calculate the savings generated by the use of the state pharmacy benefits manager and to annually increase its dispensing fee by the amount of such savings. The bill requires the Department to annually (1) publish and make available on its website its annual and total savings achieved, the annual and total amount applied to dispensing fees increases, and the updated dispensing fees and (2) report to the General Assembly on the state pharmacy benefits manager's compliance, national average drug acquisition cost compliance, pharmacy reimbursement trends, network adequacy compliance, and dispensing fee sufficiency.
Who sponsors VA HB 631?
Katrina Callsen is the primary sponsor of VA HB 631, joined by 3 cosponsors.
Description
State pharmacy benefits manager; contractual provisions; report. Requires the Department of Medical Assistance Services' contract with the state pharmacy benefits manager to (i) require that that ingredient-cost reimbursement is based on the national average drug acquisition cost, or if unavailable, the wholesale acquisition cost minus a discount set by the Department, plus a professional dispensing fee, determined by the Department; (ii) require real-time or near real-time transparency in drug costs, rebates collected and paid, dispensing fees paid, administrative fees, and all other charges, fees, costs, and holdbacks, claim denials appeals, and network participation; (iii) prohibit the state pharmacy benefits manager from steering Medicaid recipients to affiliated pharmacies through differential cost-sharing, restrictive network design, or the mandatory use of a mail order pharmacy provider; (iv) require the state pharmacy benefits manager to (a) meet network adequacy standards established by the Department; (b) allow any willing pharmacy to participate in the pharmacy network; (c) verify that all contracted pharmacies are actively accepting Medicaid recipients; (d) submit annual reports containing certain information; (e) disclose to the Department pricing and maximum acquisition cost methodologies; and (f) allow invoice-based or national average drug acquisition cost-based appeals and require an adjustment of rates network-wide when an appeal is upheld; and (v) include enforcement mechanisms and monetary penalties for noncompliance. Additionally, the bill requires Department to annually calculate the savings generated by the use of the state pharmacy benefits manager and to annually increase its dispensing fee by the amount of such savings. The bill requires the Department to annually (1) publish and make available on its website its annual and total savings achieved, the annual and total amount applied to dispensing fees increases, and the updated dispensing fees and (2) report to the General Assembly on the state pharmacy benefits manager's compliance, national average drug acquisition cost compliance, pharmacy reimbursement trends, network adequacy compliance, and dispensing fee sufficiency.
- Introduced
- 2026-01-13
- Latest action
- 2026-02-18 — Left in Committee Appropriations
- Bill type
- bill
- Last updated
- —
Sponsors
- Katrina Callsenprimary
- Elizabeth R. Guzmancosponsor
- H. Otto Wachsmann, Jr.cosponsor
- Nicole Colecosponsor
Committees
Not provided by source.
Action timeline
2026-01-13
Prefiled and ordered printed; Offered 01-14-2026 26103637D
filing,introduction
2026-01-13
Referred to Committee on Labor and Commerce
referral-committee
2026-01-20
Assigned HCL sub: Subcommittee #1
referral-committee
2026-02-03
House subcommittee offered
2026-02-03
Subcommittee recommends reporting with amendment(s) and referring to Appropriations (9-Y 0-N)
2026-02-04
Fiscal Impact Statement from Department of Planning and Budget (HB631)
2026-02-05
Reported from Labor and Commerce with amendment(s) and referred to Appropriations (21-Y 1-N)
committee-passage
2026-02-05
Assigned HAPP sub: Health & Human Resources
referral-committee
2026-02-13
Subcommittee recommends laying on the table (6-Y 1-N)
2026-02-18
Left in Committee Appropriations
Versions
Documents
Votes
Subcommittee recommends reporting with amendment(s)
2026-02-03 · pass · 9-0
Member-level votes (9)
- Michelle Lopes Maldonado: yes
- Richard C. "Rip" Sullivan, Jr.: yes
- Irene Shin: yes
- Laura Jane Cohen: yes
- Rae Cousins: yes
- JJ Singh: yes
- Terry G. Kilgore: yes
- Israel D. O'Quinn: yes
- Jason S. Ballard: yes
Reported from Labor and Commerce with amendment(s)
2026-02-05 · pass · 21-1
Member-level votes (22)
- Jeion A. Ward: yes
- Richard C. "Rip" Sullivan, Jr.: yes
- Alfonso H. Lopez: yes
- Kelly K. Convirs-Fowler: yes
- Dan I. Helmer: yes
- Michelle Lopes Maldonado: yes
- Irene Shin: yes
- Destiny LeVere Bolling: yes
- Michael B. Feggans: yes
- Nadarius E. Clark: yes
- Rae Cousins: yes
- Bonita G. Anthony: yes
- Laura Jane Cohen: yes
- JJ Singh: yes
- May Nivar: yes
- Terry G. Kilgore: yes
- Israel D. O'Quinn: yes
- Michael J. Webert: yes
- Tony O. Wilt: yes
- Chris S. Runion: yes
- Jason S. Ballard: yes
- Wren M. Williams: no
Subcommittee recommends laying on the table
2026-02-13 · pass · 6-1
Member-level votes (7)
- Rodney T. Willett: yes
- Betsy B. Carr: yes
- Paul E. Krizek: yes
- C.E. Cliff Hayes, Jr.: yes
- Kathy K.L. Tran: yes
- M. Keith Hodges: no
- Ellen H. McLaughlin: yes
Related bills
No related bills recorded for this bill.
Official source
Attribution
Data from openstates_bulk_csv, retrieved 2026-07-24T05:35:59.552682Z
Inspect retained evidence for changes recorded after evidence tracking began:
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