republic-os/legislation/us/states/va/2022/sb-428.md

type, title, description, jurisdiction, legislature, session, identifier, citation, classification, subjects, status, primary_sponsors, version_count, action_count, vote_count, first_action, last_action, source, source_identifier, source_url, source_hash, vintage, source_snapshot, retrieved_at, confidence, tags

type	title	description	jurisdiction	legislature	session	identifier	citation	classification	subjects	status	primary_sponsors	version_count	action_count	vote_count	first_action	last_action	source	source_identifier	source_url	source_hash	vintage	source_snapshot	retrieved_at	confidence	tags
Bill	Health insurance; carrier contracts, carrier provision of certain prescription drug information.	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.	us/states/va	Virginia General Assembly	2022	SB 428	Virginia SB 428 (2022)	bill		enacted	Siobhan S. Dunnavant	4	33	6	2022-01-11	2022-04-08	openstates	ocd-bill/7f32aa30-1318-42bf-b513-cc616d31efd2	https://lis.virginia.gov/cgi-bin/legp604.exe?221+sum+SB428	bcbc2e97bc773fd1e2d99a207cc3594bbffcbf062ec878930dff706edf179a05	2026-07-01	https://data.openstates.org/daily/2026-07-01/public.pgdump	2026-07-06	reported	legislation bill us-va

Virginia SB 428 (2022) — Health insurance; carrier contracts, carrier provision of certain prescription drug information.

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.

Version chain

The bill's text revisions, in order — the diff chain from filing to enrollment.

1. CHAP0285 (committee substitute) — source
2. Committee substitute printed 22106220D-S1 (committee substitute) — source
3. Prefiled and ordered printed; offered 01/12/22 22101437D (committee substitute) — source
4. SB428ER (committee substitute) — source

Votes

• Read third time and passed Senate (40-Y 0-N) — 40–0 (pass) · upper
• Reported from Commerce and Labor with substitute (15-Y 0-N) — 15–0 (pass) · upper
• Reported from Health, Welfare and Institutions with amendment(s) (22-Y 0-N) — 22–0 (pass) · lower
• VOTE: Block Vote Passage (100-Y 0-N) — 99–0 (pass) · lower
• House amendments agreed to by Senate (40-Y 0-N) — 40–0 (pass) · upper
• Constitutional reading dispensed (40-Y 0-N) — 40–0 (pass) · upper

Sponsors

• Siobhan S. Dunnavant — primary (person)

Timeline

The legislative action history — every referral, reading, and vote.

• 2022-01-11 Prefiled and ordered printed; offered 01/12/22 22101437D introduction
• 2022-01-11 Referred to Committee on Commerce and Labor referral-committee
• 2022-01-31 Impact statement from DPB (SB428)
• 2022-01-31 Senate committee, floor amendments and substitutes offered
• 2022-02-07 Senate committee, floor amendments and substitutes offered
• 2022-02-07 Reported from Commerce and Labor with substitute (15-Y 0-N) committee-passage
• 2022-02-07 Committee substitute printed 22106220D-S1 substitution
• 2022-02-08 Constitutional reading dispensed (40-Y 0-N)
• 2022-02-09 Read second time reading-2
• 2022-02-09 Reading of substitute waived
• 2022-02-09 Committee substitute agreed to 22106220D-S1
• 2022-02-09 Engrossed by Senate - committee substitute SB428S1
• 2022-02-10 Read third time and passed Senate (40-Y 0-N) passage, reading-3
• 2022-02-11 Impact statement from DPB (SB428S1)
• 2022-02-21 Placed on Calendar
• 2022-02-21 Read first time reading-1
• 2022-02-21 Referred to Committee on Health, Welfare and Institutions referral-committee
• 2022-02-24 House committee, floor amendments and substitutes offered
• 2022-02-24 Reported from Health, Welfare and Institutions with amendment(s) (22-Y 0-N) committee-passage
• 2022-02-28 Read second time reading-2
• 2022-03-01 Read third time reading-3
• 2022-03-01 Committee amendments agreed to
• 2022-03-01 Engrossed by House as amended
• 2022-03-01 Passed House with amendments BLOCK VOTE (100-Y 0-N) passage
• 2022-03-01 VOTE: Block Vote Passage (100-Y 0-N)
• 2022-03-03 House amendments agreed to by Senate (40-Y 0-N)
• 2022-03-08 Enrolled
• 2022-03-08 Signed by President
• 2022-03-08 Signed by Speaker
• 2022-03-09 Impact statement from DPB (SB428ER)
• 2022-03-22 Enrolled Bill Communicated to Governor on March 22, 2022
• 2022-03-22 Governor's Action Deadline 11:59 p.m., April 11, 2022
• 2022-04-08 Approved by Governor-Chapter 285 (effective - see bill) executive-signature

Source

OpenStates / OpenCivicData bulk snapshot 2026-07-01; origin ocd-bill/7f32aa30-1318-42bf-b513-cc616d31efd2. Confidence: reported (aggregated from official Virginia legislature records).