Overview
In 2024, Virginia passed legislation amending prior authorization language, and legislation that directed the Board of Health to convene the State Health Services Plan Task Force to make recommendations on expedited review of projects subject to certificate of public need requirements.
Virginia is an active state in promoting price transparency in health care. Virginia operates an All-Payer Claims Database and provides other datasets online relating to cost and quality, including the average charge data for 25 of the most frequently reported health care services. All medical facilities and health maintenance organizations are required to submit utilization data to the Commissioner to populate the database. Virginia law provides prohibition against surprise and balance billing for both emergency and non-emergency healthcare services. The state also enacted legislation that requires health carriers to establish a comparable health care service incentive program under which savings are shared with a covered person who elects to receive a covered comparable health care service from a lower-cost provider.
In healthcare market competition, the state requires notice to the attorney general for all mergers, acquisitions, and other transactions involving nonprofit hospitals. The merger review criteria for the AG includes factors such as how the transaction will impact access to care and the affordability or cost of care. The legislature also introduced legislation to prohibit anticompetitive contracting practices in provider contracts, including the use of most-favored nation, all-or-nothing, and anti-tiering/anti-steering clauses.
State Action
Latest Legislative Session: 1/11/2023 - 2/25/2023 (2022-2023 term). *Current session bill updates are ongoing. Check back weekly for updates.
A 193 – Virginia
Introduced: 2016 Status: Inactive / Dead
Creates a two-phase process to sunset certificate of public need requirements for many categories of medical care facilities and projects, with the requirement for a certificate of public need (i) for ambulatory and outpatient surgery …
HB 1001 – Virginia
Introduced: 2018 Status: Inactive / Dead
Health care shared savings; incentive programs. Requires health carriers to establish a comparable health care service incentive program under which savings are shared with a covered person who elects to receive a covered health care …
HB 1003 – Virginia
Introduced: 2018 Status: Enacted
Health care data reporting; penalty for failure to report. Provides that any medical care facility that fails to report data on utilization of services for which a certificate of public need is required or data …
HB 1018 – Virginia
Introduced: 2020 Status: Inactive / Dead
Virginia Health Benefit Exchange. Creates the Virginia Health Benefit Exchange, which will be established and operated by a new division within the State Corporation Commission (SCC). The Exchange shall facilitate the purchase and sale of …
HB 1037 (see companion bill SB 404) – Virginia
Introduced: 2020 Status: Enacted
Health insurance; short-term limited-duration medical plans. Prohibits carriers from issuing in the Commonwealth, on or after July 1, 2021, any short-term limited-duration medical plan with a duration that exceeds three months or that can be …
HB 1177 (see companion bill SB 933) – Virginia
Introduced: 2018 Status: Enacted
PHARMACISTS AND PHARMACY PRACTICES. Provides that no provider contract between a health carrier or its pharmacy benefits manager and a pharmacy or its contracting agent shall contain a provision (i) authorizing the carrier or its …
HB 1450 – Virginia
Introduced: 2017 Status: Enacted
Pharmacy freedom of choice. Requires a health insurer or health maintenance organization, or its intermediary (the carrier), when it receives notice from a pharmacy’s intermediary of the pharmacy’s agreement to accept reimbursement for its services …
HB 234 – Virginia
Introduced: 2018 Status: Enacted
Health insurance; synchronization of medications. Requires any health plan providing prescription drug coverage to permit and apply a prorated daily cost-sharing rate to prescriptions that are dispensed by a network pharmacy for a partial supply …
HB 2515 (see companion bill SB 1596) – Virginia
Introduced: 2019 Status: Enacted
Health plans; calculation of enrollee’s contribution: Requires any carrier issuing a health plan in the Commonwealth to count any payments made by another person on the enrollee’s behalf, as well as payments made by the …
HB 520 – Virginia
Introduced: 2018 Status: Enacted
Board of Pharmacy; nonresident warehousers and nonresident third-party logistics providers. Requires warehouser or third-party logistics providers that are located outside the Commonwealth and that ship prescription drugs or devices into the Commonwealth to register with …
United States et al. v. Anthem, Inc., and Cigna Corp. – California, Colorado, Connecticut, District of Columbia, Federal, Georgia, Iowa, Maine, Maryland, New Hampshire, New York, Tennessee, Virginia
District Court: District of Columbia Status: Decided
On April 28, 2017, the D.C. Circuit Court of Appeals affirmed the District Court’s decision to block the proposed $54 billion merger between Anthem and …
In re: Suboxone Antitrust Litigation (State of Wisconsin, et al. v. Indivior Inc, et al.) – Alabama, Alaska, Arkansas, California, Colorado, Connecticut, Delaware, District of Columbia, Florida, Georgia, Hawaii, Idaho, Illinois, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Nebraska, New Hampshire, New Mexico, New York, North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania, South Dakota, Tennessee, Utah, Virginia, Washington, West Virginia, Wisconsin
District Court: E.D. Pennsylvania Status: Pending
In September 2016, 35 state attorneys general and the District of Columbia brought a multi-district case against pharmaceutical manufacturer Indivior, MonoSol RX et al., alleging …
In Re: Generic Pharmaceuticals Pricing Antitrust Litigation – Alabama, Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, District of Columbia, Florida, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, South Carolina, Tennessee, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin
District Court: Eastern District of Pennsylvania Status: Pending
Plaintiffs are attorney generals from 48 states, Puerto Rico, and the District of Columbia, as well as classes of private plaintiffs that filed an antitrust …
Additional Resources
STATE BUDGET
Virginia operates under a two-year (biennial) budget cycle. Each year the Governor prepares the proposed budget bill for introduction by the General Assembly. The biennial budget is enacted into law in even-numbered years, and amendments to it are enacted in odd-numbered years. The budget cycle begins in July.
STATE LEGISLATURE
The Virginia General Assembly is the oldest continuous law-making body in the Western Hemisphere, having been established on July 30, 1619. The state Senate has 40 members, and the state House of Delegates has 100. The Virginia General Assembly convenes annually on the second Wednesday in January. On years ending with an odd number, the General Assembly convenes for 30 days; on years ending with an even number, the General Assembly convenes for 60 days. Virginia is one of only two states (along with New Jersey) to carry over legislation from even years to odd years.
