{"formats":[{"name":"JSON","format":"json","url":"\/downloads\/2025\/code-json\/32.1-331.15.json"},{"name":"Plain Text","format":"text","url":"\/downloads\/2025\/code-text\/32.1-331.15.txt"},{"name":"XML","format":"xml","url":"\/downloads\/2025\/code-xml\/32.1-331.15.xml"},{"name":"HTML","format":"html","url":"\/downloads\/2025\/code-html\/32.1-331.15.html"}],"law_id":80759,"edition_id":1,"section_id":80759,"structure_id":16038,"section_number":"32.1-331.15","catch_line":"Prior authorization of prescription drug products; coverage under state plan","history":"1993, c. 537; 2004, c. 855.","full_text":"A\n\nThe Committee shall review prescription drug products to recommend prior authorization under the state plan in accordance with this article and regulations promulgated by the Board. Such review may be initiated by the Director, the Committee itself, or by written request of the Board. The Committee shall complete its recommendations to the Board within no more than six months from receipt of any such request.B\n\nCoverage under the state plan for any drug requiring prior authorization shall not be approved unless the prescriber obtains prior approval of such use in accordance with regulations promulgated by the Board and procedures established by the Department.\n\t\t\tIn formulating its recommendations to the Board, the Committee shall consider the potential impact on patient care and the potential fiscal impact of prior authorization on pharmacy, prescriber, hospitalization and outpatient costs. Any proposed regulation making a drug or category of drugs subject to prior authorization shall be accompanied by a statement of the estimated impact of such action on pharmacy, prescriber, hospitalization and outpatient costs.C\n\nThe Committee shall not review any drug for which it has recommended or the Board has required prior authorization within the previous 12 months, unless new or previously unavailable relevant and objective information is presented.D\n\nConfidential proprietary information identified as such by a manufacturer or supplier in writing in advance and furnished to the Committee or the Board pursuant to this article shall not be subject to the disclosure requirements of the Virginia Freedom of Information Act (§ 2.2-3700 et seq.). The Board shall establish by regulation the means by which such confidential proprietary information shall be protected.","order_by":null,"text":{"0":{"id":289464,"text":"The Committee shall review prescription drug products to recommend prior authorization under the state plan in accordance with this article and regulations promulgated by the Board. Such review may be initiated by the Director, the Committee itself, or by written request of the Board. The Committee shall complete its recommendations to the Board within no more than six months from receipt of any such request.","type":"section","prefixes":["A"],"prefix":"A","entire_prefix":"A","prefix_anchor":"A","level":1,"next_prefix":"B"},"1":{"id":289465,"text":"Coverage under the state plan for any drug requiring prior authorization shall not be approved unless the prescriber obtains prior approval of such use in accordance with regulations promulgated by the Board and procedures established by the Department.\n\t\t\tIn formulating its recommendations to the Board, the Committee shall consider the potential impact on patient care and the potential fiscal impact of prior authorization on pharmacy, prescriber, hospitalization and outpatient costs. Any proposed regulation making a drug or category of drugs subject to prior authorization shall be accompanied by a statement of the estimated impact of such action on pharmacy, prescriber, hospitalization and outpatient costs.","type":"section","prefixes":["B"],"prefix":"B","entire_prefix":"B","prefix_anchor":"B","level":1,"prior_prefix":"A","next_prefix":"C"},"2":{"id":289466,"text":"The Committee shall not review any drug for which it has recommended or the Board has required prior authorization within the previous 12 months, unless new or previously unavailable relevant and objective information is presented.","type":"section","prefixes":["C"],"prefix":"C","entire_prefix":"C","prefix_anchor":"C","level":1,"prior_prefix":"B","next_prefix":"D"},"3":{"id":289467,"text":"Confidential proprietary information identified as such by a manufacturer or supplier in writing in advance and furnished to the Committee or the Board pursuant to this article shall not be subject to the disclosure requirements of the Virginia Freedom of Information Act (§ 2.2-3700 et seq.). The Board shall establish by regulation the means by which such confidential proprietary information shall be protected.","type":"section","prefixes":["D"],"prefix":"D","entire_prefix":"D","prefix_anchor":"D","level":1,"prior_prefix":"C"}},"ancestry":[{"id":16038,"edition_id":1,"name":"Medicaid Prior Authorization Advisory Committee","identifier":"4","label":"article","depth":3,"order_by":1,"parent_id":13275,"metadata":{},"date_created":"2026-06-26 04:04:29","date_modified":"2026-06-26 04:04:29","permalink":{"id":201541,"object_type":"structure","relational_id":16038,"identifier":"4","token":"32.1\/10\/4","url":"\/32.1\/10\/4\/","edition_id":1,"permalink":0,"preferred":1}},{"id":13275,"edition_id":1,"name":"Department of Medical Assistance Services","identifier":"10","label":"chapter","depth":2,"order_by":1,"parent_id":12727,"metadata":{},"date_created":"2026-06-26 03:44:33","date_modified":"2026-06-26 03:44:33","permalink":{"id":201353,"object_type":"structure","relational_id":13275,"identifier":"10","token":"32.1\/10","url":"\/32.1\/10\/","edition_id":1,"permalink":0,"preferred":1}},{"id":12727,"edition_id":1,"name":"Health","identifier":"32.1","label":"title","depth":1,"order_by":1,"parent_id":null,"metadata":{},"date_created":"2026-06-26 03:43:50","date_modified":"2026-06-26 03:43:50","permalink":{"id":201099,"object_type":"structure","relational_id":12727,"identifier":"32.1","token":"32.1","url":"\/32.1\/","edition_id":1,"permalink":0,"preferred":1}}],"structure_contents":[{"id":70519,"structure_id":16038,"section_number":"32.1-331.12","catch_line":"Definitions","url":"\/32.1-331.12\/","token":"32.1\/10\/4\/32.1-331.12","metadata":false},{"id":64553,"structure_id":16038,"section_number":"32.1-331.13","catch_line":"Medicaid Prior Authorization Advisory Committee; membership","url":"\/32.1-331.13\/","token":"32.1\/10\/4\/32.1-331.13","metadata":false},{"id":84478,"structure_id":16038,"section_number":"32.1-331.14","catch_line":"Duties of the Committee","url":"\/32.1-331.14\/","token":"32.1\/10\/4\/32.1-331.14","metadata":false},{"id":80759,"structure_id":16038,"section_number":"32.1-331.15","catch_line":"Prior authorization of prescription drug products; coverage under state plan","url":"\/32.1-331.15\/","token":"32.1\/10\/4\/32.1-331.15","metadata":false},{"id":74971,"structure_id":16038,"section_number":"32.1-331.16","catch_line":"Immunity","url":"\/32.1-331.16\/","token":"32.1\/10\/4\/32.1-331.16","metadata":false},{"id":62900,"structure_id":16038,"section_number":"32.1-331.17","catch_line":"Annual report to Joint Commission","url":"\/32.1-331.17\/","token":"32.1\/10\/4\/32.1-331.17","metadata":false}],"previous_section":{"id":84478,"structure_id":16038,"section_number":"32.1-331.14","catch_line":"Duties of the Committee","url":"\/32.1-331.14\/","token":"32.1\/10\/4\/32.1-331.14","metadata":false},"next_section":{"id":74971,"structure_id":16038,"section_number":"32.1-331.16","catch_line":"Immunity","url":"\/32.1-331.16\/","token":"32.1\/10\/4\/32.1-331.16","metadata":false},"metadata":false,"official_url":"https:\/\/law.lis.virginia.gov\/vacode\/32.1-331.15\/","history_text":"

This law was first created in 1993. The record of its establishment is cataloged in chapter 537 of that year\u2019s edition of \u201cActs of Assembly,\u201d the annual state publication listing all changes made to the Code of Virginia in that year. Unfortunately, the 1993 \u201cActs\u201d aren\u2019t available online. It has been modified 1 time. Those modifications are cataloged by \u201cThe Acts of Assembly,\u201d a state publication, by year and chapter. Those modifications that can be read on the General Assembly\u2019s website will be linked accordingly. That modification is as follows: in 2004, chapter 855<\/a>.<\/p>","references":false,"refers_to":[{"id":55569,"section_number":"2.2-3700","catch_line":"Short title; policy","order_by":null,"url":"\/2.2-3700\/"}],"permalink":{"id":201555,"object_type":"law","relational_id":80759,"identifier":"32.1-331.15","token":"32.1\/10\/4\/32.1-331.15","url":"\/32.1-331.15\/","edition_id":1,"permalink":0,"preferred":1},"url":"\/32.1-331.15\/","token":"32.1\/10\/4\/32.1-331.15","dublin_core":{"Title":"Prior authorization of prescription drug products; coverage under state plan","Type":"Text","Format":"text\/html","Identifier":"\u00a7 32.1-331.15","Relation":"Code of Virginia"},"html":"\n\t\t\t\t\t\t

A.<\/span> The Committee<\/span> shall review prescription drug products to recommend prior authorization under the state plan in accordance with this article and regulations promulgated by the Board<\/span>. Such review may be initiated by the Director<\/span>, the Committee<\/span> itself, or by written request of the Board<\/span>. The Committee<\/span> shall complete its recommendations to the Board<\/span> within no more than six months from receipt of any such request. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

B.<\/span> Coverage under the state plan for any drug requiring prior authorization shall not be approved unless the prescriber obtains prior approval of such use in accordance with regulations promulgated by the Board<\/span> and procedures established by the Department<\/span>.\n\t\t\tIn formulating its recommendations to the Board<\/span>, the Committee<\/span> shall consider the potential impact on patient care and the potential fiscal impact of prior authorization on pharmacy, prescriber, hospitalization and outpatient costs. Any proposed regulation making a drug or category of drugs subject to prior authorization shall be accompanied by a statement of the estimated impact of such action on pharmacy, prescriber, hospitalization and outpatient costs. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

C.<\/span> The Committee<\/span> shall not review any drug for which it has recommended or the Board<\/span> has required prior authorization within the previous 12 months, unless new or previously unavailable relevant and objective information is presented. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

D.<\/span> Confidential proprietary information identified as such by a manufacturer or supplier in writing in advance and furnished to the Committee<\/span> or the Board<\/span> pursuant to this article shall not be subject to the disclosure requirements of the Virginia Freedom of Information Act (§ 2.2-3700<\/a> et seq.). The Board<\/span> shall establish by regulation the means by which such confidential proprietary information shall be protected. <\/i><\/a><\/p><\/section>","plain_text":" CODE OF VIRGINIA\n\nPRIOR AUTHORIZATION OF PRESCRIPTION DRUG PRODUCTS; COVERAGE UNDER STATE PLAN (\u00a7\n32.1-331.15)\n\nA. The Committee shall review prescription drug products to recommend prior\nauthorization under the state plan in accordance with this article and\nregulations promulgated by the Board. Such review may be initiated by the\nDirector, the Committee itself, or by written request of the Board. The\nCommittee shall complete its recommendations to the Board within no more than\nsix months from receipt of any such request.\n\nB. Coverage under the state plan for any drug requiring prior authorization\nshall not be approved unless the prescriber obtains prior approval of such use\nin accordance with regulations promulgated by the Board and procedures\nestablished by the Department.\n\t\t\tIn formulating its recommendations to the Board, the Committee shall consider\nthe potential impact on patient care and the potential fiscal impact of prior\nauthorization on pharmacy, prescriber, hospitalization and outpatient costs. Any\nproposed regulation making a drug or category of drugs subject to prior\nauthorization shall be accompanied by a statement of the estimated impact of\nsuch action on pharmacy, prescriber, hospitalization and outpatient costs.\n\nC. The Committee shall not review any drug for which it has recommended or the\nBoard has required prior authorization within the previous 12 months, unless new\nor previously unavailable relevant and objective information is presented.\n\nD. Confidential proprietary information identified as such by a manufacturer or\nsupplier in writing in advance and furnished to the Committee or the Board\npursuant to this article shall not be subject to the disclosure requirements of\nthe Virginia Freedom of Information Act (§ 2.2-3700 et seq.). The Board\nshall establish by regulation the means by which such confidential proprietary\ninformation shall be protected.\n\nHISTORY: 1993, c. 537; 2004, c. 855.","edition":{"id":1,"name":"2025","slug":"2025","date_created":"2026-06-21 22:39:22","date_modified":"2026-06-21 22:39:22","current":1,"order_by":1,"last_import":null}}