{"formats":[{"name":"JSON","format":"json","url":"\/downloads\/2025\/code-json\/38.2-3407.15_6.json"},{"name":"Plain Text","format":"text","url":"\/downloads\/2025\/code-text\/38.2-3407.15_6.txt"},{"name":"XML","format":"xml","url":"\/downloads\/2025\/code-xml\/38.2-3407.15_6.xml"},{"name":"HTML","format":"html","url":"\/downloads\/2025\/code-html\/38.2-3407.15_6.html"}],"law_id":80337,"edition_id":1,"section_id":80337,"structure_id":12994,"section_number":"38.2-3407.15:6","catch_line":"Prescription drug price transparency","history":"2021, Sp. Sess. I, c. 304; 2025, c. 269.","full_text":"A\n\nAs used in this section:\n\t\t\t“Carrier” has the same meaning as set forth in § 38.2-3407.10.\n\t\t\t“Health benefit plan” has the same meaning as set forth in § 38.2-3438.\n\t\t\t“Manufacturer” has the same meaning as set forth in § 54.1-3401.\n\t\t\t“Nonprofit data services organization” has the same meaning as set forth in § 32.1-23.4.\n\t\t\t“Pharmacy benefits management” has the same meaning as set forth in § 38.2-3407.15:4.\n\t\t\t“Pharmacy benefits manager” has the same meaning as set forth in § 38.2-3407.15:4.\n\t\t\t“Pharmacy services administrative organization” has the same meaning as set forth in § 32.1-23.4.B\n\nEvery carrier offering a health benefit plan shall report annually by April 1 to the nonprofit data services organization with which the Department of Health has entered into a contract or agreement pursuant to \u00a7 32.1-23.4 the following information on spending on prescription drugs in total, before enrollee cost sharing, for each health benefit plan offered by the carrier in the Commonwealth:1\n\nFor covered outpatient prescription drugs that were prescribed to enrollees during the calendar year, the names of (i) the 25 most frequently prescribed outpatient prescription drugs, (ii) the names of the 25 outpatient prescription drugs covered at the greatest cost, calculated using the total annual spending by such health benefit plan for each outpatient prescription drug covered by the health benefit plan; and (iii) the 25 outpatient prescription drugs that experienced the greatest year-over-year increase in cost, calculated using the total annual spending by such health benefit plan for each outpatient prescription drug covered by the health benefit plan;2\n\nThe percent increase in annual net spending for prescription drugs after accounting for aggregated rebates, discounts, or other reductions in price;3\n\nThe percent increase in premiums that were attributable to each health care service, including prescription drugs;4\n\nThe percentage of specialty drugs with utilization management requirements; and5\n\nThe premium reductions that were attributable to specialty drug utilization management.C\n\nA report submitted by a carrier pursuant to this section shall not disclose the identity of a specific health benefit plan or the price charged for a specific prescription drug or class of prescription drugs.D\n\nEvery carrier offering a health benefit plan shall require each pharmacy benefits manager with which it enters into a contract for pharmacy benefits management to report annually by April 1 to the nonprofit data services organization with which the Department has entered into a contract or agreement pursuant to \u00a7 32.1-23.2 the following information for each drug specified by the Department of Health:1\n\nThe aggregate amount of rebates received by the pharmacy benefits manager;2\n\nThe aggregate amount of rebates distributed to the relevant health benefit plan; and3\n\nThe aggregate amount of rebates passed on to enrollees of each health benefit plan at the point of sale that reduced the enrollees’ applicable deductible, copayment, coinsurance, or other cost-sharing amount.E\n\nA pharmacy services administrative organization shall, to the extent allowed by law, submit a report annually by April 1 to the nonprofit data services organization with which the Department has entered into a contract or agreement pursuant to \u00a7 32.1-23.4. Such report shall include the following information for each prescription drug specified by the Department of Health:1\n\nThe negotiated reimbursement rate that the pharmacy services administrative organization pays pharmacies for brand, generic, and specialty drugs for each pharmacy benefits manager’s pharmacy network;2\n\nThe negotiated reimbursement rate that the pharmacy benefits manager pays the pharmacy services administrative organization for brand, generic, and specialty drugs for each pharmacy benefits manager’s pharmacy network; and3\n\nThe schedule of fees charged by the organization to pharmacies.\n\t\t\t\tA pharmacy services administrative organization that solely generates revenue from charging flat service fees to pharmacies and does not charge pharmacies for services based on prescription drug prices or volume shall be exempt from the reporting requirements of this section.F\n\nA report submitted by a pharmacy benefits manager or pharmacy services administrative organization pursuant to subsection D or E shall not disclose the identity of a specific health benefit plan or covered person, the price charged for a specific prescription drug or class of prescription drugs, or the amount of any rebate or fee provided for a specific prescription drug or class of prescription drugs.","order_by":null,"text":{"0":{"id":287552,"text":"As used in this section:\n\t\t\t“Carrier” has the same meaning as set forth in § 38.2-3407.10.\n\t\t\t“Health benefit plan” has the same meaning as set forth in § 38.2-3438.\n\t\t\t“Manufacturer” has the same meaning as set forth in § 54.1-3401.\n\t\t\t“Nonprofit data services organization” has the same meaning as set forth in § 32.1-23.4.\n\t\t\t“Pharmacy benefits management” has the same meaning as set forth in § 38.2-3407.15:4.\n\t\t\t“Pharmacy benefits manager” has the same meaning as set forth in § 38.2-3407.15:4.\n\t\t\t“Pharmacy services administrative organization” has the same meaning as set forth in § 32.1-23.4.","type":"section","prefixes":["A"],"prefix":"A","entire_prefix":"A","prefix_anchor":"A","level":1,"next_prefix":"B"},"1":{"id":287553,"text":"Every carrier offering a health benefit plan shall report annually by April 1 to the nonprofit data services organization with which the Department of Health has entered into a contract or agreement pursuant to \u00a7 32.1-23.4 the following information on spending on prescription drugs in total, before enrollee cost sharing, for each health benefit plan offered by the carrier in the Commonwealth:","type":"section","prefixes":["B"],"prefix":"B","entire_prefix":"B","prefix_anchor":"B","level":1,"prior_prefix":"A","next_prefix":"B1"},"2":{"id":287554,"text":"For covered outpatient prescription drugs that were prescribed to enrollees during the calendar year, the names of (i) the 25 most frequently prescribed outpatient prescription drugs, (ii) the names of the 25 outpatient prescription drugs covered at the greatest cost, calculated using the total annual spending by such health benefit plan for each outpatient prescription drug covered by the health benefit plan; and (iii) the 25 outpatient prescription drugs that experienced the greatest year-over-year increase in cost, calculated using the total annual spending by such health benefit plan for each outpatient prescription drug covered by the health benefit plan;","type":"section","prefixes":["B","1"],"prefix":"1","entire_prefix":"B1","prefix_anchor":"B1","level":2,"prior_prefix":"B","next_prefix":"B2"},"3":{"id":287555,"text":"The percent increase in annual net spending for prescription drugs after accounting for aggregated rebates, discounts, or other reductions in price;","type":"section","prefixes":["B","2"],"prefix":"2","entire_prefix":"B2","prefix_anchor":"B2","level":2,"prior_prefix":"B1","next_prefix":"B3"},"4":{"id":287556,"text":"The percent increase in premiums that were attributable to each health care service, including prescription drugs;","type":"section","prefixes":["B","3"],"prefix":"3","entire_prefix":"B3","prefix_anchor":"B3","level":2,"prior_prefix":"B2","next_prefix":"B4"},"5":{"id":287557,"text":"The percentage of specialty drugs with utilization management requirements; and","type":"section","prefixes":["B","4"],"prefix":"4","entire_prefix":"B4","prefix_anchor":"B4","level":2,"prior_prefix":"B3","next_prefix":"B5"},"6":{"id":287558,"text":"The premium reductions that were attributable to specialty drug utilization management.","type":"section","prefixes":["B","5"],"prefix":"5","entire_prefix":"B5","prefix_anchor":"B5","level":2,"prior_prefix":"B4","next_prefix":"C"},"7":{"id":287559,"text":"A report submitted by a carrier pursuant to this section shall not disclose the identity of a specific health benefit plan or the price charged for a specific prescription drug or class of prescription drugs.","type":"section","prefixes":["C"],"prefix":"C","entire_prefix":"C","prefix_anchor":"C","level":1,"prior_prefix":"B5","next_prefix":"D"},"8":{"id":287560,"text":"Every carrier offering a health benefit plan shall require each pharmacy benefits manager with which it enters into a contract for pharmacy benefits management to report annually by April 1 to the nonprofit data services organization with which the Department has entered into a contract or agreement pursuant to \u00a7 32.1-23.2 the following information for each drug specified by the Department of Health:","type":"section","prefixes":["D"],"prefix":"D","entire_prefix":"D","prefix_anchor":"D","level":1,"prior_prefix":"C","next_prefix":"D1"},"9":{"id":287561,"text":"The aggregate amount of rebates received by the pharmacy benefits manager;","type":"section","prefixes":["D","1"],"prefix":"1","entire_prefix":"D1","prefix_anchor":"D1","level":2,"prior_prefix":"D","next_prefix":"D2"},"10":{"id":287562,"text":"The aggregate amount of rebates distributed to the relevant health benefit plan; and","type":"section","prefixes":["D","2"],"prefix":"2","entire_prefix":"D2","prefix_anchor":"D2","level":2,"prior_prefix":"D1","next_prefix":"D3"},"11":{"id":287563,"text":"The aggregate amount of rebates passed on to enrollees of each health benefit plan at the point of sale that reduced the enrollees’ applicable deductible, copayment, coinsurance, or other cost-sharing amount.","type":"section","prefixes":["D","3"],"prefix":"3","entire_prefix":"D3","prefix_anchor":"D3","level":2,"prior_prefix":"D2","next_prefix":"E"},"12":{"id":287564,"text":"A pharmacy services administrative organization shall, to the extent allowed by law, submit a report annually by April 1 to the nonprofit data services organization with which the Department has entered into a contract or agreement pursuant to \u00a7 32.1-23.4. Such report shall include the following information for each prescription drug specified by the Department of Health:","type":"section","prefixes":["E"],"prefix":"E","entire_prefix":"E","prefix_anchor":"E","level":1,"prior_prefix":"D3","next_prefix":"E1"},"13":{"id":287565,"text":"The negotiated reimbursement rate that the pharmacy services administrative organization pays pharmacies for brand, generic, and specialty drugs for each pharmacy benefits manager’s pharmacy network;","type":"section","prefixes":["E","1"],"prefix":"1","entire_prefix":"E1","prefix_anchor":"E1","level":2,"prior_prefix":"E","next_prefix":"E2"},"14":{"id":287566,"text":"The negotiated reimbursement rate that the pharmacy benefits manager pays the pharmacy services administrative organization for brand, generic, and specialty drugs for each pharmacy benefits manager’s pharmacy network; and","type":"section","prefixes":["E","2"],"prefix":"2","entire_prefix":"E2","prefix_anchor":"E2","level":2,"prior_prefix":"E1","next_prefix":"E3"},"15":{"id":287567,"text":"The schedule of fees charged by the organization to pharmacies.\n\t\t\t\tA pharmacy services administrative organization that solely generates revenue from charging flat service fees to pharmacies and does not charge pharmacies for services based on prescription drug prices or volume shall be exempt from the reporting requirements of this section.","type":"section","prefixes":["E","3"],"prefix":"3","entire_prefix":"E3","prefix_anchor":"E3","level":2,"prior_prefix":"E2","next_prefix":"F"},"16":{"id":287568,"text":"A report submitted by a pharmacy benefits manager or pharmacy services administrative organization pursuant to subsection D or E shall not disclose the identity of a specific health benefit plan or covered person, the price charged for a specific prescription drug or class of prescription drugs, or the amount of any rebate or fee provided for a specific prescription drug or class of prescription drugs.","type":"section","prefixes":["F"],"prefix":"F","entire_prefix":"F","prefix_anchor":"F","level":1,"prior_prefix":"E3"}},"ancestry":[{"id":12994,"edition_id":1,"name":"General Provisions","identifier":"1","label":"article","depth":3,"order_by":1,"parent_id":12993,"metadata":{},"date_created":"2026-06-26 03:44:07","date_modified":"2026-06-26 03:44:07","permalink":{"id":214889,"object_type":"structure","relational_id":12994,"identifier":"1","token":"38.2\/34\/1","url":"\/38.2\/34\/1\/","edition_id":1,"permalink":0,"preferred":1}},{"id":12993,"edition_id":1,"name":"Provisions Relating to Accident and Sickness Insurance","identifier":"34","label":"chapter","depth":2,"order_by":1,"parent_id":12698,"metadata":{},"date_created":"2026-06-26 03:44:07","date_modified":"2026-06-26 03:44:07","permalink":{"id":214887,"object_type":"structure","relational_id":12993,"identifier":"34","token":"38.2\/34","url":"\/38.2\/34\/","edition_id":1,"permalink":0,"preferred":1}},{"id":12698,"edition_id":1,"name":"Insurance","identifier":"38.2","label":"title","depth":1,"order_by":1,"parent_id":null,"metadata":{},"date_created":"2026-06-26 03:43:49","date_modified":"2026-06-26 03:43:49","permalink":{"id":210661,"object_type":"structure","relational_id":12698,"identifier":"38.2","token":"38.2","url":"\/38.2\/","edition_id":1,"permalink":0,"preferred":1}}],"structure_contents":[{"id":57593,"structure_id":12994,"section_number":"38.2-3400","catch_line":"Application of chapter","url":"\/38.2-3400\/","token":"38.2\/34\/1\/38.2-3400","metadata":false},{"id":72072,"structure_id":12994,"section_number":"38.2-3401","catch_line":"Forms of insurance authorized","url":"\/38.2-3401\/","token":"38.2\/34\/1\/38.2-3401","metadata":false},{"id":65240,"structure_id":12994,"section_number":"38.2-3402","catch_line":"Certification to accompany application","url":"\/38.2-3402\/","token":"38.2\/34\/1\/38.2-3402","metadata":false},{"id":83988,"structure_id":12994,"section_number":"38.2-3403","catch_line":"Fraudulent procurement of policy","url":"\/38.2-3403\/","token":"38.2\/34\/1\/38.2-3403","metadata":false},{"id":65279,"structure_id":12994,"section_number":"38.2-3404","catch_line":"Commission may establish rules and regulations for simplified and readable accident and sickness insurance policies","url":"\/38.2-3404\/","token":"38.2\/34\/1\/38.2-3404","metadata":false},{"id":62539,"structure_id":12994,"section_number":"38.2-3405","catch_line":"Certain subrogation provisions and limitations upon recovery in hospital, medical, etc., policies forbidden; 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freedom of choice","url":"\/38.2-3407.7\/","token":"38.2\/34\/1\/38.2-3407.7","metadata":false},{"id":73400,"structure_id":12994,"section_number":"38.2-3407.8","catch_line":"Repealed","url":"\/38.2-3407.8\/","token":"38.2\/34\/1\/38.2-3407.8","metadata":false},{"id":72540,"structure_id":12994,"section_number":"38.2-3407.9","catch_line":"Reimbursement for emergency medical services vehicle transportation services","url":"\/38.2-3407.9\/","token":"38.2\/34\/1\/38.2-3407.9","metadata":false},{"id":62232,"structure_id":12994,"section_number":"38.2-3407.9:01","catch_line":"Prescription drug formularies","url":"\/38.2-3407.9_01\/","token":"38.2\/34\/1\/38.2-3407.9_01","metadata":false},{"id":62074,"structure_id":12994,"section_number":"38.2-3407.9:02","catch_line":"Requirement for prescription drug coverage","url":"\/38.2-3407.9_02\/","token":"38.2\/34\/1\/38.2-3407.9_02","metadata":false},{"id":68601,"structure_id":12994,"section_number":"38.2-3407.9:03","catch_line":"Payment of clean claims to administrators of pharmacy benefits","url":"\/38.2-3407.9_03\/","token":"38.2\/34\/1\/38.2-3407.9_03","metadata":false},{"id":56568,"structure_id":12994,"section_number":"38.2-3407.9:04","catch_line":"Medication synchronization","url":"\/38.2-3407.9_04\/","token":"38.2\/34\/1\/38.2-3407.9_04","metadata":false},{"id":71499,"structure_id":12994,"section_number":"38.2-3407.9:05","catch_line":"Step therapy protocols","url":"\/38.2-3407.9_05\/","token":"38.2\/34\/1\/38.2-3407.9_05","metadata":false}],"previous_section":{"id":57527,"structure_id":12994,"section_number":"38.2-3407.15:5","catch_line":"Limit on cost-sharing payments for prescription insulin drugs","url":"\/38.2-3407.15_5\/","token":"38.2\/34\/1\/38.2-3407.15_5","metadata":false},"next_section":{"id":87317,"structure_id":12994,"section_number":"38.2-3407.15:7","catch_line":"Carrier provision of certain information","url":"\/38.2-3407.15_7\/","token":"38.2\/34\/1\/38.2-3407.15_7","metadata":false},"metadata":false,"official_url":"https:\/\/law.lis.virginia.gov\/vacode\/38.2-3407.15:6\/","history_text":"

The record of this law\u2019s original creation isn\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 2025, chapter 269<\/a>.<\/p>","references":[{"id":59772,"section_number":"2.2-3705.6","catch_line":"Exclusions to application of chapter; proprietary records and trade secrets","order_by":null,"url":"\/2.2-3705.6\/"},{"id":72225,"section_number":"32.1-23.4","catch_line":"Prescription drug price transparency; civil penalty","order_by":null,"url":"\/32.1-23.4\/"}],"refers_to":[{"id":87156,"section_number":"32.1-23.2","catch_line":"Sexual assault nurse examiner information","order_by":null,"url":"\/32.1-23.2\/"},{"id":72225,"section_number":"32.1-23.4","catch_line":"Prescription drug price transparency; civil penalty","order_by":null,"url":"\/32.1-23.4\/"},{"id":58079,"section_number":"38.2-3407.10","catch_line":"Health care provider panels","order_by":null,"url":"\/38.2-3407.10\/"},{"id":73491,"section_number":"38.2-3407.15:4","catch_line":"Limit on copayment for prescription drugs; permitted disclosures","order_by":null,"url":"\/38.2-3407.15_4\/"},{"id":57210,"section_number":"38.2-3438","catch_line":"Definitions","order_by":null,"url":"\/38.2-3438\/"},{"id":59669,"section_number":"54.1-3401","catch_line":"Definitions","order_by":null,"url":"\/54.1-3401\/"}],"permalink":{"id":215023,"object_type":"law","relational_id":80337,"identifier":"38.2-3407.15:6","token":"38.2\/34\/1\/38.2-3407.15_6","url":"\/38.2-3407.15_6\/","edition_id":1,"permalink":0,"preferred":1},"url":"\/38.2-3407.15_6\/","token":"38.2\/34\/1\/38.2-3407.15_6","dublin_core":{"Title":"Prescription drug price transparency","Type":"Text","Format":"text\/html","Identifier":"\u00a7 38.2-3407.15:6","Relation":"Code of Virginia"},"html":"\n\t\t\t\t\t\t

A.<\/span> As used in this section:\n\t\t\t“Carrier<\/span>” has the same meaning as set forth in § 38.2-3407.10<\/a>.\n\t\t\t“Health benefit plan<\/span>” has the same meaning as set forth in § 38.2-3438<\/a>.\n\t\t\t“Manufacturer<\/span>” has the same meaning as set forth in § 54.1-3401<\/a>.\n\t\t\t“Nonprofit data services organization<\/span>” has the same meaning as set forth in § 32.1-23.4<\/a>.\n\t\t\t“Pharmacy benefits management<\/span>” has the same meaning as set forth in § 38.2-3407.15:4<\/a>.\n\t\t\t“Pharmacy benefits manager<\/span>” has the same meaning as set forth in § 38.2-3407.15:4<\/a>.\n\t\t\t“Pharmacy services administrative organization<\/span>” has the same meaning as set forth in § 32.1-23.4<\/a>. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

B.<\/span> Every carrier<\/span> offering a health benefit plan<\/span> shall report annually by April 1 to the nonprofit data services organization<\/span> with which the Department of Health has entered into a contract<\/span> or agreement pursuant to \u00a7 32.1-23.4<\/a> the following information on spending on prescription drugs in total, before enrollee cost sharing, for each health benefit plan<\/span> offered by the carrier<\/span> in the Commonwealth: <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

1.<\/span> For covered outpatient prescription drugs that were prescribed to enrollees during the calendar year, the names of (i) the 25 most frequently prescribed outpatient prescription drugs, (ii) the names of the 25 outpatient prescription drugs covered at the greatest cost, calculated using the total annual spending by such health benefit plan<\/span> for each outpatient prescription drug covered by the health benefit plan<\/span>; and (iii) the 25 outpatient prescription drugs that experienced the greatest year-over-year increase in cost, calculated using the total annual spending by such health benefit plan<\/span> for each outpatient prescription drug covered by the health benefit plan<\/span>; <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

2.<\/span> The percent increase in annual net spending for prescription drugs after accounting for aggregated rebates, discounts, or other reductions in price; <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

3.<\/span> The percent increase in premiums that were attributable to each health care service, including prescription drugs; <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

4.<\/span> The percentage of specialty drugs with utilization management requirements; and <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

5.<\/span> The premium reductions that were attributable to specialty drug utilization management. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

C.<\/span> A report submitted by a carrier<\/span> pursuant to this section shall not disclose the identity of a specific health benefit plan<\/span> or the price charged for a specific prescription drug or class of prescription drugs. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

D.<\/span> Every carrier<\/span> offering a health benefit plan<\/span> shall require each pharmacy benefits manager<\/span> with which it enters into a contract<\/span> for pharmacy benefits management<\/span> to report annually by April 1 to the nonprofit data services organization<\/span> with which the Department has entered into a contract<\/span> or agreement pursuant to \u00a7 32.1-23.2<\/a> the following information for each drug specified by the Department of Health: <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

1.<\/span> The aggregate amount of rebates received by the pharmacy benefits manager<\/span>; <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

2.<\/span> The aggregate amount of rebates distributed to the relevant health benefit plan<\/span>; and <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

3.<\/span> The aggregate amount of rebates passed on to enrollees of each health benefit plan<\/span> at the point of sale that reduced the enrollees’ applicable deductible, copayment, coinsurance, or other cost-sharing amount. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

E.<\/span> A pharmacy services administrative organization<\/span> shall, to the extent allowed by law<\/span>, submit a report annually by April 1 to the nonprofit data services organization<\/span> with which the Department has entered into a contract<\/span> or agreement pursuant to \u00a7 32.1-23.4<\/a>. Such report shall include the following information for each prescription drug specified by the Department of Health: <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

1.<\/span> The negotiated reimbursement rate<\/span> that the pharmacy services administrative organization<\/span> pays pharmacies for brand, generic, and specialty drugs for each pharmacy benefits manager<\/span>’s pharmacy network; <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

2.<\/span> The negotiated reimbursement rate<\/span> that the pharmacy benefits manager<\/span> pays the pharmacy services administrative organization<\/span> for brand, generic, and specialty drugs for each pharmacy benefits manager<\/span>’s pharmacy network; and <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

3.<\/span> The schedule of fees charged by the organization to pharmacies.\n\t\t\t\tA pharmacy services administrative organization<\/span> that solely generates revenue from charging flat service fees to pharmacies and does not charge pharmacies for services based on prescription drug prices or volume shall be exempt from the reporting requirements of this section. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

F.<\/span> A report submitted by a pharmacy benefits manager<\/span> or pharmacy services administrative organization<\/span> pursuant to subsection D or E shall not disclose the identity of a specific health benefit plan<\/span> or covered person<\/span>, the price charged for a specific prescription drug or class of prescription drugs, or the amount of any rebate or fee provided for a specific prescription drug or class of prescription drugs. <\/i><\/a><\/p><\/section>","plain_text":" CODE OF VIRGINIA\n\nPRESCRIPTION DRUG PRICE TRANSPARENCY (\u00a7 38.2-3407.15:6)\n\nA. As used in this section:\n\t\t\t“Carrier” has the same meaning as set forth in §\n38.2-3407.10.\n\t\t\t“Health benefit plan” has the same meaning as set forth in §\n38.2-3438.\n\t\t\t“Manufacturer” has the same meaning as set forth in §\n54.1-3401.\n\t\t\t“Nonprofit data services organization” has the same meaning as\nset forth in § 32.1-23.4.\n\t\t\t“Pharmacy benefits management” has the same meaning as set forth\nin § 38.2-3407.15:4.\n\t\t\t“Pharmacy benefits manager” has the same meaning as set forth in\n§ 38.2-3407.15:4.\n\t\t\t“Pharmacy services administrative organization” has the same\nmeaning as set forth in § 32.1-23.4.\n\nB. Every carrier offering a health benefit plan shall report annually by April 1\nto the nonprofit data services organization with which the Department of Health\nhas entered into a contract or agreement pursuant to \u00a7 32.1-23.4 the following\ninformation on spending on prescription drugs in total, before enrollee cost\nsharing, for each health benefit plan offered by the carrier in the\nCommonwealth:\n\n 1. For covered outpatient prescription drugs that were prescribed to enrollees\n during the calendar year, the names of (i) the 25 most frequently prescribed\n outpatient prescription drugs, (ii) the names of the 25 outpatient\n prescription drugs covered at the greatest cost, calculated using the total\n annual spending by such health benefit plan for each outpatient prescription\n drug covered by the health benefit plan; and (iii) the 25 outpatient\n prescription drugs that experienced the greatest year-over-year increase in\n cost, calculated using the total annual spending by such health benefit plan\n for each outpatient prescription drug covered by the health benefit plan;\n\n 2. The percent increase in annual net spending for prescription drugs after\n accounting for aggregated rebates, discounts, or other reductions in price;\n\n 3. The percent increase in premiums that were attributable to each health care\n service, including prescription drugs;\n\n 4. The percentage of specialty drugs with utilization management requirements;\n and\n\n 5. The premium reductions that were attributable to specialty drug utilization\n management.\n\nC. A report submitted by a carrier pursuant to this section shall not disclose\nthe identity of a specific health benefit plan or the price charged for a\nspecific prescription drug or class of prescription drugs.\n\nD. Every carrier offering a health benefit plan shall require each pharmacy\nbenefits manager with which it enters into a contract for pharmacy benefits\nmanagement to report annually by April 1 to the nonprofit data services\norganization with which the Department has entered into a contract or agreement\npursuant to \u00a7 32.1-23.2 the following information for each drug specified by\nthe Department of Health:\n\n 1. The aggregate amount of rebates received by the pharmacy benefits manager;\n\n 2. The aggregate amount of rebates distributed to the relevant health benefit\n plan; and\n\n 3. The aggregate amount of rebates passed on to enrollees of each health\n benefit plan at the point of sale that reduced the enrollees’ applicable\n deductible, copayment, coinsurance, or other cost-sharing amount.\n\nE. A pharmacy services administrative organization shall, to the extent allowed\nby law, submit a report annually by April 1 to the nonprofit data services\norganization with which the Department has entered into a contract or agreement\npursuant to \u00a7 32.1-23.4. Such report shall include the following information\nfor each prescription drug specified by the Department of Health:\n\n 1. The negotiated reimbursement rate that the pharmacy services administrative\n organization pays pharmacies for brand, generic, and specialty drugs for each\n pharmacy benefits manager’s pharmacy network;\n\n 2. The negotiated reimbursement rate that the pharmacy benefits manager pays\n the pharmacy services administrative organization for brand, generic, and\n specialty drugs for each pharmacy benefits manager’s pharmacy network;\n and\n\n 3. The schedule of fees charged by the organization to pharmacies.\n \t\t\t\tA pharmacy services administrative organization that solely generates\n revenue from charging flat service fees to pharmacies and does not charge\n pharmacies for services based on prescription drug prices or volume shall be\n exempt from the reporting requirements of this section.\n\nF. A report submitted by a pharmacy benefits manager or pharmacy services\nadministrative organization pursuant to subsection D or E shall not disclose the\nidentity of a specific health benefit plan or covered person, the price charged\nfor a specific prescription drug or class of prescription drugs, or the amount\nof any rebate or fee provided for a specific prescription drug or class of\nprescription drugs.\n\nHISTORY: 2021, Sp. Sess. I, c. 304; 2025, c. 269.","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}}