{"formats":[{"name":"JSON","format":"json","url":"\/downloads\/2025\/code-json\/38.2-3407.7.json"},{"name":"Plain Text","format":"text","url":"\/downloads\/2025\/code-text\/38.2-3407.7.txt"},{"name":"XML","format":"xml","url":"\/downloads\/2025\/code-xml\/38.2-3407.7.xml"},{"name":"HTML","format":"html","url":"\/downloads\/2025\/code-html\/38.2-3407.7.html"}],"law_id":72641,"edition_id":1,"section_id":72641,"structure_id":12994,"section_number":"38.2-3407.7","catch_line":"Pharmacies; freedom of choice","history":"1994, c. 963; 1995, c. 467; 2010, cc. 157, 357; 2017, c. 615; 2019, c. 674; 2021, Sp. Sess. I, c. 229.","full_text":"A\n\nNotwithstanding any provision of § 38.2-3407 to the contrary, no insurer or its pharmacy benefits manager, as defined in § 38.2-3465, proposing to issue either preferred provider policies or contracts or exclusive provider policies or contracts shall prohibit any person receiving pharmacy benefits, including specialty pharmacy benefits, furnished thereunder from selecting, without limitation, the pharmacy of his choice to furnish such benefits. This right of selection extends to and includes any pharmacy that is a nonpreferred or nonparticipating provider and that has previously notified the insurer on its own behalf or through an intermediary, by facsimile or otherwise, of its agreement to accept reimbursement for its services at rates applicable to pharmacies that are preferred or participating providers, including any copayment consistently imposed by the insurer, as payment in full. Each insurer or its pharmacy benefits manager shall permit prompt electronic or telephonic transmittal of the reimbursement agreement by the pharmacy and ensure prompt verification to the pharmacy of the terms of reimbursement. In no event shall any person receiving a covered pharmacy benefit from a nonpreferred or nonparticipating provider that has submitted a reimbursement agreement be responsible for amounts that may be charged by the nonpreferred or nonparticipating provider in excess of the copayment and the insurer’s reimbursement applicable to all of its preferred or participating pharmacy providers. If a pharmacy has provided notice pursuant to this subsection through an intermediary, the insurer or its intermediary may elect to respond directly to the pharmacy instead of the intermediary. Nothing in this subsection shall (i) require an insurer or its intermediary to contract with or to disclose confidential information to a pharmacy’s intermediary or (ii) prohibit an insurer or its intermediary from contracting with or disclosing confidential information to a pharmacy’s intermediary.B\n\nNo such insurer or its pharmacy benefits manager shall impose upon any person receiving pharmaceutical benefits furnished under any such policy or contract:1\n\nAny copayment, fee or condition that is not equally imposed upon all individuals in the same benefit category, class or copayment level, whether or not such benefits are furnished by pharmacists who are nonpreferred or nonparticipating providers;2\n\nAny monetary penalty that would affect or influence any such person’s choice of pharmacy; or3\n\nAny reduction in allowable reimbursement for pharmacy services related to utilization of pharmacists who are nonpreferred or nonparticipating providers.C\n\nFor purposes of this section, a prohibited condition or penalty shall include, without limitation: (i) denying immediate access to electronic claims filing to a pharmacy that is a nonpreferred or nonparticipating provider and that has complied with subsection D or (ii) requiring a person receiving pharmacy benefits to make payment at point of service, except to the extent such conditions and penalties are similarly imposed on preferred or participating providers.D\n\nAny pharmacy that wishes to be covered by this section shall, if requested to do so in writing by an insurer or its pharmacy benefits manager, within 30 days of the pharmacy’s receipt of the request, execute and deliver to the insurer or its pharmacy benefits manager the direct service agreement or preferred or participating provider agreement that the insurer requires all of its preferred or participating providers of pharmacy benefits to execute. Any pharmacy that fails to timely execute and deliver such agreement shall not be covered by this section with respect to that insurer or its pharmacy benefits manager unless and until the pharmacy executes and delivers the agreement. No pharmacy shall be precluded from obtaining a direct service agreement or participating provider agreement for retail and specialty pharmacy if the pharmacy meets the terms and conditions of participation. Any request by a pharmacy for a direct service agreement or a participating provider agreement shall be acted upon by an insurer or its pharmacy benefits manager within 60 days of receipt of the pharmacy’s request or any subsequent submission of supplemental information if requested by the insurer or its pharmacy benefits manager.E\n\nThe Commission shall have no jurisdiction to adjudicate controversies arising out of this section.F\n\nNothing in this section shall limit the authority of an insurer proposing to issue preferred provider policies or contracts or exclusive provider policies or contracts to select a single mail order pharmacy provider as the exclusive provider of pharmacy services that are delivered to the covered person’s address by mail, common carrier, or delivery service. The provisions of this section shall not apply to such contracts. As used in this subsection, “mail order pharmacy provider” means a pharmacy permitted to conduct business in the Commonwealth whose primary business is to dispense a prescription drug or device under a prescriptive drug order and to deliver the drug or device to a patient primarily by mail, common carrier, or delivery service.","order_by":null,"text":{"0":{"id":261477,"text":"Notwithstanding any provision of § 38.2-3407 to the contrary, no insurer or its pharmacy benefits manager, as defined in § 38.2-3465, proposing to issue either preferred provider policies or contracts or exclusive provider policies or contracts shall prohibit any person receiving pharmacy benefits, including specialty pharmacy benefits, furnished thereunder from selecting, without limitation, the pharmacy of his choice to furnish such benefits. This right of selection extends to and includes any pharmacy that is a nonpreferred or nonparticipating provider and that has previously notified the insurer on its own behalf or through an intermediary, by facsimile or otherwise, of its agreement to accept reimbursement for its services at rates applicable to pharmacies that are preferred or participating providers, including any copayment consistently imposed by the insurer, as payment in full. Each insurer or its pharmacy benefits manager shall permit prompt electronic or telephonic transmittal of the reimbursement agreement by the pharmacy and ensure prompt verification to the pharmacy of the terms of reimbursement. In no event shall any person receiving a covered pharmacy benefit from a nonpreferred or nonparticipating provider that has submitted a reimbursement agreement be responsible for amounts that may be charged by the nonpreferred or nonparticipating provider in excess of the copayment and the insurer’s reimbursement applicable to all of its preferred or participating pharmacy providers. If a pharmacy has provided notice pursuant to this subsection through an intermediary, the insurer or its intermediary may elect to respond directly to the pharmacy instead of the intermediary. Nothing in this subsection shall (i) require an insurer or its intermediary to contract with or to disclose confidential information to a pharmacy’s intermediary or (ii) prohibit an insurer or its intermediary from contracting with or disclosing confidential information to a pharmacy’s intermediary.","type":"section","prefixes":["A"],"prefix":"A","entire_prefix":"A","prefix_anchor":"A","level":1,"next_prefix":"B"},"1":{"id":261478,"text":"No such insurer or its pharmacy benefits manager shall impose upon any person receiving pharmaceutical benefits furnished under any such policy or contract:","type":"section","prefixes":["B"],"prefix":"B","entire_prefix":"B","prefix_anchor":"B","level":1,"prior_prefix":"A","next_prefix":"B1"},"2":{"id":261479,"text":"Any copayment, fee or condition that is not equally imposed upon all individuals in the same benefit category, class or copayment level, whether or not such benefits are furnished by pharmacists who are nonpreferred or nonparticipating providers;","type":"section","prefixes":["B","1"],"prefix":"1","entire_prefix":"B1","prefix_anchor":"B1","level":2,"prior_prefix":"B","next_prefix":"B2"},"3":{"id":261480,"text":"Any monetary penalty that would affect or influence any such person’s choice of pharmacy; or","type":"section","prefixes":["B","2"],"prefix":"2","entire_prefix":"B2","prefix_anchor":"B2","level":2,"prior_prefix":"B1","next_prefix":"B3"},"4":{"id":261481,"text":"Any reduction in allowable reimbursement for pharmacy services related to utilization of pharmacists who are nonpreferred or nonparticipating providers.","type":"section","prefixes":["B","3"],"prefix":"3","entire_prefix":"B3","prefix_anchor":"B3","level":2,"prior_prefix":"B2","next_prefix":"C"},"5":{"id":261482,"text":"For purposes of this section, a prohibited condition or penalty shall include, without limitation: (i) denying immediate access to electronic claims filing to a pharmacy that is a nonpreferred or nonparticipating provider and that has complied with subsection D or (ii) requiring a person receiving pharmacy benefits to make payment at point of service, except to the extent such conditions and penalties are similarly imposed on preferred or participating providers.","type":"section","prefixes":["C"],"prefix":"C","entire_prefix":"C","prefix_anchor":"C","level":1,"prior_prefix":"B3","next_prefix":"D"},"6":{"id":261483,"text":"Any pharmacy that wishes to be covered by this section shall, if requested to do so in writing by an insurer or its pharmacy benefits manager, within 30 days of the pharmacy’s receipt of the request, execute and deliver to the insurer or its pharmacy benefits manager the direct service agreement or preferred or participating provider agreement that the insurer requires all of its preferred or participating providers of pharmacy benefits to execute. Any pharmacy that fails to timely execute and deliver such agreement shall not be covered by this section with respect to that insurer or its pharmacy benefits manager unless and until the pharmacy executes and delivers the agreement. No pharmacy shall be precluded from obtaining a direct service agreement or participating provider agreement for retail and specialty pharmacy if the pharmacy meets the terms and conditions of participation. Any request by a pharmacy for a direct service agreement or a participating provider agreement shall be acted upon by an insurer or its pharmacy benefits manager within 60 days of receipt of the pharmacy’s request or any subsequent submission of supplemental information if requested by the insurer or its pharmacy benefits manager.","type":"section","prefixes":["D"],"prefix":"D","entire_prefix":"D","prefix_anchor":"D","level":1,"prior_prefix":"C","next_prefix":"E"},"7":{"id":261484,"text":"The Commission shall have no jurisdiction to adjudicate controversies arising out of this section.","type":"section","prefixes":["E"],"prefix":"E","entire_prefix":"E","prefix_anchor":"E","level":1,"prior_prefix":"D","next_prefix":"F"},"8":{"id":261485,"text":"Nothing in this section shall limit the authority of an insurer proposing to issue preferred provider policies or contracts or exclusive provider policies or contracts to select a single mail order pharmacy provider as the exclusive provider of pharmacy services that are delivered to the covered person’s address by mail, common carrier, or delivery service. The provisions of this section shall not apply to such contracts. As used in this subsection, “mail order pharmacy provider” means a pharmacy permitted to conduct business in the Commonwealth whose primary business is to dispense a prescription drug or device under a prescriptive drug order and to deliver the drug or device to a patient primarily by mail, common carrier, or delivery service.","type":"section","prefixes":["F"],"prefix":"F","entire_prefix":"F","prefix_anchor":"F","level":1,"prior_prefix":"E"}},"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; limitations on disclosure of medical treatment options prohibited","url":"\/38.2-3405\/","token":"38.2\/34\/1\/38.2-3405","metadata":false},{"id":84136,"structure_id":12994,"section_number":"38.2-3405.1","catch_line":"Commonwealth's right to certain accident and sickness benefits","url":"\/38.2-3405.1\/","token":"38.2\/34\/1\/38.2-3405.1","metadata":false},{"id":70730,"structure_id":12994,"section_number":"38.2-3406","catch_line":"Accident and sickness benefits not subject to legal process","url":"\/38.2-3406\/","token":"38.2\/34\/1\/38.2-3406","metadata":false},{"id":84333,"structure_id":12994,"section_number":"38.2-3406.1","catch_line":"Application of requirements that policies offered by small employers include state-mandated health benefits","url":"\/38.2-3406.1\/","token":"38.2\/34\/1\/38.2-3406.1","metadata":false},{"id":67972,"structure_id":12994,"section_number":"38.2-3406.2","catch_line":"Capped benefits under insurance policies and contracts","url":"\/38.2-3406.2\/","token":"38.2\/34\/1\/38.2-3406.2","metadata":false},{"id":76321,"structure_id":12994,"section_number":"38.2-3407","catch_line":"Health benefit programs","url":"\/38.2-3407\/","token":"38.2\/34\/1\/38.2-3407","metadata":false},{"id":66921,"structure_id":12994,"section_number":"38.2-3407.1","catch_line":"Interest on accident and sickness claim proceeds","url":"\/38.2-3407.1\/","token":"38.2\/34\/1\/38.2-3407.1","metadata":false},{"id":58079,"structure_id":12994,"section_number":"38.2-3407.10","catch_line":"Health care provider panels","url":"\/38.2-3407.10\/","token":"38.2\/34\/1\/38.2-3407.10","metadata":false},{"id":66411,"structure_id":12994,"section_number":"38.2-3407.10:1","catch_line":"Processing of new provider applications and reimbursement for services rendered during pendency of a participating provider's credentialing application","url":"\/38.2-3407.10_1\/","token":"38.2\/34\/1\/38.2-3407.10_1","metadata":false},{"id":56463,"structure_id":12994,"section_number":"38.2-3407.10:2","catch_line":"Credentialing of private mental health agencies","url":"\/38.2-3407.10_2\/","token":"38.2\/34\/1\/38.2-3407.10_2","metadata":false},{"id":82372,"structure_id":12994,"section_number":"38.2-3407.11","catch_line":"Access to obstetrician-gynecologists","url":"\/38.2-3407.11\/","token":"38.2\/34\/1\/38.2-3407.11","metadata":false},{"id":70024,"structure_id":12994,"section_number":"38.2-3407.11:1","catch_line":"Access to specialists; 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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":74649,"structure_id":12994,"section_number":"38.2-3407.6:1","catch_line":"Denial of benefits for certain prescription drugs prohibited","url":"\/38.2-3407.6_1\/","token":"38.2\/34\/1\/38.2-3407.6_1","metadata":false},"next_section":{"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},"metadata":false,"official_url":"https:\/\/law.lis.virginia.gov\/vacode\/38.2-3407.7\/","history_text":"

This law was first created in 1994. The record of its establishment is cataloged in chapter 963<\/a> 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. It has been modified 4 times. 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. Those modifications are as follows: in 1995, chapter 467<\/a>; in 2010, chapters 157<\/a> and 357<\/a>; in 2017, chapter 615<\/a>; in 2019, chapter 674<\/a>.<\/p>","references":[{"id":68442,"section_number":"38.2-3407.12","catch_line":"Patient optional point-of-service benefit","order_by":null,"url":"\/38.2-3407.12\/"},{"id":62232,"section_number":"38.2-3407.9:01","catch_line":"Prescription drug formularies","order_by":null,"url":"\/38.2-3407.9_01\/"}],"refers_to":[{"id":76321,"section_number":"38.2-3407","catch_line":"Health benefit programs","order_by":null,"url":"\/38.2-3407\/"},{"id":60000,"section_number":"38.2-3465","catch_line":"Definitions","order_by":null,"url":"\/38.2-3465\/"}],"permalink":{"id":215111,"object_type":"law","relational_id":72641,"identifier":"38.2-3407.7","token":"38.2\/34\/1\/38.2-3407.7","url":"\/38.2-3407.7\/","edition_id":1,"permalink":0,"preferred":1},"url":"\/38.2-3407.7\/","token":"38.2\/34\/1\/38.2-3407.7","dublin_core":{"Title":"Pharmacies; freedom of choice","Type":"Text","Format":"text\/html","Identifier":"\u00a7 38.2-3407.7","Relation":"Code of Virginia"},"html":"\n\t\t\t\t\t\t

A.<\/span> Notwithstanding any provision of § 38.2-3407<\/a> to the contrary, no insurer<\/span> or its pharmacy benefits manager, as defined in § 38.2-3465<\/a>, proposing to issue<\/span> either preferred provider policies or contracts<\/span> or exclusive provider policies or contracts<\/span> shall prohibit any person<\/span> receiving pharmacy benefits, including specialty pharmacy benefits, furnished thereunder from selecting, without limitation, the pharmacy of his choice to furnish such benefits. This right of selection extends to and includes any pharmacy that is a nonpreferred or nonparticipating provider and that has previously notified the insurer<\/span> on its own behalf or through an intermediary, by facsimile or otherwise, of its agreement to accept reimbursement for its services at rates<\/span><\/span> applicable to pharmacies that are preferred or participating providers, including any copayment consistently imposed by the insurer<\/span>, as payment in full. Each insurer<\/span> or its pharmacy benefits manager shall permit prompt electronic or telephonic transmittal of the reimbursement agreement by the pharmacy and ensure prompt verification to the pharmacy of the terms of reimbursement. In no event shall any person<\/span> receiving a covered pharmacy benefit from a nonpreferred or nonparticipating provider that has submitted a reimbursement agreement be responsible for amounts that may be charged by the nonpreferred or nonparticipating provider in excess of the copayment and the insurer<\/span>’s reimbursement applicable to all of its preferred or participating pharmacy providers. If a pharmacy has provided notice pursuant to this subsection through an intermediary, the insurer<\/span> or its intermediary may elect to respond directly to the pharmacy instead of the intermediary. Nothing in this subsection shall (i) require an insurer<\/span> or its intermediary to contract<\/span> with or to disclose confidential information to a pharmacy’s intermediary or (ii) prohibit an insurer<\/span> or its intermediary from contracting with or disclosing confidential information to a pharmacy’s intermediary. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

B.<\/span> No such insurer<\/span> or its pharmacy benefits manager shall impose upon any person<\/span> receiving pharmaceutical benefits furnished under any such policy or contract<\/span>: <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

1.<\/span> Any copayment, fee or condition that is not equally imposed upon all individuals in the same benefit category, class or copayment level, whether or not such benefits are furnished by pharmacists who are nonpreferred or nonparticipating providers; <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

2.<\/span> Any monetary penalty<\/span> that would affect or influence any such person<\/span>’s choice of pharmacy; or <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

3.<\/span> Any reduction in allowable reimbursement for pharmacy services related to utilization of pharmacists who are nonpreferred or nonparticipating providers. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

C.<\/span> For purposes of this section, a prohibited condition or penalty<\/span> shall include, without limitation: (i) denying immediate access to electronic claims filing to a pharmacy that is a nonpreferred or nonparticipating provider and that has complied with subsection D or (ii) requiring a person<\/span> receiving pharmacy benefits to make payment at point of service, except to the extent such conditions and penalties are similarly imposed on preferred or participating providers. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

D.<\/span> Any pharmacy that wishes to be covered by this section shall, if requested to do so in writing by an insurer<\/span> or its pharmacy benefits manager, within 30 days of the pharmacy’s receipt of the request, execute and deliver to the insurer<\/span> or its pharmacy benefits manager the direct service agreement or preferred or participating provider agreement that the insurer<\/span> requires all of its preferred or participating providers of pharmacy benefits to execute. Any pharmacy that fails to timely execute and deliver such agreement shall not be covered by this section with respect to that insurer<\/span> or its pharmacy benefits manager unless and until the pharmacy executes and delivers the agreement. No pharmacy shall be precluded from obtaining a direct service agreement or participating provider agreement for retail and specialty pharmacy if the pharmacy meets the terms and conditions of participation. Any request by a pharmacy for a direct service agreement or a participating provider agreement shall be acted upon by an insurer<\/span> or its pharmacy benefits manager within 60 days of receipt of the pharmacy’s request or any subsequent submission of supplemental information if requested by the insurer<\/span> or its pharmacy benefits manager. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

E.<\/span> The Commission<\/span> shall have no jurisdiction<\/span> to adjudicate<\/span> controversies arising out of this section. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

F.<\/span> Nothing in this section shall limit the authority of an insurer<\/span> proposing to issue<\/span> preferred provider policies or contracts<\/span> or exclusive provider policies or contracts<\/span> to select a single mail order pharmacy provider<\/span> as the exclusive provider of pharmacy services that are delivered to the covered person<\/span>’s address by mail, common carrier, or delivery service. The provisions of this section shall not apply to such contracts<\/span>. As used in this subsection, “mail order pharmacy provider<\/span>” means a pharmacy permitted to conduct business in the Commonwealth whose primary business is to dispense a prescription drug or device under a prescriptive drug order and to deliver the drug or device to a patient primarily by mail, common carrier, or delivery service. <\/i><\/a><\/p><\/section>","plain_text":" CODE OF VIRGINIA\n\nPHARMACIES; FREEDOM OF CHOICE (\u00a7 38.2-3407.7)\n\nA. Notwithstanding any provision of § 38.2-3407 to the contrary, no insurer\nor its pharmacy benefits manager, as defined in § 38.2-3465, proposing to\nissue either preferred provider policies or contracts or exclusive provider\npolicies or contracts shall prohibit any person receiving pharmacy benefits,\nincluding specialty pharmacy benefits, furnished thereunder from selecting,\nwithout limitation, the pharmacy of his choice to furnish such benefits. This\nright of selection extends to and includes any pharmacy that is a nonpreferred\nor nonparticipating provider and that has previously notified the insurer on its\nown behalf or through an intermediary, by facsimile or otherwise, of its\nagreement to accept reimbursement for its services at rates applicable to\npharmacies that are preferred or participating providers, including any\ncopayment consistently imposed by the insurer, as payment in full. Each insurer\nor its pharmacy benefits manager shall permit prompt electronic or telephonic\ntransmittal of the reimbursement agreement by the pharmacy and ensure prompt\nverification to the pharmacy of the terms of reimbursement. In no event shall\nany person receiving a covered pharmacy benefit from a nonpreferred or\nnonparticipating provider that has submitted a reimbursement agreement be\nresponsible for amounts that may be charged by the nonpreferred or\nnonparticipating provider in excess of the copayment and the insurer’s\nreimbursement applicable to all of its preferred or participating pharmacy\nproviders. If a pharmacy has provided notice pursuant to this subsection through\nan intermediary, the insurer or its intermediary may elect to respond directly\nto the pharmacy instead of the intermediary. Nothing in this subsection shall\n(i) require an insurer or its intermediary to contract with or to disclose\nconfidential information to a pharmacy’s intermediary or (ii) prohibit an\ninsurer or its intermediary from contracting with or disclosing confidential\ninformation to a pharmacy’s intermediary.\n\nB. No such insurer or its pharmacy benefits manager shall impose upon any person\nreceiving pharmaceutical benefits furnished under any such policy or contract:\n\n 1. Any copayment, fee or condition that is not equally imposed upon all\n individuals in the same benefit category, class or copayment level, whether or\n not such benefits are furnished by pharmacists who are nonpreferred or\n nonparticipating providers;\n\n 2. Any monetary penalty that would affect or influence any such person’s\n choice of pharmacy; or\n\n 3. Any reduction in allowable reimbursement for pharmacy services related to\n utilization of pharmacists who are nonpreferred or nonparticipating providers.\n\nC. For purposes of this section, a prohibited condition or penalty shall\ninclude, without limitation: (i) denying immediate access to electronic claims\nfiling to a pharmacy that is a nonpreferred or nonparticipating provider and\nthat has complied with subsection D or (ii) requiring a person receiving\npharmacy benefits to make payment at point of service, except to the extent such\nconditions and penalties are similarly imposed on preferred or participating\nproviders.\n\nD. Any pharmacy that wishes to be covered by this section shall, if requested to\ndo so in writing by an insurer or its pharmacy benefits manager, within 30 days\nof the pharmacy’s receipt of the request, execute and deliver to the\ninsurer or its pharmacy benefits manager the direct service agreement or\npreferred or participating provider agreement that the insurer requires all of\nits preferred or participating providers of pharmacy benefits to execute. Any\npharmacy that fails to timely execute and deliver such agreement shall not be\ncovered by this section with respect to that insurer or its pharmacy benefits\nmanager unless and until the pharmacy executes and delivers the agreement. No\npharmacy shall be precluded from obtaining a direct service agreement or\nparticipating provider agreement for retail and specialty pharmacy if the\npharmacy meets the terms and conditions of participation. Any request by a\npharmacy for a direct service agreement or a participating provider agreement\nshall be acted upon by an insurer or its pharmacy benefits manager within 60\ndays of receipt of the pharmacy’s request or any subsequent submission of\nsupplemental information if requested by the insurer or its pharmacy benefits\nmanager.\n\nE. The Commission shall have no jurisdiction to adjudicate controversies arising\nout of this section.\n\nF. Nothing in this section shall limit the authority of an insurer proposing to\nissue preferred provider policies or contracts or exclusive provider policies or\ncontracts to select a single mail order pharmacy provider as the exclusive\nprovider of pharmacy services that are delivered to the covered person’s\naddress by mail, common carrier, or delivery service. The provisions of this\nsection shall not apply to such contracts. As used in this subsection,\n“mail order pharmacy provider” means a pharmacy permitted to conduct\nbusiness in the Commonwealth whose primary business is to dispense a\nprescription drug or device under a prescriptive drug order and to deliver the\ndrug or device to a patient primarily by mail, common carrier, or delivery\nservice.\n\nHISTORY: 1994, c. 963; 1995, c. 467; 2010, cc. 157, 357; 2017, c. 615; 2019, c.\n674; 2021, Sp. Sess. I, c. 229.","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}}