{"formats":[{"name":"JSON","format":"json","url":"\/downloads\/2025\/code-json\/38.2-3465.json"},{"name":"Plain Text","format":"text","url":"\/downloads\/2025\/code-text\/38.2-3465.txt"},{"name":"XML","format":"xml","url":"\/downloads\/2025\/code-xml\/38.2-3465.xml"},{"name":"HTML","format":"html","url":"\/downloads\/2025\/code-html\/38.2-3465.html"}],"law_id":60000,"edition_id":1,"section_id":60000,"structure_id":15137,"section_number":"38.2-3465","catch_line":"Definitions","history":"2020, cc. 219, 1288; 2022, c. 319; 2024, cc. 329, 626; 2025, cc. 413, 429.","full_text":"A\n\nAs used in this article, unless the context requires a different meaning:\n\t\t\t“Aggregate retained rebate percentage” means the sum total dollar amount of a pharmacy benefits manager’s retained rebates relating to all carrier clients of such pharmacy benefits manager divided by the sum total dollar amount of all rebates received by such pharmacy benefits manager relating to all such clients.\n\t\t\t“Carrier” has the same meaning ascribed thereto in subsection A of § 38.2-3407.15. However, “carrier” does not include a nonprofit health maintenance organization that operates as a group model whose internal pharmacy operation exclusively serves the members or patients of the nonprofit health maintenance organization.\n\t\t\t“Claim” means a request from a pharmacy or pharmacist to be reimbursed for the cost of administering, filling, or refilling a prescription for a drug or for providing a medical supply or device.\n\t\t\t“Claims processing services” means the administrative services performed in connection with the processing and adjudicating of claims relating to pharmacist services that include (i) receiving payments for pharmacist services, (ii) making payments to pharmacists or pharmacies for pharmacist services, or (iii) both receiving and making payments.\n\t\t\t“Contract pharmacy” means a pharmacy operating under contract with a 340B-covered entity to provide dispensing services to the 340B-covered entity, as described in 75 Fed. Reg. 10272 (March 5, 2010) or any superseding guidance published thereafter.\n\t\t\t“Covered entity” means an entity described in § 340B(a)(4) of the federal Public Health Service Act, 42 U.S.C. § 256B(a)(4).\n\t\t\t“Covered individual” means an individual receiving prescription medication coverage or reimbursement provided by a pharmacy benefits manager or a carrier under a health benefit plan.\n\t\t\t“Health benefit plan” has the same meaning ascribed thereto in § 38.2-3438.\n\t\t\t“Mail order pharmacy” means a pharmacy whose primary business is to receive prescriptions by mail or through electronic submissions and to dispense medication to covered individuals through the use of the United States mail or other common or contract carrier services and that provides any consultation with covered individuals electronically rather than face-to-face.\n\t\t\t“Pharmacy benefits management” means the administration or management of prescription drug benefits provided by a carrier for the benefit of covered individuals. “Pharmacy benefits management” does not include any service provided by a nonprofit health maintenance organization that operates as a group model provided that the service is furnished through the internal pharmacy operation exclusively serves the members or patients of the nonprofit health maintenance organization.\n\t\t\t“Pharmacy benefits manager” or “PBM” means an entity that performs pharmacy benefits management. “Pharmacy benefits manager” includes an entity acting for a PBM in a contractual relationship in the performance of pharmacy benefits management for a carrier, nonprofit hospital, or third-party payor under a health program administered by the Commonwealth.\n\t\t\t“Pharmacy benefits manager affiliate” means a business, pharmacy, or pharmacist that directly or indirectly, through one or more intermediaries, owns or controls, is owned or controlled by, or is under common ownership interest or control with a pharmacy benefits manager.\n\t\t\t“Rebate” means a discount or other price concession, including without limitation incentives, disbursements, and reasonable estimates of a volume-based discount, or a payment that is (i) based on utilization of a prescription drug and (ii) paid by a manufacturer or third party, directly or indirectly, to a pharmacy benefits manager, pharmacy services administrative organization, or pharmacy after a claim has been processed and paid at a pharmacy.\n\t\t\t“Retail community pharmacy” means a pharmacy that is open to the public, serves walk-in customers, and makes available face-to-face consultations between licensed pharmacists and persons to whom medications are dispensed.\n\t\t\t“Retained rebate” means a rebate that is not passed on to a health benefit plan.\n\t\t\t“Retained rebate percentage” means the sum total dollar amount of a pharmacy benefits manager’s retained rebates relating to a health benefit plan divided by the sum total dollar amount of all rebates received by such pharmacy benefits manager relating to such health benefit plan.\n\t\t\t“Spread pricing” means the model of prescription drug pricing in which the pharmacy benefits manager charges a health benefit plan a contracted price for prescription drugs, and the contracted price for the prescription drugs differs from the amount the pharmacy benefits manager directly or indirectly pays the pharmacist or pharmacy for pharmacist services.","order_by":null,"text":{"0":{"id":219666,"text":"As used in this article, unless the context requires a different meaning:\n\t\t\t“Aggregate retained rebate percentage” means the sum total dollar amount of a pharmacy benefits manager’s retained rebates relating to all carrier clients of such pharmacy benefits manager divided by the sum total dollar amount of all rebates received by such pharmacy benefits manager relating to all such clients.\n\t\t\t“Carrier” has the same meaning ascribed thereto in subsection A of § 38.2-3407.15. However, “carrier” does not include a nonprofit health maintenance organization that operates as a group model whose internal pharmacy operation exclusively serves the members or patients of the nonprofit health maintenance organization.\n\t\t\t“Claim” means a request from a pharmacy or pharmacist to be reimbursed for the cost of administering, filling, or refilling a prescription for a drug or for providing a medical supply or device.\n\t\t\t“Claims processing services” means the administrative services performed in connection with the processing and adjudicating of claims relating to pharmacist services that include (i) receiving payments for pharmacist services, (ii) making payments to pharmacists or pharmacies for pharmacist services, or (iii) both receiving and making payments.\n\t\t\t“Contract pharmacy” means a pharmacy operating under contract with a 340B-covered entity to provide dispensing services to the 340B-covered entity, as described in 75 Fed. Reg. 10272 (March 5, 2010) or any superseding guidance published thereafter.\n\t\t\t“Covered entity” means an entity described in § 340B(a)(4) of the federal Public Health Service Act, 42 U.S.C. § 256B(a)(4).\n\t\t\t“Covered individual” means an individual receiving prescription medication coverage or reimbursement provided by a pharmacy benefits manager or a carrier under a health benefit plan.\n\t\t\t“Health benefit plan” has the same meaning ascribed thereto in § 38.2-3438.\n\t\t\t“Mail order pharmacy” means a pharmacy whose primary business is to receive prescriptions by mail or through electronic submissions and to dispense medication to covered individuals through the use of the United States mail or other common or contract carrier services and that provides any consultation with covered individuals electronically rather than face-to-face.\n\t\t\t“Pharmacy benefits management” means the administration or management of prescription drug benefits provided by a carrier for the benefit of covered individuals. “Pharmacy benefits management” does not include any service provided by a nonprofit health maintenance organization that operates as a group model provided that the service is furnished through the internal pharmacy operation exclusively serves the members or patients of the nonprofit health maintenance organization.\n\t\t\t“Pharmacy benefits manager” or “PBM” means an entity that performs pharmacy benefits management. “Pharmacy benefits manager” includes an entity acting for a PBM in a contractual relationship in the performance of pharmacy benefits management for a carrier, nonprofit hospital, or third-party payor under a health program administered by the Commonwealth.\n\t\t\t“Pharmacy benefits manager affiliate” means a business, pharmacy, or pharmacist that directly or indirectly, through one or more intermediaries, owns or controls, is owned or controlled by, or is under common ownership interest or control with a pharmacy benefits manager.\n\t\t\t“Rebate” means a discount or other price concession, including without limitation incentives, disbursements, and reasonable estimates of a volume-based discount, or a payment that is (i) based on utilization of a prescription drug and (ii) paid by a manufacturer or third party, directly or indirectly, to a pharmacy benefits manager, pharmacy services administrative organization, or pharmacy after a claim has been processed and paid at a pharmacy.\n\t\t\t“Retail community pharmacy” means a pharmacy that is open to the public, serves walk-in customers, and makes available face-to-face consultations between licensed pharmacists and persons to whom medications are dispensed.\n\t\t\t“Retained rebate” means a rebate that is not passed on to a health benefit plan.\n\t\t\t“Retained rebate percentage” means the sum total dollar amount of a pharmacy benefits manager’s retained rebates relating to a health benefit plan divided by the sum total dollar amount of all rebates received by such pharmacy benefits manager relating to such health benefit plan.\n\t\t\t“Spread pricing” means the model of prescription drug pricing in which the pharmacy benefits manager charges a health benefit plan a contracted price for prescription drugs, and the contracted price for the prescription drugs differs from the amount the pharmacy benefits manager directly or indirectly pays the pharmacist or pharmacy for pharmacist services.","type":"section","prefixes":["A"],"prefix":"A","entire_prefix":"A","prefix_anchor":"A","level":1}},"ancestry":[{"id":15137,"edition_id":1,"name":"Pharmacy Benefits Managers","identifier":"9","label":"article","depth":3,"order_by":1,"parent_id":12993,"metadata":{},"date_created":"2026-06-26 03:52:27","date_modified":"2026-06-26 03:52:27","permalink":{"id":215615,"object_type":"structure","relational_id":15137,"identifier":"9","token":"38.2\/34\/9","url":"\/38.2\/34\/9\/","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":60000,"structure_id":15137,"section_number":"38.2-3465","catch_line":"Definitions","url":"\/38.2-3465\/","token":"38.2\/34\/9\/38.2-3465","metadata":false},{"id":82100,"structure_id":15137,"section_number":"38.2-3466","catch_line":"License required to provide pharmacy benefits management services; requirements for a license, renewal, and revocation or suspension; civil penalty","url":"\/38.2-3466\/","token":"38.2\/34\/9\/38.2-3466","metadata":false},{"id":73357,"structure_id":15137,"section_number":"38.2-3467","catch_line":"Prohibited conduct by carriers and pharmacy benefits managers","url":"\/38.2-3467\/","token":"38.2\/34\/9\/38.2-3467","metadata":false},{"id":79303,"structure_id":15137,"section_number":"38.2-3468","catch_line":"Examination of books and records; reports; access to records","url":"\/38.2-3468\/","token":"38.2\/34\/9\/38.2-3468","metadata":false},{"id":57673,"structure_id":15137,"section_number":"38.2-3469","catch_line":"Enforcement; regulations","url":"\/38.2-3469\/","token":"38.2\/34\/9\/38.2-3469","metadata":false},{"id":72179,"structure_id":15137,"section_number":"38.2-3470","catch_line":"Scope of article","url":"\/38.2-3470\/","token":"38.2\/34\/9\/38.2-3470","metadata":false}],"next_section":{"id":82100,"structure_id":15137,"section_number":"38.2-3466","catch_line":"License required to provide pharmacy benefits management services; requirements for a license, renewal, and revocation or suspension; civil penalty","url":"\/38.2-3466\/","token":"38.2\/34\/9\/38.2-3466","metadata":false},"metadata":false,"official_url":"https:\/\/law.lis.virginia.gov\/vacode\/38.2-3465\/","history_text":"

This law was first created in 2020. The record of its establishment is cataloged in chapters 219<\/a> and 1288<\/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 3 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 2022, chapter 319<\/a>; in 2024, chapters 329<\/a> and 626<\/a>; in 2025, chapters 413<\/a> and 429<\/a>.<\/p>","references":[{"id":60835,"section_number":"32.1-325.5","catch_line":"State pharmacy benefits manager","order_by":null,"url":"\/32.1-325.5\/"},{"id":87317,"section_number":"38.2-3407.15:7","catch_line":"Carrier provision of certain information","order_by":null,"url":"\/38.2-3407.15_7\/"},{"id":72641,"section_number":"38.2-3407.7","catch_line":"Pharmacies; freedom of choice","order_by":null,"url":"\/38.2-3407.7\/"},{"id":67453,"section_number":"38.2-4209.1","catch_line":"Pharmacies; freedom of choice","order_by":null,"url":"\/38.2-4209.1\/"},{"id":55347,"section_number":"38.2-4214","catch_line":"Application of certain provisions of law","order_by":null,"url":"\/38.2-4214\/"},{"id":82617,"section_number":"38.2-4312.1","catch_line":"Pharmacies; freedom of choice","order_by":null,"url":"\/38.2-4312.1\/"},{"id":67952,"section_number":"38.2-4319","catch_line":"Statutory construction and relationship to other laws","order_by":null,"url":"\/38.2-4319\/"}],"refers_to":[{"id":71060,"section_number":"38.2-3407.15","catch_line":"Ethics and fairness in carrier business practices","order_by":null,"url":"\/38.2-3407.15\/"},{"id":57210,"section_number":"38.2-3438","catch_line":"Definitions","order_by":null,"url":"\/38.2-3438\/"}],"permalink":{"id":215617,"object_type":"law","relational_id":60000,"identifier":"38.2-3465","token":"38.2\/34\/9\/38.2-3465","url":"\/38.2-3465\/","edition_id":1,"permalink":0,"preferred":1},"url":"\/38.2-3465\/","token":"38.2\/34\/9\/38.2-3465","dublin_core":{"Title":"Definitions","Type":"Text","Format":"text\/html","Identifier":"\u00a7 38.2-3465","Relation":"Code of Virginia"},"html":"\n\t\t\t\t\t\t

A.<\/span> As used in this article, unless the context requires a different meaning:\n\t\t\t“Aggregate retained rebate percentage<\/span><\/span>” means the sum total dollar amount of a pharmacy benefits manager<\/span>’s retained rebates<\/span> relating to all carrier clients of such pharmacy benefits manager<\/span> divided by the sum total dollar amount of all rebates received by such pharmacy benefits manager<\/span> relating to all such clients.\n\t\t\t“Carrier” has the same meaning ascribed thereto in subsection A of § 38.2-3407.15<\/a>. However, “carrier” does not include a nonprofit health maintenance organization that operates as a group model whose internal pharmacy operation exclusively serves the members or patients of the nonprofit health maintenance organization.\n\t\t\t“Claim<\/span>” means a request from a pharmacy or pharmacist to be reimbursed for the cost of administering, filling, or refilling a prescription for a drug or for providing a medical supply or device.\n\t\t\t“Claims processing services<\/span>” means the administrative services performed in connection with the processing and adjudicating of claims relating to pharmacist services that include (i) receiving payments for pharmacist services, (ii) making payments to pharmacists or pharmacies for pharmacist services, or (iii) both receiving and making payments.\n\t\t\t“Contract pharmacy<\/span>” means a pharmacy operating under contract with a 340B-covered entity<\/span> to provide dispensing services to the 340B-covered entity<\/span>, as described in 75 Fed. Reg. 10272 (March 5, 2010) or any superseding guidance published thereafter.\n\t\t\t“Covered entity<\/span>” means an entity described in § 340B(a)(4) of the federal Public Health Service Act, 42 U.S.C. § 256B(a)(4).\n\t\t\t“Covered individual<\/span>” means an individual receiving prescription medication coverage or reimbursement provided by a pharmacy benefits manager<\/span> or a carrier under a health benefit plan.\n\t\t\t“Health benefit plan” has the same meaning ascribed thereto in § 38.2-3438<\/a>.\n\t\t\t“Mail order pharmacy<\/span>” means a pharmacy whose primary business is to receive prescriptions by mail or through electronic submissions and to dispense medication to covered individuals<\/span> through the use of the United States<\/span> mail or other common or contract carrier services and that provides any consultation with covered individuals<\/span> electronically rather than face-to-face.\n\t\t\t“Pharmacy benefits management<\/span>” means the administration or management of prescription drug benefits provided by a carrier for the benefit of covered individuals<\/span>. “Pharmacy benefits management<\/span>” does not include any service provided by a nonprofit health maintenance organization that operates as a group model provided that the service is furnished through the internal pharmacy operation exclusively serves the members or patients of the nonprofit health maintenance organization.\n\t\t\t“Pharmacy benefits manager<\/span>” or “PBM<\/span>” means an entity that performs pharmacy benefits management<\/span>. “Pharmacy benefits manager<\/span>” includes an entity acting for a PBM<\/span> in a contractual relationship in the performance of pharmacy benefits management<\/span> for a carrier, nonprofit hospital, or third-party<\/span> payor under a health program administered by the Commonwealth.\n\t\t\t“Pharmacy benefits manager<\/span> affiliate<\/span>” means a business, pharmacy, or pharmacist that directly or indirectly, through one or more intermediaries, owns or controls, is owned or controlled by, or is under common ownership interest or control with a pharmacy benefits manager<\/span>.\n\t\t\t“Rebate” means a discount or other price concession, including without limitation incentives, disbursements, and reasonable estimates of a volume-based discount, or a payment that is (i) based on utilization of a prescription drug and (ii) paid by a manufacturer or third party<\/span>, directly or indirectly, to a pharmacy benefits manager<\/span>, pharmacy services administrative organization, or pharmacy after a claim<\/span> has been processed and paid at a pharmacy.\n\t\t\t“Retail community pharmacy<\/span>” means a pharmacy that is open to the public, serves walk-in customers, and makes available face-to-face consultations between licensed pharmacists and persons<\/span> to whom medications are dispensed.\n\t\t\t“Retained rebate” means a rebate that is not passed on to a health benefit plan.\n\t\t\t“Retained rebate percentage<\/span>” means the sum total dollar amount of a pharmacy benefits manager<\/span>’s retained rebates<\/span> relating to a health benefit plan divided by the sum total dollar amount of all rebates received by such pharmacy benefits manager<\/span> relating to such health benefit plan.\n\t\t\t“Spread pricing<\/span>” means the model of prescription drug pricing in which the pharmacy benefits manager<\/span> charges a health benefit plan a contracted price for prescription drugs, and the contracted price for the prescription drugs differs from the amount the pharmacy benefits manager<\/span> directly or indirectly pays the pharmacist or pharmacy for pharmacist services. <\/i><\/a><\/p><\/section>","plain_text":" CODE OF VIRGINIA\n\nDEFINITIONS (\u00a7 38.2-3465)\n\nA. As used in this article, unless the context requires a different meaning:\n\t\t\t“Aggregate retained rebate percentage” means the sum total dollar\namount of a pharmacy benefits manager’s retained rebates relating to all\ncarrier clients of such pharmacy benefits manager divided by the sum total\ndollar amount of all rebates received by such pharmacy benefits manager relating\nto all such clients.\n\t\t\t“Carrier” has the same meaning ascribed thereto in subsection A\nof § 38.2-3407.15. However, “carrier” does not include a\nnonprofit health maintenance organization that operates as a group model whose\ninternal pharmacy operation exclusively serves the members or patients of the\nnonprofit health maintenance organization.\n\t\t\t“Claim” means a request from a pharmacy or pharmacist to be\nreimbursed for the cost of administering, filling, or refilling a prescription\nfor a drug or for providing a medical supply or device.\n\t\t\t“Claims processing services” means the administrative services\nperformed in connection with the processing and adjudicating of claims relating\nto pharmacist services that include (i) receiving payments for pharmacist\nservices, (ii) making payments to pharmacists or pharmacies for pharmacist\nservices, or (iii) both receiving and making payments.\n\t\t\t“Contract pharmacy” means a pharmacy operating under contract\nwith a 340B-covered entity to provide dispensing services to the 340B-covered\nentity, as described in 75 Fed. Reg. 10272 (March 5, 2010) or any superseding\nguidance published thereafter.\n\t\t\t“Covered entity” means an entity described in § 340B(a)(4)\nof the federal Public Health Service Act, 42 U.S.C. § 256B(a)(4).\n\t\t\t“Covered individual” means an individual receiving prescription\nmedication coverage or reimbursement provided by a pharmacy benefits manager or\na carrier under a health benefit plan.\n\t\t\t“Health benefit plan” has the same meaning ascribed thereto in\n§ 38.2-3438.\n\t\t\t“Mail order pharmacy” means a pharmacy whose primary business is\nto receive prescriptions by mail or through electronic submissions and to\ndispense medication to covered individuals through the use of the United States\nmail or other common or contract carrier services and that provides any\nconsultation with covered individuals electronically rather than face-to-face.\n\t\t\t“Pharmacy benefits management” means the administration or\nmanagement of prescription drug benefits provided by a carrier for the benefit\nof covered individuals. “Pharmacy benefits management” does not\ninclude any service provided by a nonprofit health maintenance organization that\noperates as a group model provided that the service is furnished through the\ninternal pharmacy operation exclusively serves the members or patients of the\nnonprofit health maintenance organization.\n\t\t\t“Pharmacy benefits manager” or “PBM” means an entity\nthat performs pharmacy benefits management. “Pharmacy benefits\nmanager” includes an entity acting for a PBM in a contractual relationship\nin the performance of pharmacy benefits management for a carrier, nonprofit\nhospital, or third-party payor under a health program administered by the\nCommonwealth.\n\t\t\t“Pharmacy benefits manager affiliate” means a business, pharmacy,\nor pharmacist that directly or indirectly, through one or more intermediaries,\nowns or controls, is owned or controlled by, or is under common ownership\ninterest or control with a pharmacy benefits manager.\n\t\t\t“Rebate” means a discount or other price concession, including\nwithout limitation incentives, disbursements, and reasonable estimates of a\nvolume-based discount, or a payment that is (i) based on utilization of a\nprescription drug and (ii) paid by a manufacturer or third party, directly or\nindirectly, to a pharmacy benefits manager, pharmacy services administrative\norganization, or pharmacy after a claim has been processed and paid at a\npharmacy.\n\t\t\t“Retail community pharmacy” means a pharmacy that is open to the\npublic, serves walk-in customers, and makes available face-to-face consultations\nbetween licensed pharmacists and persons to whom medications are dispensed.\n\t\t\t“Retained rebate” means a rebate that is not passed on to a\nhealth benefit plan.\n\t\t\t“Retained rebate percentage” means the sum total dollar amount of\na pharmacy benefits manager’s retained rebates relating to a health\nbenefit plan divided by the sum total dollar amount of all rebates received by\nsuch pharmacy benefits manager relating to such health benefit plan.\n\t\t\t“Spread pricing” means the model of prescription drug pricing in\nwhich the pharmacy benefits manager charges a health benefit plan a contracted\nprice for prescription drugs, and the contracted price for the prescription\ndrugs differs from the amount the pharmacy benefits manager directly or\nindirectly pays the pharmacist or pharmacy for pharmacist services.\n\nHISTORY: 2020, cc. 219, 1288; 2022, c. 319; 2024, cc. 329, 626; 2025, cc. 413,\n429.","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}}