{"formats":[{"name":"JSON","format":"json","url":"\/downloads\/2025\/code-json\/38.2-3467.json"},{"name":"Plain Text","format":"text","url":"\/downloads\/2025\/code-text\/38.2-3467.txt"},{"name":"XML","format":"xml","url":"\/downloads\/2025\/code-xml\/38.2-3467.xml"},{"name":"HTML","format":"html","url":"\/downloads\/2025\/code-html\/38.2-3467.html"}],"law_id":73357,"edition_id":1,"section_id":73357,"structure_id":15137,"section_number":"38.2-3467","catch_line":"Prohibited conduct by carriers and pharmacy benefits managers","history":"2020, cc. 219, 1288; 2022, c. 319.","full_text":"A\n\nNo carrier on its own or through its contracted pharmacy benefits manager or representative of a pharmacy benefits manager shall:1\n\nCause or knowingly permit the use of any advertisement, promotion, solicitation, representation, proposal, or offer that is untrue;2\n\nCharge a pharmacist or pharmacy a fee related to the adjudication of a claim other than a reasonable fee for an initial claim submission;3\n\nReimburse a pharmacy or pharmacist an amount less than the amount that the pharmacy benefits manager reimburses a pharmacy benefits manager affiliate for providing the same pharmacist services, calculated on a per-unit basis using the same generic product identifier or generic code number and reflecting all drug manufacturer’s rebates, direct and indirect administrative fees, and costs and any remuneration;4\n\nPenalize or retaliate against a pharmacist or pharmacy for exercising rights provided pursuant to the provisions of this article;5\n\nImpose requirements, exclusions, reimbursement terms, or other conditions on a covered entity or contract pharmacy that differ from those applied to entities or pharmacies that are not covered entities or contract pharmacies on the basis that the entity or pharmacy is a covered entity or contract pharmacy or that the entity or pharmacy dispenses 340B-covered drugs. Nothing in this subdivision shall (i) apply to drugs with an annual estimated per-patient cost exceeding $250,000 or (ii) prohibit the identification of a 340B reimbursement request; or6\n\nInterfere with a covered individual’s right to choose a pharmacy or provider, based on the pharmacy or provider’s status as a covered entity or contract pharmacy.B\n\nNo carrier, on its own or through its contracted pharmacy benefits manager or representative of a pharmacy benefits manager, shall restrict participation of a pharmacy in a pharmacy network for provider accreditation standards or certification requirements if a pharmacist meets such accreditation standards or certification standards.C\n\nNo carrier, on its own or through its contracted pharmacy benefits manager or representative of a pharmacy benefits manager, shall include any mail order pharmacy or pharmacy benefits manager affiliate in calculating or determining network adequacy under any law or contract in the Commonwealth.D\n\nNo carrier, on its own or through its contracted pharmacy benefits manager or representative of a pharmacy benefits manager, shall conduct spread pricing in the Commonwealth.E\n\nEach carrier on its own or through its contracted pharmacy benefits manager or representative of a pharmacy benefits manager shall comply with the provisions of this section in addition to complying with the provisions of § 38.2-3407.15:1.","order_by":null,"text":{"0":{"id":263994,"text":"No carrier on its own or through its contracted pharmacy benefits manager or representative of a pharmacy benefits manager shall:","type":"section","prefixes":["A"],"prefix":"A","entire_prefix":"A","prefix_anchor":"A","level":1,"next_prefix":"A1"},"1":{"id":263995,"text":"Cause or knowingly permit the use of any advertisement, promotion, solicitation, representation, proposal, or offer that is untrue;","type":"section","prefixes":["A","1"],"prefix":"1","entire_prefix":"A1","prefix_anchor":"A1","level":2,"prior_prefix":"A","next_prefix":"A2"},"2":{"id":263996,"text":"Charge a pharmacist or pharmacy a fee related to the adjudication of a claim other than a reasonable fee for an initial claim submission;","type":"section","prefixes":["A","2"],"prefix":"2","entire_prefix":"A2","prefix_anchor":"A2","level":2,"prior_prefix":"A1","next_prefix":"A3"},"3":{"id":263997,"text":"Reimburse a pharmacy or pharmacist an amount less than the amount that the pharmacy benefits manager reimburses a pharmacy benefits manager affiliate for providing the same pharmacist services, calculated on a per-unit basis using the same generic product identifier or generic code number and reflecting all drug manufacturer’s rebates, direct and indirect administrative fees, and costs and any remuneration;","type":"section","prefixes":["A","3"],"prefix":"3","entire_prefix":"A3","prefix_anchor":"A3","level":2,"prior_prefix":"A2","next_prefix":"A4"},"4":{"id":263998,"text":"Penalize or retaliate against a pharmacist or pharmacy for exercising rights provided pursuant to the provisions of this article;","type":"section","prefixes":["A","4"],"prefix":"4","entire_prefix":"A4","prefix_anchor":"A4","level":2,"prior_prefix":"A3","next_prefix":"A5"},"5":{"id":263999,"text":"Impose requirements, exclusions, reimbursement terms, or other conditions on a covered entity or contract pharmacy that differ from those applied to entities or pharmacies that are not covered entities or contract pharmacies on the basis that the entity or pharmacy is a covered entity or contract pharmacy or that the entity or pharmacy dispenses 340B-covered drugs. Nothing in this subdivision shall (i) apply to drugs with an annual estimated per-patient cost exceeding $250,000 or (ii) prohibit the identification of a 340B reimbursement request; or","type":"section","prefixes":["A","5"],"prefix":"5","entire_prefix":"A5","prefix_anchor":"A5","level":2,"prior_prefix":"A4","next_prefix":"A6"},"6":{"id":264000,"text":"Interfere with a covered individual’s right to choose a pharmacy or provider, based on the pharmacy or provider’s status as a covered entity or contract pharmacy.","type":"section","prefixes":["A","6"],"prefix":"6","entire_prefix":"A6","prefix_anchor":"A6","level":2,"prior_prefix":"A5","next_prefix":"B"},"7":{"id":264001,"text":"No carrier, on its own or through its contracted pharmacy benefits manager or representative of a pharmacy benefits manager, shall restrict participation of a pharmacy in a pharmacy network for provider accreditation standards or certification requirements if a pharmacist meets such accreditation standards or certification standards.","type":"section","prefixes":["B"],"prefix":"B","entire_prefix":"B","prefix_anchor":"B","level":1,"prior_prefix":"A6","next_prefix":"C"},"8":{"id":264002,"text":"No carrier, on its own or through its contracted pharmacy benefits manager or representative of a pharmacy benefits manager, shall include any mail order pharmacy or pharmacy benefits manager affiliate in calculating or determining network adequacy under any law or contract in the Commonwealth.","type":"section","prefixes":["C"],"prefix":"C","entire_prefix":"C","prefix_anchor":"C","level":1,"prior_prefix":"B","next_prefix":"D"},"9":{"id":264003,"text":"No carrier, on its own or through its contracted pharmacy benefits manager or representative of a pharmacy benefits manager, shall conduct spread pricing in the Commonwealth.","type":"section","prefixes":["D"],"prefix":"D","entire_prefix":"D","prefix_anchor":"D","level":1,"prior_prefix":"C","next_prefix":"E"},"10":{"id":264004,"text":"Each carrier on its own or through its contracted pharmacy benefits manager or representative of a pharmacy benefits manager shall comply with the provisions of this section in addition to complying with the provisions of § 38.2-3407.15:1.","type":"section","prefixes":["E"],"prefix":"E","entire_prefix":"E","prefix_anchor":"E","level":1,"prior_prefix":"D"}},"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}],"previous_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},"next_section":{"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},"metadata":false,"official_url":"https:\/\/law.lis.virginia.gov\/vacode\/38.2-3467\/","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 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 2022, chapter 319<\/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\/"}],"refers_to":[{"id":79973,"section_number":"38.2-3407.15:1","catch_line":"Carrier contracts with pharmacy providers; required provisions; limit on termination or nonrenewal","order_by":null,"url":"\/38.2-3407.15_1\/"}],"permalink":{"id":215625,"object_type":"law","relational_id":73357,"identifier":"38.2-3467","token":"38.2\/34\/9\/38.2-3467","url":"\/38.2-3467\/","edition_id":1,"permalink":0,"preferred":1},"url":"\/38.2-3467\/","token":"38.2\/34\/9\/38.2-3467","dublin_core":{"Title":"Prohibited conduct by carriers and pharmacy benefits managers","Type":"Text","Format":"text\/html","Identifier":"\u00a7 38.2-3467","Relation":"Code of Virginia"},"html":"\n\t\t\t\t\t\t

A.<\/span> No carrier on its own or through its contracted pharmacy benefits manager or representative of a pharmacy benefits manager shall: <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

1.<\/span> Cause or knowingly permit the use of any advertisement, promotion, solicitation, representation, proposal, or offer that is untrue; <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

2.<\/span> Charge a pharmacist or pharmacy a fee related to the adjudication of a claim other than a reasonable fee for an initial claim submission; <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

3.<\/span> Reimburse a pharmacy or pharmacist an amount less than the amount that the pharmacy benefits manager reimburses a pharmacy benefits manager affiliate for providing the same pharmacist services, calculated on a per-unit basis using the same generic product identifier or generic code number and reflecting all drug manufacturer’s rebates, direct and indirect administrative fees, and costs and any remuneration; <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

4.<\/span> Penalize or retaliate against a pharmacist or pharmacy for exercising rights provided pursuant to the provisions of this article; <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

5.<\/span> Impose requirements, exclusions, reimbursement terms, or other conditions on a covered entity or contract<\/span> pharmacy that differ from those applied to entities or pharmacies that are not covered entities or contract<\/span> pharmacies on the basis that the entity or pharmacy is a covered entity or contract<\/span> pharmacy or that the entity or pharmacy dispenses 340B-covered drugs. Nothing in this subdivision shall (i) apply to drugs with an annual estimated per-patient cost exceeding $250,000 or (ii) prohibit the identification of a 340B reimbursement request; or <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

6.<\/span> Interfere with a covered individual’s right to choose a pharmacy or provider, based on the pharmacy or provider’s status as a covered entity or contract<\/span> pharmacy. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

B.<\/span> No carrier, on its own or through its contracted pharmacy benefits manager or representative of a pharmacy benefits manager, shall restrict participation of a pharmacy in a pharmacy network for provider accreditation standards or certification requirements if a pharmacist meets such accreditation standards or certification standards. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

C.<\/span> No carrier, on its own or through its contracted pharmacy benefits manager or representative of a pharmacy benefits manager, shall include any mail order<\/span> pharmacy or pharmacy benefits manager affiliate in calculating or determining network adequacy under any law<\/span> or contract<\/span> in the Commonwealth. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

D.<\/span> No carrier, on its own or through its contracted pharmacy benefits manager or representative of a pharmacy benefits manager, shall conduct spread pricing in the Commonwealth. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

E.<\/span> Each carrier on its own or through its contracted pharmacy benefits manager or representative of a pharmacy benefits manager shall comply with the provisions of this section in addition to complying with the provisions of § 38.2-3407.15:1<\/a>. <\/i><\/a><\/p><\/section>","plain_text":" CODE OF VIRGINIA\n\nPROHIBITED CONDUCT BY CARRIERS AND PHARMACY BENEFITS MANAGERS (\u00a7 38.2-3467)\n\nA. No carrier on its own or through its contracted pharmacy benefits manager or\nrepresentative of a pharmacy benefits manager shall:\n\n 1. Cause or knowingly permit the use of any advertisement, promotion,\n solicitation, representation, proposal, or offer that is untrue;\n\n 2. Charge a pharmacist or pharmacy a fee related to the adjudication of a\n claim other than a reasonable fee for an initial claim submission;\n\n 3. Reimburse a pharmacy or pharmacist an amount less than the amount that the\n pharmacy benefits manager reimburses a pharmacy benefits manager affiliate for\n providing the same pharmacist services, calculated on a per-unit basis using\n the same generic product identifier or generic code number and reflecting all\n drug manufacturer’s rebates, direct and indirect administrative fees,\n and costs and any remuneration;\n\n 4. Penalize or retaliate against a pharmacist or pharmacy for exercising\n rights provided pursuant to the provisions of this article;\n\n 5. Impose requirements, exclusions, reimbursement terms, or other conditions\n on a covered entity or contract pharmacy that differ from those applied to\n entities or pharmacies that are not covered entities or contract pharmacies on\n the basis that the entity or pharmacy is a covered entity or contract pharmacy\n or that the entity or pharmacy dispenses 340B-covered drugs. Nothing in this\n subdivision shall (i) apply to drugs with an annual estimated per-patient cost\n exceeding $250,000 or (ii) prohibit the identification of a 340B reimbursement\n request; or\n\n 6. Interfere with a covered individual’s right to choose a pharmacy or\n provider, based on the pharmacy or provider’s status as a covered entity\n or contract pharmacy.\n\nB. No carrier, on its own or through its contracted pharmacy benefits manager or\nrepresentative of a pharmacy benefits manager, shall restrict participation of a\npharmacy in a pharmacy network for provider accreditation standards or\ncertification requirements if a pharmacist meets such accreditation standards or\ncertification standards.\n\nC. No carrier, on its own or through its contracted pharmacy benefits manager or\nrepresentative of a pharmacy benefits manager, shall include any mail order\npharmacy or pharmacy benefits manager affiliate in calculating or determining\nnetwork adequacy under any law or contract in the Commonwealth.\n\nD. No carrier, on its own or through its contracted pharmacy benefits manager or\nrepresentative of a pharmacy benefits manager, shall conduct spread pricing in\nthe Commonwealth.\n\nE. Each carrier on its own or through its contracted pharmacy benefits manager\nor representative of a pharmacy benefits manager shall comply with the\nprovisions of this section in addition to complying with the provisions of\n§ 38.2-3407.15:1.\n\nHISTORY: 2020, cc. 219, 1288; 2022, c. 319.","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}}