{"formats":[{"name":"JSON","format":"json","url":"\/downloads\/2025\/code-json\/38.2-3468.json"},{"name":"Plain Text","format":"text","url":"\/downloads\/2025\/code-text\/38.2-3468.txt"},{"name":"XML","format":"xml","url":"\/downloads\/2025\/code-xml\/38.2-3468.xml"},{"name":"HTML","format":"html","url":"\/downloads\/2025\/code-html\/38.2-3468.html"}],"law_id":79303,"edition_id":1,"section_id":79303,"structure_id":15137,"section_number":"38.2-3468","catch_line":"Examination of books and records; reports; access to records","history":"2020, cc. 219, 1288; 2022, c. 283; 2024, cc. 329, 626.","full_text":"A\n\nEach carrier, on its own or through its contract for pharmacy benefits, shall ensure that the Commissioner may examine or audit the books and records of a pharmacy benefits manager providing claims processing services or other prescription drug or device services for a carrier that are relevant to determining if the pharmacy benefits manager is in compliance with this article. The carrier shall be responsible for the charges incurred in the examination, including the expenses of the Commissioner or his designee and the expenses and compensation of his examiners and assistants.B\n\nEach carrier, on its own or through its contract for pharmacy benefits, shall report the following information to the Commissioner for each health benefit plan:1\n\nThe aggregate amount of rebates received by the pharmacy benefits manager;2\n\nThe aggregate amount of rebates distributed to the appropriate health benefit plan;3\n\nThe aggregate amount of rebates passed on to the enrollees of each health benefit plan at the point of sale that reduced the enrollees’ applicable deductible, copayment, coinsurance, or other cost-sharing amount;4\n\nThe aggregate amount of the pharmacy benefits manager’s retained rebates;5\n\nThe pharmacy benefits manager’s aggregate retained rebate percentage;6\n\nThe aggregate amount of administrative fees received by the pharmacy benefits manager;7\n\nUpon the request of the Commission, the individual and aggregate amount paid by the health benefit plan to the pharmacy benefits manager for services itemized by pharmacy, by product, and by goods and services; and8\n\nUpon the request of the Commission, the individual and aggregate amount a pharmacy benefits manager paid for services itemized by pharmacy, by product, and by goods and services.\n\t\t\t\tThe report required by this subsection shall be filed on a quarterly basis through March 31, 2023. The final quarterly report shall include information for the period ending December 31, 2022. Thereafter, by March 31 of each year, the report shall be filed on a calendar year basis. The 2023 calendar year report shall be filed by March 31, 2024.C\n\nAll working papers, documents, reports, and copies thereof, produced by, obtained by or disclosed to the Commission or any other person in the course of an examination made under this article and any analysis of such information or documents shall be given confidential treatment, are not subject to subpoena, and may not be made public by the Commission or any other person. Access may also be granted to (i) a regulatory official of any state or country; (ii) the National Association of Insurance Commissioners (NAIC), its affiliate, or its subsidiary; or (iii) a law-enforcement authority of any state or country, provided that those officials are required under their law to maintain its confidentiality. Any such disclosure by the Commission shall not constitute a waiver of confidentiality of such papers, documents, reports or copies thereof. Any parties receiving such papers must agree in writing prior to receiving the information to provide to it the same confidential treatment as required by this section.","order_by":null,"text":{"0":{"id":283914,"text":"Each carrier, on its own or through its contract for pharmacy benefits, shall ensure that the Commissioner may examine or audit the books and records of a pharmacy benefits manager providing claims processing services or other prescription drug or device services for a carrier that are relevant to determining if the pharmacy benefits manager is in compliance with this article. The carrier shall be responsible for the charges incurred in the examination, including the expenses of the Commissioner or his designee and the expenses and compensation of his examiners and assistants.","type":"section","prefixes":["A"],"prefix":"A","entire_prefix":"A","prefix_anchor":"A","level":1,"next_prefix":"B"},"1":{"id":283915,"text":"Each carrier, on its own or through its contract for pharmacy benefits, shall report the following information to the Commissioner for each health benefit plan:","type":"section","prefixes":["B"],"prefix":"B","entire_prefix":"B","prefix_anchor":"B","level":1,"prior_prefix":"A","next_prefix":"B1"},"2":{"id":283916,"text":"The aggregate amount of rebates received by the pharmacy benefits manager;","type":"section","prefixes":["B","1"],"prefix":"1","entire_prefix":"B1","prefix_anchor":"B1","level":2,"prior_prefix":"B","next_prefix":"B2"},"3":{"id":283917,"text":"The aggregate amount of rebates distributed to the appropriate health benefit plan;","type":"section","prefixes":["B","2"],"prefix":"2","entire_prefix":"B2","prefix_anchor":"B2","level":2,"prior_prefix":"B1","next_prefix":"B3"},"4":{"id":283918,"text":"The aggregate amount of rebates passed on to the 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":["B","3"],"prefix":"3","entire_prefix":"B3","prefix_anchor":"B3","level":2,"prior_prefix":"B2","next_prefix":"B4"},"5":{"id":283919,"text":"The aggregate amount of the pharmacy benefits manager’s retained rebates;","type":"section","prefixes":["B","4"],"prefix":"4","entire_prefix":"B4","prefix_anchor":"B4","level":2,"prior_prefix":"B3","next_prefix":"B5"},"6":{"id":283920,"text":"The pharmacy benefits manager’s aggregate retained rebate percentage;","type":"section","prefixes":["B","5"],"prefix":"5","entire_prefix":"B5","prefix_anchor":"B5","level":2,"prior_prefix":"B4","next_prefix":"B6"},"7":{"id":283921,"text":"The aggregate amount of administrative fees received by the pharmacy benefits manager;","type":"section","prefixes":["B","6"],"prefix":"6","entire_prefix":"B6","prefix_anchor":"B6","level":2,"prior_prefix":"B5","next_prefix":"B7"},"8":{"id":283922,"text":"Upon the request of the Commission, the individual and aggregate amount paid by the health benefit plan to the pharmacy benefits manager for services itemized by pharmacy, by product, and by goods and services; and","type":"section","prefixes":["B","7"],"prefix":"7","entire_prefix":"B7","prefix_anchor":"B7","level":2,"prior_prefix":"B6","next_prefix":"B8"},"9":{"id":283923,"text":"Upon the request of the Commission, the individual and aggregate amount a pharmacy benefits manager paid for services itemized by pharmacy, by product, and by goods and services.\n\t\t\t\tThe report required by this subsection shall be filed on a quarterly basis through March 31, 2023. The final quarterly report shall include information for the period ending December 31, 2022. Thereafter, by March 31 of each year, the report shall be filed on a calendar year basis. The 2023 calendar year report shall be filed by March 31, 2024.","type":"section","prefixes":["B","8"],"prefix":"8","entire_prefix":"B8","prefix_anchor":"B8","level":2,"prior_prefix":"B7","next_prefix":"C"},"10":{"id":283924,"text":"All working papers, documents, reports, and copies thereof, produced by, obtained by or disclosed to the Commission or any other person in the course of an examination made under this article and any analysis of such information or documents shall be given confidential treatment, are not subject to subpoena, and may not be made public by the Commission or any other person. Access may also be granted to (i) a regulatory official of any state or country; (ii) the National Association of Insurance Commissioners (NAIC), its affiliate, or its subsidiary; or (iii) a law-enforcement authority of any state or country, provided that those officials are required under their law to maintain its confidentiality. Any such disclosure by the Commission shall not constitute a waiver of confidentiality of such papers, documents, reports or copies thereof. Any parties receiving such papers must agree in writing prior to receiving the information to provide to it the same confidential treatment as required by this section.","type":"section","prefixes":["C"],"prefix":"C","entire_prefix":"C","prefix_anchor":"C","level":1,"prior_prefix":"B8"}},"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":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},"next_section":{"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},"metadata":false,"official_url":"https:\/\/law.lis.virginia.gov\/vacode\/38.2-3468\/","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 2 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 283<\/a>; in 2024, chapters 329<\/a> and 626<\/a>.<\/p>","references":false,"refers_to":false,"permalink":{"id":215629,"object_type":"law","relational_id":79303,"identifier":"38.2-3468","token":"38.2\/34\/9\/38.2-3468","url":"\/38.2-3468\/","edition_id":1,"permalink":0,"preferred":1},"url":"\/38.2-3468\/","token":"38.2\/34\/9\/38.2-3468","dublin_core":{"Title":"Examination of books and records; reports; access to records","Type":"Text","Format":"text\/html","Identifier":"\u00a7 38.2-3468","Relation":"Code of Virginia"},"html":"\n\t\t\t\t\t\t

A.<\/span> Each carrier, on its own or through its contract<\/span> for pharmacy benefits, shall ensure that the Commissioner<\/span> may examine or audit the books and records of a pharmacy benefits manager providing claims processing services or other prescription drug or device services for a carrier that are relevant to determining if the pharmacy benefits manager is in compliance with this article. The carrier shall be responsible for the charges incurred in the examination, including the expenses of the Commissioner<\/span> or his designee and the expenses and compensation of his examiners and assistants. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

B.<\/span> Each carrier, on its own or through its contract<\/span> for pharmacy benefits, shall report the following information to the Commissioner<\/span> for each health benefit plan: <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

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

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

3.<\/span> The aggregate amount of rebates passed on to the enrollees of each health benefit plan 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

4.<\/span> The aggregate amount of the pharmacy benefits manager’s retained rebates; <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

5.<\/span> The pharmacy benefits manager’s aggregate retained rebate percentage; <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

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

7.<\/span> Upon the request of the Commission<\/span>, the individual and aggregate amount paid by the health benefit plan to the pharmacy benefits manager for services itemized by pharmacy, by product, and by goods and services; and <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

8.<\/span> Upon the request of the Commission<\/span>, the individual and aggregate amount a pharmacy benefits manager paid for services itemized by pharmacy, by product, and by goods and services.\n\t\t\t\tThe report required by this subsection shall be filed on a quarterly basis through March 31, 2023. The final quarterly report shall include information for the period ending December 31, 2022. Thereafter, by March 31 of each year, the report shall be filed on a calendar year basis. The 2023 calendar year report shall be filed by March 31, 2024. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

C.<\/span> All working papers, documents, reports, and copies thereof, produced by, obtained by or disclosed to the Commission<\/span> or any other person<\/span> in the course of an examination made under this article and any analysis of such information or documents shall be given confidential treatment, are not subject to subpoena<\/span>, and may not be made public by the Commission<\/span> or any other person<\/span>. Access may also be granted to (i) a regulatory official of any state<\/span> or country; (ii) the National Association of Insurance<\/span> Commissioners<\/span> (NAIC), its affiliate, or its subsidiary; or (iii) a law<\/span>-enforcement authority of any state<\/span> or country, provided that those officials are required under their law<\/span> to maintain its confidentiality. Any such disclosure by the Commission<\/span> shall not constitute a waiver<\/span> of confidentiality of such papers, documents, reports or copies thereof. Any parties receiving such papers must agree in writing prior to receiving the information to provide to it the same confidential treatment as required by this section. <\/i><\/a><\/p><\/section>","plain_text":" CODE OF VIRGINIA\n\nEXAMINATION OF BOOKS AND RECORDS; REPORTS; ACCESS TO RECORDS (\u00a7 38.2-3468)\n\nA. Each carrier, on its own or through its contract for pharmacy benefits, shall\nensure that the Commissioner may examine or audit the books and records of a\npharmacy benefits manager providing claims processing services or other\nprescription drug or device services for a carrier that are relevant to\ndetermining if the pharmacy benefits manager is in compliance with this article.\nThe carrier shall be responsible for the charges incurred in the examination,\nincluding the expenses of the Commissioner or his designee and the expenses and\ncompensation of his examiners and assistants.\n\nB. Each carrier, on its own or through its contract for pharmacy benefits, shall\nreport the following information to the Commissioner for each health benefit\nplan:\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 appropriate health\n benefit plan;\n\n 3. The aggregate amount of rebates passed on to the 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\n 4. The aggregate amount of the pharmacy benefits manager’s retained\n rebates;\n\n 5. The pharmacy benefits manager’s aggregate retained rebate percentage;\n\n 6. The aggregate amount of administrative fees received by the pharmacy\n benefits manager;\n\n 7. Upon the request of the Commission, the individual and aggregate amount\n paid by the health benefit plan to the pharmacy benefits manager for services\n itemized by pharmacy, by product, and by goods and services; and\n\n 8. Upon the request of the Commission, the individual and aggregate amount a\n pharmacy benefits manager paid for services itemized by pharmacy, by product,\n and by goods and services.\n \t\t\t\tThe report required by this subsection shall be filed on a quarterly basis\n through March 31, 2023. The final quarterly report shall include information\n for the period ending December 31, 2022. Thereafter, by March 31 of each year,\n the report shall be filed on a calendar year basis. The 2023 calendar year\n report shall be filed by March 31, 2024.\n\nC. All working papers, documents, reports, and copies thereof, produced by,\nobtained by or disclosed to the Commission or any other person in the course of\nan examination made under this article and any analysis of such information or\ndocuments shall be given confidential treatment, are not subject to subpoena,\nand may not be made public by the Commission or any other person. Access may\nalso be granted to (i) a regulatory official of any state or country; (ii) the\nNational Association of Insurance Commissioners (NAIC), its affiliate, or its\nsubsidiary; or (iii) a law-enforcement authority of any state or country,\nprovided that those officials are required under their law to maintain its\nconfidentiality. Any such disclosure by the Commission shall not constitute a\nwaiver of confidentiality of such papers, documents, reports or copies thereof.\nAny parties receiving such papers must agree in writing prior to receiving the\ninformation to provide to it the same confidential treatment as required by this\nsection.\n\nHISTORY: 2020, cc. 219, 1288; 2022, c. 283; 2024, cc. 329, 626.","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}}