{"formats":[{"name":"JSON","format":"json","url":"\/downloads\/2025\/code-json\/38.2-4209.1.json"},{"name":"Plain Text","format":"text","url":"\/downloads\/2025\/code-text\/38.2-4209.1.txt"},{"name":"XML","format":"xml","url":"\/downloads\/2025\/code-xml\/38.2-4209.1.xml"},{"name":"HTML","format":"html","url":"\/downloads\/2025\/code-html\/38.2-4209.1.html"}],"law_id":67453,"edition_id":1,"section_id":67453,"structure_id":12968,"section_number":"38.2-4209.1","catch_line":"Pharmacies; freedom of choice","history":"1994, c. 963; 1995, c. 467; 2010, cc. 157, 357; 2021, Sp. Sess. I, c. 229.","full_text":"A\n\nNotwithstanding any provision of § 38.2-4209, no corporation providing preferred provider subscription contracts or its pharmacy benefits manager, as defined in § 38.2-3465, shall prohibit any person receiving pharmaceutical benefits, including specialty pharmacy benefits, thereunder from selecting, without limitation, the pharmacy of his choice to furnish such benefits. This right of selection extends to and includes pharmacies that are nonpreferred providers and that have previously notified the corporation or its pharmacy benefits manager, by facsimile or otherwise, of their agreement to accept reimbursement for their services at rates applicable to pharmacies that are preferred providers, including any copayment consistently imposed by the corporation, as payment in full. Each corporation or its pharmacy benefits manager shall permit prompt electronic or telephonic transmittal of the reimbursement agreement by the pharmacy and ensure payment verification to the pharmacy of the terms of reimbursement. In no event shall any person receiving a covered pharmacy benefit from a nonpreferred provider that has submitted a reimbursement agreement be responsible for amounts that may be charged by the nonpreferred provider in excess of the copayment and the corporation’s reimbursement applicable to all of its preferred pharmacy providers.B\n\nNo such corporation or its pharmacy benefits manager shall impose upon any person receiving pharmaceutical benefits furnished under any such 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 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 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 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 providers.D\n\nAny pharmacy that wishes to be covered by this section shall, if requested to do so in writing by a corporation or its pharmacy benefits manager, within 30 days of the pharmacy’s receipt of the request, execute and deliver to the corporation or its pharmacy benefits manager the direct service agreement or preferred provider agreement that the corporation requires all of its preferred 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 corporation 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 any 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 a corporation 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 corporation 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 a corporation issuing preferred 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":244411,"text":"Notwithstanding any provision of § 38.2-4209, no corporation providing preferred provider subscription contracts or its pharmacy benefits manager, as defined in § 38.2-3465, shall prohibit any person receiving pharmaceutical benefits, including specialty pharmacy benefits, thereunder from selecting, without limitation, the pharmacy of his choice to furnish such benefits. This right of selection extends to and includes pharmacies that are nonpreferred providers and that have previously notified the corporation or its pharmacy benefits manager, by facsimile or otherwise, of their agreement to accept reimbursement for their services at rates applicable to pharmacies that are preferred providers, including any copayment consistently imposed by the corporation, as payment in full. Each corporation or its pharmacy benefits manager shall permit prompt electronic or telephonic transmittal of the reimbursement agreement by the pharmacy and ensure payment verification to the pharmacy of the terms of reimbursement. In no event shall any person receiving a covered pharmacy benefit from a nonpreferred provider that has submitted a reimbursement agreement be responsible for amounts that may be charged by the nonpreferred provider in excess of the copayment and the corporation’s reimbursement applicable to all of its preferred pharmacy providers.","type":"section","prefixes":["A"],"prefix":"A","entire_prefix":"A","prefix_anchor":"A","level":1,"next_prefix":"B"},"1":{"id":244412,"text":"No such corporation or its pharmacy benefits manager shall impose upon any person receiving pharmaceutical benefits furnished under any such contract:","type":"section","prefixes":["B"],"prefix":"B","entire_prefix":"B","prefix_anchor":"B","level":1,"prior_prefix":"A","next_prefix":"B1"},"2":{"id":244413,"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 providers;","type":"section","prefixes":["B","1"],"prefix":"1","entire_prefix":"B1","prefix_anchor":"B1","level":2,"prior_prefix":"B","next_prefix":"B2"},"3":{"id":244414,"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":244415,"text":"Any reduction in allowable reimbursement for pharmacy services related to utilization of pharmacists who are nonpreferred providers.","type":"section","prefixes":["B","3"],"prefix":"3","entire_prefix":"B3","prefix_anchor":"B3","level":2,"prior_prefix":"B2","next_prefix":"C"},"5":{"id":244416,"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 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 providers.","type":"section","prefixes":["C"],"prefix":"C","entire_prefix":"C","prefix_anchor":"C","level":1,"prior_prefix":"B3","next_prefix":"D"},"6":{"id":244417,"text":"Any pharmacy that wishes to be covered by this section shall, if requested to do so in writing by a corporation or its pharmacy benefits manager, within 30 days of the pharmacy’s receipt of the request, execute and deliver to the corporation or its pharmacy benefits manager the direct service agreement or preferred provider agreement that the corporation requires all of its preferred 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 corporation 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 any 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 a corporation 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 corporation 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":244418,"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":244419,"text":"Nothing in this section shall limit the authority of a corporation issuing preferred 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":12968,"edition_id":1,"name":"In General","identifier":"1","label":"article","depth":3,"order_by":1,"parent_id":12967,"metadata":{},"date_created":"2026-06-26 03:44:05","date_modified":"2026-06-26 03:44:05","permalink":{"id":216659,"object_type":"structure","relational_id":12968,"identifier":"1","token":"38.2\/42\/1","url":"\/38.2\/42\/1\/","edition_id":1,"permalink":0,"preferred":1}},{"id":12967,"edition_id":1,"name":"Health Services Plans","identifier":"42","label":"chapter","depth":2,"order_by":1,"parent_id":12698,"metadata":{},"date_created":"2026-06-26 03:44:05","date_modified":"2026-06-26 03:44:05","permalink":{"id":216657,"object_type":"structure","relational_id":12967,"identifier":"42","token":"38.2\/42","url":"\/38.2\/42\/","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":78890,"structure_id":12968,"section_number":"38.2-4200","catch_line":"Applicability of chapter","url":"\/38.2-4200\/","token":"38.2\/42\/1\/38.2-4200","metadata":false},{"id":76897,"structure_id":12968,"section_number":"38.2-4201","catch_line":"Definitions","url":"\/38.2-4201\/","token":"38.2\/42\/1\/38.2-4201","metadata":false},{"id":71531,"structure_id":12968,"section_number":"38.2-4202","catch_line":"Hospital services plans","url":"\/38.2-4202\/","token":"38.2\/42\/1\/38.2-4202","metadata":false},{"id":80676,"structure_id":12968,"section_number":"38.2-4203","catch_line":"Medical or surgical services plans","url":"\/38.2-4203\/","token":"38.2\/42\/1\/38.2-4203","metadata":false},{"id":68874,"structure_id":12968,"section_number":"38.2-4204","catch_line":"Merger of nonstock corporations","url":"\/38.2-4204\/","token":"38.2\/42\/1\/38.2-4204","metadata":false},{"id":59642,"structure_id":12968,"section_number":"38.2-4204.1","catch_line":"Commission approval of mergers of nonstock corporations operating prepaid hospital, medical and surgical services plans","url":"\/38.2-4204.1\/","token":"38.2\/42\/1\/38.2-4204.1","metadata":false},{"id":54058,"structure_id":12968,"section_number":"38.2-4205","catch_line":"Dental and optometric services","url":"\/38.2-4205\/","token":"38.2\/42\/1\/38.2-4205","metadata":false},{"id":70123,"structure_id":12968,"section_number":"38.2-4206","catch_line":"Nonstock corporation required","url":"\/38.2-4206\/","token":"38.2\/42\/1\/38.2-4206","metadata":false},{"id":84087,"structure_id":12968,"section_number":"38.2-4207","catch_line":"Existing foreign nonstock corporation","url":"\/38.2-4207\/","token":"38.2\/42\/1\/38.2-4207","metadata":false},{"id":61631,"structure_id":12968,"section_number":"38.2-4208","catch_line":"Nonstock corporation not required to act as agent","url":"\/38.2-4208\/","token":"38.2\/42\/1\/38.2-4208","metadata":false},{"id":80669,"structure_id":12968,"section_number":"38.2-4209","catch_line":"Preferred provider subscription contracts","url":"\/38.2-4209\/","token":"38.2\/42\/1\/38.2-4209","metadata":false},{"id":67453,"structure_id":12968,"section_number":"38.2-4209.1","catch_line":"Pharmacies; freedom of choice","url":"\/38.2-4209.1\/","token":"38.2\/42\/1\/38.2-4209.1","metadata":false},{"id":79670,"structure_id":12968,"section_number":"38.2-4209.2","catch_line":"Repealed","url":"\/38.2-4209.2\/","token":"38.2\/42\/1\/38.2-4209.2","metadata":false},{"id":65462,"structure_id":12968,"section_number":"38.2-4210","catch_line":"Liability of participants","url":"\/38.2-4210\/","token":"38.2\/42\/1\/38.2-4210","metadata":false},{"id":65554,"structure_id":12968,"section_number":"38.2-4211","catch_line":"Change of participants","url":"\/38.2-4211\/","token":"38.2\/42\/1\/38.2-4211","metadata":false},{"id":80058,"structure_id":12968,"section_number":"38.2-4212","catch_line":"Board of directors of nonstock corporation operating plan","url":"\/38.2-4212\/","token":"38.2\/42\/1\/38.2-4212","metadata":false},{"id":57906,"structure_id":12968,"section_number":"38.2-4213","catch_line":"Liability of participating providers upon merger of nonstock corporation","url":"\/38.2-4213\/","token":"38.2\/42\/1\/38.2-4213","metadata":false},{"id":55347,"structure_id":12968,"section_number":"38.2-4214","catch_line":"Application of certain provisions of law","url":"\/38.2-4214\/","token":"38.2\/42\/1\/38.2-4214","metadata":false},{"id":70935,"structure_id":12968,"section_number":"38.2-4214.1","catch_line":"Rehabilitation, liquidation, conservation","url":"\/38.2-4214.1\/","token":"38.2\/42\/1\/38.2-4214.1","metadata":false},{"id":69479,"structure_id":12968,"section_number":"38.2-4215","catch_line":"Payments by nonstock corporation","url":"\/38.2-4215\/","token":"38.2\/42\/1\/38.2-4215","metadata":false},{"id":83790,"structure_id":12968,"section_number":"38.2-4216","catch_line":"Repealed","url":"\/38.2-4216\/","token":"38.2\/42\/1\/38.2-4216","metadata":false},{"id":75758,"structure_id":12968,"section_number":"38.2-4216.1","catch_line":"Repealed","url":"\/38.2-4216.1\/","token":"38.2\/42\/1\/38.2-4216.1","metadata":false},{"id":76300,"structure_id":12968,"section_number":"38.2-4217","catch_line":"Reports","url":"\/38.2-4217\/","token":"38.2\/42\/1\/38.2-4217","metadata":false},{"id":73797,"structure_id":12968,"section_number":"38.2-4218","catch_line":"Subscriber to have free choice of medical practitioners available","url":"\/38.2-4218\/","token":"38.2\/42\/1\/38.2-4218","metadata":false},{"id":73334,"structure_id":12968,"section_number":"38.2-4219","catch_line":"Subscriber to be advised in writing as to benefits and limitations thereon","url":"\/38.2-4219\/","token":"38.2\/42\/1\/38.2-4219","metadata":false},{"id":57164,"structure_id":12968,"section_number":"38.2-4220","catch_line":"Interplan arrangements","url":"\/38.2-4220\/","token":"38.2\/42\/1\/38.2-4220","metadata":false},{"id":74708,"structure_id":12968,"section_number":"38.2-4221","catch_line":"Services of certain practitioners other than physicians to be covered","url":"\/38.2-4221\/","token":"38.2\/42\/1\/38.2-4221","metadata":false},{"id":70849,"structure_id":12968,"section_number":"38.2-4222","catch_line":"Licensing of nonstock corporations","url":"\/38.2-4222\/","token":"38.2\/42\/1\/38.2-4222","metadata":false},{"id":68899,"structure_id":12968,"section_number":"38.2-4223","catch_line":"Renewal of license","url":"\/38.2-4223\/","token":"38.2\/42\/1\/38.2-4223","metadata":false},{"id":63881,"structure_id":12968,"section_number":"38.2-4224","catch_line":"Licensing of agents","url":"\/38.2-4224\/","token":"38.2\/42\/1\/38.2-4224","metadata":false},{"id":75183,"structure_id":12968,"section_number":"38.2-4225","catch_line":"Repealed","url":"\/38.2-4225\/","token":"38.2\/42\/1\/38.2-4225","metadata":false},{"id":61125,"structure_id":12968,"section_number":"38.2-4226","catch_line":"Taxation","url":"\/38.2-4226\/","token":"38.2\/42\/1\/38.2-4226","metadata":false},{"id":78423,"structure_id":12968,"section_number":"38.2-4227","catch_line":"Misleading applications or contracts","url":"\/38.2-4227\/","token":"38.2\/42\/1\/38.2-4227","metadata":false},{"id":68671,"structure_id":12968,"section_number":"38.2-4228","catch_line":"Controversies involving subscription contracts","url":"\/38.2-4228\/","token":"38.2\/42\/1\/38.2-4228","metadata":false},{"id":60792,"structure_id":12968,"section_number":"38.2-4229","catch_line":"Reinsurance","url":"\/38.2-4229\/","token":"38.2\/42\/1\/38.2-4229","metadata":false},{"id":86012,"structure_id":12968,"section_number":"38.2-4229.1","catch_line":"Conversion to domestic mutual insurer","url":"\/38.2-4229.1\/","token":"38.2\/42\/1\/38.2-4229.1","metadata":false},{"id":82144,"structure_id":12968,"section_number":"38.2-4229.2","catch_line":"Hearings and investigations on effect of other state's law","url":"\/38.2-4229.2\/","token":"38.2\/42\/1\/38.2-4229.2","metadata":false}],"previous_section":{"id":80669,"structure_id":12968,"section_number":"38.2-4209","catch_line":"Preferred provider subscription contracts","url":"\/38.2-4209\/","token":"38.2\/42\/1\/38.2-4209","metadata":false},"next_section":{"id":79670,"structure_id":12968,"section_number":"38.2-4209.2","catch_line":"Repealed","url":"\/38.2-4209.2\/","token":"38.2\/42\/1\/38.2-4209.2","metadata":false},"metadata":false,"official_url":"https:\/\/law.lis.virginia.gov\/vacode\/38.2-4209.1\/","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 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 1995, chapter 467<\/a>; in 2010, chapters 157<\/a> and 357<\/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\/"}],"refers_to":[{"id":60000,"section_number":"38.2-3465","catch_line":"Definitions","order_by":null,"url":"\/38.2-3465\/"},{"id":80669,"section_number":"38.2-4209","catch_line":"Preferred provider subscription contracts","order_by":null,"url":"\/38.2-4209\/"}],"permalink":{"id":216705,"object_type":"law","relational_id":67453,"identifier":"38.2-4209.1","token":"38.2\/42\/1\/38.2-4209.1","url":"\/38.2-4209.1\/","edition_id":1,"permalink":0,"preferred":1},"url":"\/38.2-4209.1\/","token":"38.2\/42\/1\/38.2-4209.1","dublin_core":{"Title":"Pharmacies; freedom of choice","Type":"Text","Format":"text\/html","Identifier":"\u00a7 38.2-4209.1","Relation":"Code of Virginia"},"html":"\n\t\t\t\t\t\t

A.<\/span> Notwithstanding any provision of § 38.2-4209<\/a>, no corporation providing preferred provider subscription contracts<\/span> or its pharmacy benefits manager, as defined in § 38.2-3465<\/a>, shall prohibit any person<\/span> receiving pharmaceutical benefits, including specialty pharmacy benefits, thereunder from selecting, without limitation, the pharmacy of his choice to furnish such benefits. This right of selection extends to and includes pharmacies that are nonpreferred providers and that have previously notified the corporation or its pharmacy benefits manager, by facsimile or otherwise, of their agreement to accept reimbursement for their services at rates<\/span><\/span> applicable to pharmacies that are preferred providers, including any copayment consistently imposed by the corporation, as payment in full. Each corporation or its pharmacy benefits manager shall permit prompt electronic or telephonic transmittal of the reimbursement agreement by the pharmacy and ensure payment verification to the pharmacy of the terms of reimbursement. In no event shall any person<\/span> receiving a covered pharmacy benefit from a nonpreferred provider that has submitted a reimbursement agreement be responsible for amounts that may be charged by the nonpreferred provider in excess of the copayment and the corporation’s reimbursement applicable to all of its preferred pharmacy providers. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

B.<\/span> No such corporation or its pharmacy benefits manager shall impose upon any person<\/span> receiving pharmaceutical benefits furnished under any such 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 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 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 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 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 a corporation or its pharmacy benefits manager, within 30 days of the pharmacy’s receipt of the request, execute and deliver to the corporation or its pharmacy benefits manager the direct service agreement or preferred provider agreement that the corporation requires all of its preferred 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 corporation 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 any 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 a corporation 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 corporation 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 a corporation issuing preferred provider policies or contracts 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. 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 38.2-4209.1)\n\nA. Notwithstanding any provision of § 38.2-4209, no corporation providing\npreferred provider subscription contracts or its pharmacy benefits manager, as\ndefined in § 38.2-3465, shall prohibit any person receiving pharmaceutical\nbenefits, including specialty pharmacy benefits, thereunder from selecting,\nwithout limitation, the pharmacy of his choice to furnish such benefits. This\nright of selection extends to and includes pharmacies that are nonpreferred\nproviders and that have previously notified the corporation or its pharmacy\nbenefits manager, by facsimile or otherwise, of their agreement to accept\nreimbursement for their services at rates applicable to pharmacies that are\npreferred providers, including any copayment consistently imposed by the\ncorporation, as payment in full. Each corporation or its pharmacy benefits\nmanager shall permit prompt electronic or telephonic transmittal of the\nreimbursement agreement by the pharmacy and ensure payment verification to the\npharmacy of the terms of reimbursement. In no event shall any person receiving a\ncovered pharmacy benefit from a nonpreferred provider that has submitted a\nreimbursement agreement be responsible for amounts that may be charged by the\nnonpreferred provider in excess of the copayment and the corporation’s\nreimbursement applicable to all of its preferred pharmacy providers.\n\nB. No such corporation or its pharmacy benefits manager shall impose upon any\nperson receiving pharmaceutical benefits furnished under any such 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 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 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 provider and that has complied with\nsubsection D or (ii) requiring a person receiving pharmacy benefits to make\npayment at point of service, except to the extent such conditions and penalties\nare similarly imposed on preferred providers.\n\nD. Any pharmacy that wishes to be covered by this section shall, if requested to\ndo so in writing by a corporation or its pharmacy benefits manager, within 30\ndays of the pharmacy’s receipt of the request, execute and deliver to the\ncorporation or its pharmacy benefits manager the direct service agreement or\npreferred provider agreement that the corporation requires all of its preferred\nproviders of pharmacy benefits to execute. Any pharmacy that fails to timely\nexecute and deliver such agreement shall not be covered by this section with\nrespect to that corporation or its pharmacy benefits manager unless and until\nthe pharmacy executes and delivers the agreement. No pharmacy shall be precluded\nfrom obtaining a direct service agreement or participating provider agreement\nfor any retail and specialty pharmacy if the pharmacy meets the terms and\nconditions of participation. Any request by a pharmacy for a direct service\nagreement or a participating provider agreement shall be acted upon by a\ncorporation or its pharmacy benefits manager within 60 days of receipt of the\npharmacy’s request or any subsequent submission of supplemental\ninformation if requested by the corporation or its pharmacy benefits manager.\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 a corporation issuing\npreferred provider policies or contracts to select a single mail order pharmacy\nprovider as the exclusive provider of pharmacy services that are delivered to\nthe covered person’s address by mail, common carrier, or delivery service.\nThe provisions of this section shall not apply to such contracts. As used in\nthis subsection, “mail order pharmacy provider” means a pharmacy\npermitted to conduct business in the Commonwealth whose primary business is to\ndispense a prescription drug or device under a prescriptive drug order and to\ndeliver the drug or device to a patient primarily by mail, common carrier, or\ndelivery service.\n\nHISTORY: 1994, c. 963; 1995, c. 467; 2010, cc. 157, 357; 2021, Sp. Sess. I, c.\n229.","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}}