                                 CODE OF VIRGINIA

OPTION FOR REBATES TO ENROLLEES; PROTECTED INFORMATION (§ 38.2-3407.22)

A. As used in this section:
			&#8220;Carrier&#8221; has the same meaning as set forth in &#xA7;
38.2-3407.10; however, &#8220;carrier&#8221; also includes any person required
to be licensed pursuant to this title that offers or operates a managed care
health insurance plan subject to the requirements of Chapter 58 (&#xA7;
38.2-5800 et seq.) or that provides or arranges for the provision of health care
services, health plans, networks, or provider panels that are subject to
regulation as the business of insurance. &#8220;Carrier&#8221; also includes any
health insurance issuer that offers health insurance coverage, as defined in
&#xA7; 38.2-3431.
			&#8220;Enrollee&#8221; means any person entitled to health care services from
a carrier.
			&#8220;Health care services&#8221; means items or services furnished to any
individual for the purpose of preventing, alleviating, curing, or healing human
illness, injury, or physical disability.
			&#8220;Health plan&#8221; means any individual or group health care plan,
subscription contract, evidence of coverage, certificate, health services plan,
medical or hospital services plan, accident or sickness insurance policy or
certificate, managed care health insurance plan, or other similar certificate,
policy, contract, or arrangement, and any endorsement or rider thereto, to cover
all or a portion of the cost of persons receiving covered health care services,
that is subject to state regulation and that is required to be offered,
arranged, or issued in the Commonwealth by a carrier licensed under this title.
&#8220;Health plan&#8221; includes a state or local government employer plan.
&#8220;Health plan&#8221; does not mean (i) coverages issued pursuant to Title
XVIII of the Social Security Act, 42 U.S.C. &#xA7; 1395 et seq. (Medicare),
Title XIX of the Social Security Act, 42 U.S.C. &#xA7; 1396 et seq. (Medicaid),
Title XXI of the Social Security Act, 42 U.S.C. &#xA7; 1397aa et seq. (CHIP), 5
U.S.C. &#xA7; 8901 et seq. (federal employees), or 10 U.S.C. &#xA7; 1071 et seq.
(TRICARE) or (ii) accident only, credit or disability insurance, long-term care
insurance, TRICARE supplement, Medicare Supplement, or workers&#8217;
compensation coverages.
			&#8220;Pharmacy benefits manager&#8221; has the same meaning as set forth in
&#xA7; 38.2-3407.15:4.
			&#8220;Rebate&#8221; means (i) negotiated price concessions, including base
price concessions and reasonable estimates of any price protection rebates and
performance-based price concessions, that may accrue directly or indirectly to a
carrier, health plan, or pharmacy benefits manager during the coverage year from
a manufacturer, dispensing pharmacy, or other party in connection with the
dispensing or administration of a prescription drug and (ii) reasonable
estimates of any negotiated price concessions, fees, or other administrative
costs that are passed through, or are reasonably anticipated to be passed
through, to the carrier, health plan, or pharmacy benefits manager and serve to
reduce the liability of a carrier, health plan, or pharmacy benefits manager for
a prescription drug.

B. When contracting with a carrier or health plan to administer pharmacy
benefits, a pharmacy benefits manager shall offer the carrier or health plan the
option of extending point-of-sale rebates to enrollees of the plan.

C. The provisions of this section shall only apply to a carrier, health plan, or
pharmacy benefits manager to the extent permissible under applicable law.

D. In complying with the provisions of this section, a carrier, health plan,
pharmacy benefits manager, or its respective agents shall not publish or
otherwise reveal information regarding the actual amount of rebates a carrier,
health plan, or pharmacy benefits manager receives on a product-specific,
manufacturer-specific, or pharmacy-specific basis. Such information shall be
protected as a trade secret and shall not be public record or disclosed,
directly or indirectly. A carrier, health plan, or pharmacy benefits manager
shall require any vendor or third party with which the carrier, health plan, or
pharmacy benefits manager contracts for health care or administrative services
on behalf of the carrier, health plan, or pharmacy benefits manager that may
receive or have access to rebate information to comply with the provisions of
this subsection related to protection of information regarding the amount of
rebates a carrier, health plan, or pharmacy benefits manager receives on a
product-specific, manufacturer-specific, or pharmacy-specific basis.

E. The Commission may, pursuant to the provisions of &#xA7; 38.2-223, adopt such
rules and regulations as may be necessary to implement and enforce the
provisions of this section.

HISTORY: 2021, Sp. Sess. I, c. 304.