                                 CODE OF VIRGINIA

CARRIER PROVISION OF CERTAIN INFORMATION (§ 38.2-3407.15:7)

A. As used in this section:
			&#8220;Carrier&#8221; has the same meaning as provided in &#xA7;
38.2-3407.15.
			&#8220;Enrollee&#8221; has the same meaning as provided in &#xA7;
38.2-3407.10.
			&#8220;Pharmacy benefits manager&#8221; has the same meaning as provided in
&#xA7; 38.2-3465.
			&#8220;Provider&#8221; has the same meaning as provided in &#xA7;
38.2-3407.10.

B. Beginning July 1, 2025, any carrier or its pharmacy benefits manager shall
provide real-time patient-specific benefit information to enrollees and
contracted providers for the office visit, including any out-of-pocket costs and
more affordable medication alternatives or prior authorization requirements, and
shall ensure that the data is accurate. Such cost information data shall be
available to the provider at the point of prescribing in an accessible and
understandable format, such as through the provider&#8217;s e-prescribing system
or electronic health record system that the carrier or pharmacy benefits manager
or its designated subcontractor has adopted that utilizes the National Council
for Prescription Drug Programs SCRIPT standard and the National Council for
Prescription Drug Programs Real Time Benefit Standard from which the provider
makes the request.

HISTORY: 2023, cc. 474, 475.