                                 CODE OF VIRGINIA

DEFINITIONS (§ 38.2-3465)

A. As used in this article, unless the context requires a different meaning:
			&#8220;Aggregate retained rebate percentage&#8221; means the sum total dollar
amount of a pharmacy benefits manager&#8217;s retained rebates relating to all
carrier clients of such pharmacy benefits manager divided by the sum total
dollar amount of all rebates received by such pharmacy benefits manager relating
to all such clients.
			&#8220;Carrier&#8221; has the same meaning ascribed thereto in subsection A
of &#xA7; 38.2-3407.15. However, &#8220;carrier&#8221; does not include a
nonprofit health maintenance organization that operates as a group model whose
internal pharmacy operation exclusively serves the members or patients of the
nonprofit health maintenance organization.
			&#8220;Claim&#8221; means a request from a pharmacy or pharmacist to be
reimbursed for the cost of administering, filling, or refilling a prescription
for a drug or for providing a medical supply or device.
			&#8220;Claims processing services&#8221; means the administrative services
performed in connection with the processing and adjudicating of claims relating
to pharmacist services that include (i) receiving payments for pharmacist
services, (ii) making payments to pharmacists or pharmacies for pharmacist
services, or (iii) both receiving and making payments.
			&#8220;Contract pharmacy&#8221; means a pharmacy operating under contract
with a 340B-covered entity to provide dispensing services to the 340B-covered
entity, as described in 75 Fed. Reg. 10272 (March 5, 2010) or any superseding
guidance published thereafter.
			&#8220;Covered entity&#8221; means an entity described in &#xA7; 340B(a)(4)
of the federal Public Health Service Act, 42 U.S.C. &#xA7; 256B(a)(4).
			&#8220;Covered individual&#8221; means an individual receiving prescription
medication coverage or reimbursement provided by a pharmacy benefits manager or
a carrier under a health benefit plan.
			&#8220;Health benefit plan&#8221; has the same meaning ascribed thereto in
&#xA7; 38.2-3438.
			&#8220;Mail order pharmacy&#8221; means a pharmacy whose primary business is
to receive prescriptions by mail or through electronic submissions and to
dispense medication to covered individuals through the use of the United States
mail or other common or contract carrier services and that provides any
consultation with covered individuals electronically rather than face-to-face.
			&#8220;Pharmacy benefits management&#8221; means the administration or
management of prescription drug benefits provided by a carrier for the benefit
of covered individuals. &#8220;Pharmacy benefits management&#8221; does not
include any service provided by a nonprofit health maintenance organization that
operates as a group model provided that the service is furnished through the
internal pharmacy operation exclusively serves the members or patients of the
nonprofit health maintenance organization.
			&#8220;Pharmacy benefits manager&#8221; or &#8220;PBM&#8221; means an entity
that performs pharmacy benefits management. &#8220;Pharmacy benefits
manager&#8221; includes an entity acting for a PBM in a contractual relationship
in the performance of pharmacy benefits management for a carrier, nonprofit
hospital, or third-party payor under a health program administered by the
Commonwealth.
			&#8220;Pharmacy benefits manager affiliate&#8221; means a business, pharmacy,
or pharmacist that directly or indirectly, through one or more intermediaries,
owns or controls, is owned or controlled by, or is under common ownership
interest or control with a pharmacy benefits manager.
			&#8220;Rebate&#8221; means a discount or other price concession, including
without limitation incentives, disbursements, and reasonable estimates of a
volume-based discount, or a payment that is (i) based on utilization of a
prescription drug and (ii) paid by a manufacturer or third party, directly or
indirectly, to a pharmacy benefits manager, pharmacy services administrative
organization, or pharmacy after a claim has been processed and paid at a
pharmacy.
			&#8220;Retail community pharmacy&#8221; means a pharmacy that is open to the
public, serves walk-in customers, and makes available face-to-face consultations
between licensed pharmacists and persons to whom medications are dispensed.
			&#8220;Retained rebate&#8221; means a rebate that is not passed on to a
health benefit plan.
			&#8220;Retained rebate percentage&#8221; means the sum total dollar amount of
a pharmacy benefits manager&#8217;s retained rebates relating to a health
benefit plan divided by the sum total dollar amount of all rebates received by
such pharmacy benefits manager relating to such health benefit plan.
			&#8220;Spread pricing&#8221; means the model of prescription drug pricing in
which the pharmacy benefits manager charges a health benefit plan a contracted
price for prescription drugs, and the contracted price for the prescription
drugs differs from the amount the pharmacy benefits manager directly or
indirectly pays the pharmacist or pharmacy for pharmacist services.

HISTORY: 2020, cc. 219, 1288; 2022, c. 319; 2024, cc. 329, 626; 2025, cc. 413,
429.