                                 CODE OF VIRGINIA

PROHIBITED CONDUCT BY CARRIERS AND PHARMACY BENEFITS MANAGERS (§ 38.2-3467)

A. No carrier on its own or through its contracted pharmacy benefits manager or
representative of a pharmacy benefits manager shall:

   1. Cause or knowingly permit the use of any advertisement, promotion,
   solicitation, representation, proposal, or offer that is untrue;

   2. Charge a pharmacist or pharmacy a fee related to the adjudication of a
   claim other than a reasonable fee for an initial claim submission;

   3. Reimburse a pharmacy or pharmacist an amount less than the amount that the
   pharmacy benefits manager reimburses a pharmacy benefits manager affiliate for
   providing the same pharmacist services, calculated on a per-unit basis using
   the same generic product identifier or generic code number and reflecting all
   drug manufacturer&#8217;s rebates, direct and indirect administrative fees,
   and costs and any remuneration;

   4. Penalize or retaliate against a pharmacist or pharmacy for exercising
   rights provided pursuant to the provisions of this article;

   5. Impose requirements, exclusions, reimbursement terms, or other conditions
   on a covered entity or contract pharmacy that differ from those applied to
   entities or pharmacies that are not covered entities or contract pharmacies on
   the basis that the entity or pharmacy is a covered entity or contract pharmacy
   or that the entity or pharmacy dispenses 340B-covered drugs. Nothing in this
   subdivision shall (i) apply to drugs with an annual estimated per-patient cost
   exceeding $250,000 or (ii) prohibit the identification of a 340B reimbursement
   request; or

   6. Interfere with a covered individual&#8217;s right to choose a pharmacy or
   provider, based on the pharmacy or provider&#8217;s status as a covered entity
   or contract pharmacy.

B. No carrier, on its own or through its contracted pharmacy benefits manager or
representative of a pharmacy benefits manager, shall restrict participation of a
pharmacy in a pharmacy network for provider accreditation standards or
certification requirements if a pharmacist meets such accreditation standards or
certification standards.

C. No carrier, on its own or through its contracted pharmacy benefits manager or
representative of a pharmacy benefits manager, shall include any mail order
pharmacy or pharmacy benefits manager affiliate in calculating or determining
network adequacy under any law or contract in the Commonwealth.

D. No carrier, on its own or through its contracted pharmacy benefits manager or
representative of a pharmacy benefits manager, shall conduct spread pricing in
the Commonwealth.

E. Each carrier on its own or through its contracted pharmacy benefits manager
or representative of a pharmacy benefits manager shall comply with the
provisions of this section in addition to complying with the provisions of
&#xA7; 38.2-3407.15:1.

HISTORY: 2020, cc. 219, 1288; 2022, c. 319.