                                 CODE OF VIRGINIA

EXAMINATION OF BOOKS AND RECORDS; REPORTS; ACCESS TO RECORDS (§ 38.2-3468)

A. Each carrier, on its own or through its contract for pharmacy benefits, shall
ensure that the Commissioner may examine or audit the books and records of a
pharmacy benefits manager providing claims processing services or other
prescription drug or device services for a carrier that are relevant to
determining if the pharmacy benefits manager is in compliance with this article.
The carrier shall be responsible for the charges incurred in the examination,
including the expenses of the Commissioner or his designee and the expenses and
compensation of his examiners and assistants.

B. Each carrier, on its own or through its contract for pharmacy benefits, shall
report the following information to the Commissioner for each health benefit
plan:

   1. The aggregate amount of rebates received by the pharmacy benefits manager;

   2. The aggregate amount of rebates distributed to the appropriate health
   benefit plan;

   3. The aggregate amount of rebates passed on to the enrollees of each health
   benefit plan at the point of sale that reduced the enrollees&#8217; applicable
   deductible, copayment, coinsurance, or other cost-sharing amount;

   4. The aggregate amount of the pharmacy benefits manager&#8217;s retained
   rebates;

   5. The pharmacy benefits manager&#8217;s aggregate retained rebate percentage;

   6. The aggregate amount of administrative fees received by the pharmacy
   benefits manager;

   7. Upon the request of the Commission, the individual and aggregate amount
   paid by the health benefit plan to the pharmacy benefits manager for services
   itemized by pharmacy, by product, and by goods and services; and

   8. Upon the request of the Commission, the individual and aggregate amount a
   pharmacy benefits manager paid for services itemized by pharmacy, by product,
   and by goods and services.
   				The report required by this subsection shall be filed on a quarterly basis
   through March 31, 2023. The final quarterly report shall include information
   for the period ending December 31, 2022. Thereafter, by March 31 of each year,
   the report shall be filed on a calendar year basis. The 2023 calendar year
   report shall be filed by March 31, 2024.

C. All working papers, documents, reports, and copies thereof, produced by,
obtained by or disclosed to the Commission or any other person in the course of
an examination made under this article and any analysis of such information or
documents shall be given confidential treatment, are not subject to subpoena,
and may not be made public by the Commission or any other person. Access may
also be granted to (i) a regulatory official of any state or country; (ii) the
National Association of Insurance Commissioners (NAIC), its affiliate, or its
subsidiary; or (iii) a law-enforcement authority of any state or country,
provided that those officials are required under their law to maintain its
confidentiality. Any such disclosure by the Commission shall not constitute a
waiver of confidentiality of such papers, documents, reports or copies thereof.
Any parties receiving such papers must agree in writing prior to receiving the
information to provide to it the same confidential treatment as required by this
section.

HISTORY: 2020, cc. 219, 1288; 2022, c. 283; 2024, cc. 329, 626.