                                 CODE OF VIRGINIA

PHARMACIES; FREEDOM OF CHOICE (§ 38.2-4209.1)

A. Notwithstanding any provision of &#xA7; 38.2-4209, no corporation providing
preferred provider subscription contracts or its pharmacy benefits manager, as
defined in &#xA7; 38.2-3465, shall prohibit any person receiving pharmaceutical
benefits, including specialty pharmacy benefits, thereunder from selecting,
without limitation, the pharmacy of his choice to furnish such benefits. This
right of selection extends to and includes pharmacies that are nonpreferred
providers and that have previously notified the corporation or its pharmacy
benefits manager, by facsimile or otherwise, of their agreement to accept
reimbursement for their services at rates applicable to pharmacies that are
preferred providers, including any copayment consistently imposed by the
corporation, as payment in full. Each corporation or its pharmacy benefits
manager shall permit prompt electronic or telephonic transmittal of the
reimbursement agreement by the pharmacy and ensure payment verification to the
pharmacy of the terms of reimbursement. In no event shall any person receiving a
covered pharmacy benefit from a nonpreferred provider that has submitted a
reimbursement agreement be responsible for amounts that may be charged by the
nonpreferred provider in excess of the copayment and the corporation&#8217;s
reimbursement applicable to all of its preferred pharmacy providers.

B. No such corporation or its pharmacy benefits manager shall impose upon any
person receiving pharmaceutical benefits furnished under any such contract:

   1. Any copayment, fee or condition that is not equally imposed upon all
   individuals in the same benefit category, class or copayment level, whether or
   not such benefits are furnished by pharmacists who are nonpreferred providers;

   2. Any monetary penalty that would affect or influence any such person&#8217;s
   choice of pharmacy; or

   3. Any reduction in allowable reimbursement for pharmacy services related to
   utilization of pharmacists who are nonpreferred providers.

C. For purposes of this section, a prohibited condition or penalty shall
include, without limitation: (i) denying immediate access to electronic claims
filing to a pharmacy that is a nonpreferred provider and that has complied with
subsection D or (ii) requiring a person receiving pharmacy benefits to make
payment at point of service, except to the extent such conditions and penalties
are similarly imposed on preferred providers.

D. Any pharmacy that wishes to be covered by this section shall, if requested to
do so in writing by a corporation or its pharmacy benefits manager, within 30
days of the pharmacy&#8217;s receipt of the request, execute and deliver to the
corporation or its pharmacy benefits manager the direct service agreement or
preferred provider agreement that the corporation requires all of its preferred
providers of pharmacy benefits to execute. Any pharmacy that fails to timely
execute and deliver such agreement shall not be covered by this section with
respect to that corporation or its pharmacy benefits manager unless and until
the pharmacy executes and delivers the agreement. No pharmacy shall be precluded
from obtaining a direct service agreement or participating provider agreement
for any retail and specialty pharmacy if the pharmacy meets the terms and
conditions of participation. Any request by a pharmacy for a direct service
agreement or a participating provider agreement shall be acted upon by a
corporation or its pharmacy benefits manager within 60 days of receipt of the
pharmacy&#8217;s request or any subsequent submission of supplemental
information if requested by the corporation or its pharmacy benefits manager.

E. The Commission shall have no jurisdiction to adjudicate controversies arising
out of this section.

F. Nothing in this section shall limit the authority of a corporation issuing
preferred provider policies or contracts to select a single mail order pharmacy
provider as the exclusive provider of pharmacy services that are delivered to
the covered person&#8217;s address by mail, common carrier, or delivery service.
The provisions of this section shall not apply to such contracts. As used in
this subsection, &#8220;mail order pharmacy provider&#8221; means a pharmacy
permitted to conduct business in the Commonwealth whose primary business is to
dispense a prescription drug or device under a prescriptive drug order and to
deliver the drug or device to a patient primarily by mail, common carrier, or
delivery service.

HISTORY: 1994, c. 963; 1995, c. 467; 2010, cc. 157, 357; 2021, Sp. Sess. I, c.
229.