SB 428

Title: Health insurance; carrier contracts, carrier provision of certain prescription drug information.
Author: Siobhan Stolle Dunnavant

Summary
Health insurance; carrier disclosure of certain information. Requires each health insurance carrier, beginning July 1, 2025, to establish and maintain an online process that (i) links directly to e-prescribing systems and electronic health record systems that utilize the National Council for Prescription Drug Programs SCRIPT standard; (ii) can accept electronic prior authorization requests from a provider; (iii) can approve electronic prior authorization requests for which no additional information is needed by the carrier to process the prior authorization request, no clinical review is required, and that meet the carrier's criteria for approval; and (iv) otherwise meets the requirements of this section. The bill prohibits a carrier from (a) imposing a charge or fee on a participating health care provider for accessing the online process required by this subdivision or (b) accessing, absent provider consent, provider data via the online process other than for the enrollee. The bill requires participating health care providers, beginning July 1, 2025, to ensure that any e-prescribing system or electronic health record system owned by or contracted for the provider to maintain an enrollee's health record has the ability to access the electronic prior authorization process established by a carrier and real time cost information data for a covered prescription drug made available by a carrier. The bill provides that a provider may request a waiver of compliance for undue hardship for a period not to exceed 12 months. The bill requires any carrier or its pharmacy benefits manager to provide real-time cost information data to enrollees and contracted providers for a covered prescription drug, including any cost-sharing requirement or prior authorization requirements, and to ensure that the data is accurate. The bill requires that such cost information data is available to the provider in a format that a provider can access and understand such as through the provider's e-prescribing system or electronic health record system for which the carrier or pharmacy benefits manager or its designated subcontractor has adopted that utilizes the National Council for Prescription Drug Programs SCRIPT standard from which the provider makes the request. The bill requires the State Corporation Commission's Bureau of Insurance (the Bureau) to, in coordination with the Secretary of Health and Human Resources, establish a work group to assess the current status of electronic prior authorization in the Commonwealth and make recommendations regarding the implementation of electronic prior authorization, which may include a single standardized process as required by this act, including any recommendations for necessary statutory or regulatory changes. The bill requires the work group to include relevant stakeholders, including representatives from the Virginia Association of Health Plans, the Medical Society of Virginia, the National Council for Prescription Drug Programs, and the Virginia Hospital and Healthcare Association, and other parties with an interest in the underlying technology. The bill requires the work group to report its findings and recommendations to the Chairmen of the Senate Committee on Commerce and Labor and the House Committee on Commerce and Energy by November 1, 2022. The provisions of the bill other than the requirement for the Bureau to establish the work group will not become effective unless reenacted by the 2023 Session of the General Assembly.

Status
House: VOTE: Block Vote Passage (100-Y 0-N)

Bill Documents
SB 428 - Committee substitute printed 22106220D-S1

SB 428 - Impact Statement - Committee substitute printed 22106220D-S1

SB 428 - Prefiled and ordered printed; offered 01/12/22 22101437D

SB 428 - Impact Statement - Prefiled and ordered printed; offered 01/12/22 22101437D

SB 428 - House amendments engrossed

SB 428 - House amendments adopted

SB 428 - Substitute for S-Commerce and Labor Offered on 2/7/2022

SB 428 - Substitute for S-Commerce and Labor Offered on 1/31/2022

SB 428 - Amendment(s) for Committee: Health, Welfare and Institutions Offered on 2/24/2022

SB 428 - Summary as introduced

SB 428 - Summary as passed senate

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SB 428