2023 Session

Budget Amendments - HB1400 (Member Request)

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Chief Patron: Lopez
Workgroup on Prescription Costs

Item 493 #1h

Item 493 #1h

First Year - FY2023 Second Year - FY2024
Independent Agencies
State Corporation Commission FY2023 $0 FY2024 $50,000 NGF

Page 595, line 2, strike "$59,010,485" and insert "$59,060,485".

Page 595, after line 44, insert:

"F.  The Bureau of Insurance shall convene a workgroup that may include the Virginia Association of Health Plans, The Medical Society of Virginia, representation from at least three patient groups such as but not limited to (i) The American Cancer Society; (ii) The Leukemia and Lymphoma Society; (iii) the Arthritis Foundation; (iv) the American Diabetes Association (v) the Crohn's and Colitis Foundation (vi) National Alliance on Mental Illness of Virginia, (vii) Mental  Health America of Virginia, healthcare consumers, and other stakeholders to review the current landscape of public policy options as it relates to consumer out-of-pocket cost sharing structures and solutions to overcoming patient affordability barriers for prescription drugs. Workgroup scope of discussion may include but is not limited to the feasibility of maximizing pre-deductible coverage, the financial burden of high out-of-pocket cost-sharing, and the number and types of services that are subject to copayments rather than coinsurance. This review shall include a review of other state and federal laws, regulations, or policies that govern the consumer out-of-pocket structure for health insurance coverage of prescription medication, including the feasibility and consumer impact of imposing copay caps for prescription drugs of all tiers. These proposals should include evaluation of proposals through the Center for Medicare and Medicaid Services (CMS) Actuarial Value (AV) Calculator, or equivalent state-mandated tool, to ensure their compliance with actuarial value requirements. The workgroup may develop specific recommendations for changes identified during such workgroup discussions. The Commissioner shall report any recommendations developed by the workgroup to the Chair of the House Committees on Appropriations and Health, Welfare and Institutions and the Senate Committees of Finance and Appropriations and Education and Health by November 1, 2023."


(This amendment appropriates from the nongeneral fund in the second year and directs the Bureau of Insurance within the State Corporation Commission to convene a workgroup to review options for consumer out-of-pocket cost sharing structures and solutions to overcome patient affordability barriers for prescription drugs. This is a placeholder amendment until a final fiscal impact statement is produced.)