2023 Session

Budget Amendments - SB800 (Member Request)

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Chief Patron: Boysko
Prescription Affordability Work Group (language only)

Item 489 #2s

Item 489 #2s

Independent Agencies
State Corporation Commission


Page 594, line 15, before "Out", insert "A.".

Page 594, after line 19, insert:

"B. The Bureau of Insurance shall convene a work group to review the current landscape of public policy options as they relate to consumer out-of-pocket cost sharing structures and solutions to overcoming patient affordability barriers for prescription drugs. Such work group may include the Virginia Association of Health Plans, the Medical Society of Virginia, representation from at least three patient groups including but not limited to the American Cancer Society, the Leukemia and Lymphoma Society, the Arthritis Foundation, the American Diabetes Association, the Crohn's and Colitis Foundation, the National Alliance on Mental Illness of Virginia and Mental Health America of Virginia, healthcare consumers and other stakeholders. The work group scope of discussion may include but shall not be 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 laws, regulations, or policies from other states or the federal government that regulate 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. Resulting recommendations and proposals from this review should include evaluation of proposals through the Center for Medicare and Medicaid Services Actuarial Value Calculator, or equivalent state-mandated tool, to ensure compliance with actuarial value requirements. The Commissioners shall report any recommendations developed by the work group to the Chairs of the House Committees on Appropriation and Health, Welfare and Institutions and the Senate Committees of Finance and Appropriations and Education and Health by November 1, 2023."


(This amendment directs the Bureau of Insurance to convene a work group to study current challenges and potential solutions to ensuring greater affordability of prescription drugs for Virginia consumers.)