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HB 2258

Bureau of Insurance of SCC; step therapy protocols for health benefit plans, report.

2025 Regular Session Introduced by Karrie Delaney

Virginia requires insurers to establish step therapy protocols with expedited appeals and reporting requirements, effective July 2025, balancing medication access against cost management.

Acts of Assembly Chapter text (CHAP0256)
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Bill Summary · HB 2258

Legislative bill overview

HB 2258 requires Virginia's Bureau of Insurance to establish and enforce step therapy protocols for health benefit plans, including requirements for expedited reviews and appeals processes. The bill mandates reporting on step therapy usage and outcomes to ensure transparency and patient access to prescribed medications.

Why is this important

Step therapy—where insurers require patients to try cheaper drugs before covering more expensive ones—can delay access to medically necessary treatments. This bill creates standardized protections to prevent unnecessary treatment delays while allowing insurers to manage costs, balancing access concerns with insurance regulation.

Potential points of contention

  • Cost implications: Insurance companies may argue stricter step therapy protocols increase premiums; patient advocates counter that denial costs and delayed treatment create broader health system expenses
  • Definition of "medically necessary": Disagreement exists over who determines when step therapy requirements are inappropriate—physicians, insurers, or regulators
  • Administrative burden: Healthcare providers may face increased paperwork for expedited review requests, potentially delaying other patient care activities

Compiled from official sources — confirm details with the bill’s official record.

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