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HB 1041

Health insurance; cost-sharing, pharmacy benefits managers' compensation and duties, civil penalty.

2025 Regular Session Introduced by Israel O'Quinn and 1 co-sponsor

HB 1041 imposes regulatory requirements on Virginia pharmacy benefits managers' compensation, operational practices, and cost-sharing disclosures while establishing civil penalties for violations.

Left in Labor and Commerce
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WeVote Research Nonpartisan
Bill Summary · HB 1041

Legislative bill overview

HB 1041 regulates pharmacy benefits managers (PBMs) in Virginia by imposing requirements on their compensation structures, operational duties, and cost-sharing practices in health insurance plans. The bill establishes civil penalties for non-compliance with these new regulatory standards.

Why is this important

PBMs act as intermediaries between insurers, pharmacies, and patients, controlling drug pricing and formulary decisions that directly affect medication costs and access. Regulating PBM practices could reduce prescription drug costs for consumers, though it may also affect insurance premium structures and pharmacy operations across the state.

Potential points of contention

  • Compensation restrictions: PBM industry argues that limiting compensation mechanisms restricts business flexibility and could reduce competitive services, while consumer advocates contend current practices create conflicts of interest
  • Cost-sharing transparency: Requiring detailed disclosure of PBM fees and practices may increase administrative burden on insurers and PBMs while potentially revealing proprietary negotiating strategies
  • Enforcement and penalties: Determining appropriate civil penalty levels that are substantial enough to ensure compliance without driving PBMs from the Virginia market represents a policy balancing act

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

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