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Bill

SB 413

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

2026 Regular Session Introduced by Mark Peake

Virginia bill regulates pharmacy benefits managers' compensation and practices, imposing civil penalties to increase transparency and accountability in prescription drug administration and cost-sharing.

Incorporated by Commerce and Labor (SB669-Rouse) (15-Y 0-N)
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Bill Summary · SB 413

Legislative bill overview

SB 413 regulates pharmacy benefits managers (PBMs) in Virginia by establishing new compensation standards, clarifying their duties, and imposing civil penalties for non-compliance. The bill addresses PBM practices related to health insurance cost-sharing and pharmacy benefits administration. It has been incorporated into SB 669, suggesting the measures may be consolidated with broader health insurance reforms.

Why is this important

PBMs act as intermediaries between insurers, pharmacies, and patients, controlling drug formularies and negotiating prices—making them significant cost drivers in healthcare. This bill attempts to increase transparency and accountability in PBM operations, which directly affects prescription drug costs and patient access to medications. Virginia consumers and insurers have competing interests in how PBM compensation and practices are regulated.

Potential points of contention

  • PBM Industry Opposition: PBMs may argue that new compensation restrictions and duties could reduce their operational flexibility and increase administrative costs, potentially passed to insurers and patients
  • Definition Ambiguity: The bill's specific compensation limits and duty requirements are not detailed in available information, creating uncertainty about enforceability and practical implementation
  • Incorporation into SB 669: The consolidation into another bill suggests potential compromise or modifications that may weaken or strengthen original provisions depending on the merged language

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

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