WeVote
Log In

Bill

Bill

HB 2209

State pharmacy benefits manager; DMAS to select & contract with a third-party administrator to serve

2025 Regular Session Introduced by Keith Hodges and 1 co-sponsor

Virginia requires DMAS to contract with a third-party pharmacy benefits manager to consolidate Medicaid drug benefit administration and potentially reduce prescription costs.

Incorporated by Health and Human Services (HB2610-Callsen) (Voice Vote)
0
WeVote Research Nonpartisan
Bill Summary · HB 2209

Legislative bill overview

HB 2209 directs Virginia's Department of Medical Assistance Services (DMAS) to select and contract with a third-party administrator to serve as the state's pharmacy benefits manager (PBM). This consolidates pharmacy benefit management functions under a single contracted entity rather than the current system. The bill has been incorporated into HB 2610-Callsen, meaning its provisions are now part of a larger legislative package.

Why is this important

Pharmacy benefits managers control drug formularies, negotiate prices with pharmacies and manufacturers, and significantly influence prescription costs and access. Centralizing Virginia's Medicaid pharmacy benefits under one PBM could affect drug pricing, pharmacy participation, patient access to medications, and state healthcare spending. This restructuring has statewide implications for approximately 1 million Virginia Medicaid recipients.

Potential points of contention

  • Cost and savings uncertainty: No publicly available fiscal analysis clarifies whether consolidating PBM services will reduce or increase state costs, or how much savings (if any) will materialize
  • Pharmacy network impact: Changes to PBM administration may alter which pharmacies participate in Medicaid networks, potentially affecting patient access in rural or underserved areas
  • Transition and implementation risks: Moving from current arrangements to a new contracted administrator creates operational disruption risks and requires detailed transition planning not detailed in available materials

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

Sign in to ask a question.