                                 CODE OF VIRGINIA

OPTION FOR REBATES TO ENROLLEES; PROTECTED INFORMATION (§ 38.2-3407.22)

A. As used in this section:
			&#8220;Carrier&#8221; has the same meaning as set forth in &#xA7;
38.2-3407.10; however, &#8220;carrier&#8221; also includes any person required
to be licensed pursuant to this title that offers or operates a managed care
health insurance plan subject to the requirements of Chapter 58 (&#xA7;
38.2-5800 et seq.) or that provides or arranges for the provision of health care
services, health plans, networks, or provider panels that are subject to
regulation as the business of insurance. &#8220;Carrier&#8221; also includes any
health insurance issuer that offers health insurance coverage, as defined in
&#xA7; 38.2-3431.			&#8220;Enrollee&#8221; means any person entitled to health
care services from a carrier.			&#8220;Health care services&#8221; means items
or services furnished to any individual for the purpose of preventing,
alleviating, curing, or healing human illness, injury, or physical
disability.			&#8220;Health plan&#8221; means any individual or group health
care plan, subscription contract, evidence of coverage, certificate, health
services plan, medical or hospital services plan, accident or sickness insurance
policy or certificate, managed care health insurance plan, or other similar
certificate, policy, contract, or arrangement, and any endorsement or rider
thereto, to cover all or a portion of the cost of persons receiving covered
health care services, that is subject to state regulation and that is required
to be offered, arranged, or issued in the Commonwealth by a carrier licensed
under this title. &#8220;Health plan&#8221; includes a state or local government
employer plan. &#8220;Health plan&#8221; does not mean (i) coverages issued
pursuant to Title XVIII of the Social Security Act, 42 U.S.C. &#xA7; 1395 et
seq. (Medicare), Title XIX of the Social Security Act, 42 U.S.C. &#xA7; 1396 et
seq. (Medicaid), Title XXI of the Social Security Act, 42 U.S.C. &#xA7; 1397aa
et seq. (CHIP), 5 U.S.C. &#xA7; 8901 et seq. (federal employees), or 10 U.S.C.
&#xA7; 1071 et seq. (TRICARE) or (ii) accident only, credit or disability
insurance, long-term care insurance, TRICARE supplement, Medicare Supplement, or
workers&#8217; compensation coverages.			&#8220;Pharmacy benefits manager&#8221;
has the same meaning as set forth in &#xA7;
38.2-3407.15:4.			&#8220;Rebate&#8221; means (i) negotiated price concessions,
including base price concessions and reasonable estimates of any price
protection rebates and performance-based price concessions, that may accrue
directly or indirectly to a carrier, health plan, or pharmacy benefits manager
during the coverage year from a manufacturer, dispensing pharmacy, or other
party in connection with the dispensing or administration of a prescription drug
and (ii) reasonable estimates of any negotiated price concessions, fees, or
other administrative costs that are passed through, or are reasonably
anticipated to be passed through, to the carrier, health plan, or pharmacy
benefits manager and serve to reduce the liability of a carrier, health plan, or
pharmacy benefits manager for a prescription drug.

B. When contracting with a carrier or health plan to administer pharmacy
benefits, a pharmacy benefits manager shall offer the carrier or health plan the
option of extending point-of-sale rebates to enrollees of the plan.

C. The provisions of this section shall only apply to a carrier, health plan, or
pharmacy benefits manager to the extent permissible under applicable law.

D. In complying with the provisions of this section, a carrier, health plan,
pharmacy benefits manager, or its respective agents shall not publish or
otherwise reveal information regarding the actual amount of rebates a carrier,
health plan, or pharmacy benefits manager receives on a product-specific,
manufacturer-specific, or pharmacy-specific basis. Such information shall be
protected as a trade secret and shall not be public record or disclosed,
directly or indirectly. A carrier, health plan, or pharmacy benefits manager
shall require any vendor or third party with which the carrier, health plan, or
pharmacy benefits manager contracts for health care or administrative services
on behalf of the carrier, health plan, or pharmacy benefits manager that may
receive or have access to rebate information to comply with the provisions of
this subsection related to protection of information regarding the amount of
rebates a carrier, health plan, or pharmacy benefits manager receives on a
product-specific, manufacturer-specific, or pharmacy-specific basis.

E. The Commission may, pursuant to the provisions of &#xA7; 38.2-223, adopt such
rules and regulations as may be necessary to implement and enforce the
provisions of this section.

HISTORY: 2021, Sp. Sess. I, c. 304.