                                 CODE OF VIRGINIA

DEFINITIONS (§ 38.2-3465)

A. As used in this article, unless the context requires a different meaning:
			&#8220;Aggregate retained rebate percentage&#8221; means the sum total dollar
amount of a pharmacy benefits manager&#8217;s retained rebates relating to all
carrier clients of such pharmacy benefits manager divided by the sum total
dollar amount of all rebates received by such pharmacy benefits manager relating
to all such clients.			&#8220;Carrier&#8221; has the same meaning ascribed
thereto in subsection A of &#xA7; 38.2-3407.15. However, &#8220;carrier&#8221;
does not include a nonprofit health maintenance organization that operates as a
group model whose internal pharmacy operation exclusively serves the members or
patients of the nonprofit health maintenance organization.			&#8220;Claim&#8221;
means a request from a pharmacy or pharmacist to be reimbursed for the cost of
administering, filling, or refilling a prescription for a drug or for providing
a medical supply or device.			&#8220;Claims processing services&#8221; means the
administrative services performed in connection with the processing and
adjudicating of claims relating to pharmacist services that include (i)
receiving payments for pharmacist services, (ii) making payments to pharmacists
or pharmacies for pharmacist services, or (iii) both receiving and making
payments.			&#8220;Contract pharmacy&#8221; means a pharmacy operating under
contract with a 340B-covered entity to provide dispensing services to the
340B-covered entity, as described in 75 Fed. Reg. 10272 (March 5, 2010) or any
superseding guidance published thereafter.			&#8220;Covered entity&#8221; means
an entity described in &#xA7; 340B(a)(4) of the federal Public Health Service
Act, 42 U.S.C. &#xA7; 256B(a)(4).			&#8220;Covered individual&#8221; means an
individual receiving prescription medication coverage or reimbursement provided
by a pharmacy benefits manager or a carrier under a health benefit
plan.			&#8220;Health benefit plan&#8221; has the same meaning ascribed thereto
in &#xA7; 38.2-3438.			&#8220;Mail order pharmacy&#8221; means a pharmacy whose
primary business is to receive prescriptions by mail or through electronic
submissions and to dispense medication to covered individuals through the use of
the United States mail or other common or contract carrier services and that
provides any consultation with covered individuals electronically rather than
face-to-face.			&#8220;Pharmacy benefits management&#8221; means the
administration or management of prescription drug benefits provided by a carrier
for the benefit of covered individuals. &#8220;Pharmacy benefits
management&#8221; does not include any service provided by a nonprofit health
maintenance organization that operates as a group model provided that the
service is furnished through the internal pharmacy operation exclusively serves
the members or patients of the nonprofit health maintenance
organization.			&#8220;Pharmacy benefits manager&#8221; or &#8220;PBM&#8221;
means an entity that performs pharmacy benefits management. &#8220;Pharmacy
benefits manager&#8221; includes an entity acting for a PBM in a contractual
relationship in the performance of pharmacy benefits management for a carrier,
nonprofit hospital, or third-party payor under a health program administered by
the Commonwealth.			&#8220;Pharmacy benefits manager affiliate&#8221; means a
business, pharmacy, or pharmacist that directly or indirectly, through one or
more intermediaries, owns or controls, is owned or controlled by, or is under
common ownership interest or control with a pharmacy benefits
manager.			&#8220;Rebate&#8221; means a discount or other price concession,
including without limitation incentives, disbursements, and reasonable estimates
of a volume-based discount, or a payment that is (i) based on utilization of a
prescription drug and (ii) paid by a manufacturer or third party, directly or
indirectly, to a pharmacy benefits manager, pharmacy services administrative
organization, or pharmacy after a claim has been processed and paid at a
pharmacy.			&#8220;Retail community pharmacy&#8221; means a pharmacy that is
open to the public, serves walk-in customers, and makes available face-to-face
consultations between licensed pharmacists and persons to whom medications are
dispensed.			&#8220;Retained rebate&#8221; means a rebate that is not passed on
to a health benefit plan.			&#8220;Retained rebate percentage&#8221; means the
sum total dollar amount of a pharmacy benefits manager&#8217;s retained rebates
relating to a health benefit plan divided by the sum total dollar amount of all
rebates received by such pharmacy benefits manager relating to such health
benefit plan.			&#8220;Spread pricing&#8221; means the model of prescription
drug pricing in which the pharmacy benefits manager charges a health benefit
plan a contracted price for prescription drugs, and the contracted price for the
prescription drugs differs from the amount the pharmacy benefits manager
directly or indirectly pays the pharmacist or pharmacy for pharmacist services.

HISTORY: 2020, cc. 219, 1288; 2022, c. 319; 2024, cc. 329, 626; 2025, cc. 413,
429.