Virginia · 2025 Regular Session · Bill
SB 1078: Health insurance; cost-sharing, pharmacy benefits managers, compensation and duties, civil penalty.
In committee Official data
- Introduced
- In committee
- Passed one chamber
- Passed both chambers
- Enacted
Last official action: ·Record last updated:
Plain-language summary
SB 1078 is a bill introduced in the Virginia Senate on January 7, 2025. According to its official title, it concerns: Health insurance; cost-sharing, pharmacy benefits managers, compensation and duties, civil penalty. Primary sponsor: Mark Peake (Republican). Most recent recorded action (January 20, 2025): Failed to report (defeated) in Commerce and Labor (5-Y 10-N).
Generated automatically from the official title, sponsor list, and status record only. It does not characterize the bill’s purpose or effects. How summaries are written
Official summary
Abstract published by the legislature (via Open States). Text as published by the legislature; reproduced verbatim.
Health insurance; cost-sharing; pharmacy benefits managers; compensation and duties: civil penalty. Amends provisions related to rebates provided by carriers and health benefit plans to health plan enrollees by defining "defined cost-sharing," "pharmacy benefits management services," and "price protection rebates." The bill requires that an enrollee's defined cost-sharing for each prescription drug be calculated at the point of sale based on a price that is reduced by an amount equal to at least 80 percent of all rebates received or expected to be received in connection with the dispensing or administration of the prescription drug.The bill prohibits a pharmacy benefits manager from deriving income from pharmacy benefits management services provided to a carrier or health benefit plan except for income derived from a pharmacy benefits management fee. The bill requires the amount of any pharmacy benefits management fees to be set forth in the agreement between the pharmacy benefits manager and the carrier or health benefit plan and that such fee not be based on the acquisition cost or any other price metric of a drug; the amount of savings, rebates, or other fees charged, realized, or collected by or generated based on the activity of the pharmacy benefits manager; or the amount of premiums, deductibles, or other cost-sharing or fees charged, realized, or collected by the pharmacy benefits manager from enrollees or other persons on behalf of an enrollee. The bill requires a pharmacy benefits manager to annually certify to the State Corporation Commission that it has met certain requirements. The Commission is directed to impose a civil penalty not to exceed $1,000 per claim for a violation of these provisions.The bill establishes a pharmacy benefits manager duty, which includes the duties of care, good faith, and fair dealing, owed to any enrollee, provider, or health benefit plan that receives pharmacy benefits management services from the pharmacy benefits manager or that furnishes, covers, receives, or is administered a unit of a prescription drug for which the pharmacy benefits manager has provided pharmacy benefits management services. The bill requires the Commission to define by regulation the scope of such duty and provides for a private cause of action for any person aggrieved by the breach of such duty. The bill is identical to HB 2773.
Sponsors
Sponsors by party (alphabetical): Republican 1
| Name | Role | Party | Chamber | District |
|---|---|---|---|---|
| Mark Peake | Primary sponsor | Republican | Senate | 8 |
“Support” is shown only as formal sponsorship recorded by the legislature. Roll-call votes are available on the official bill page.
Recent official actions
- Failed to report (defeated) in Commerce and Labor (5-Y 10-N)
- Referred to Committee on Commerce and Labor
- Prefiled and ordered printed; Offered 01-08-2025 25102280D