After passing the General Assembly with overwhelming support, Gov. Glenn Youngkin (R) gutted the Medicaid Managed Care Single PBM bills (HB 2610 and SB 875) and sent them back to the General Assembly, leaving only language to study the issue. On April 2, the General Assembly held steadfast, rejecting the Governor’s version, and voted to send the original bills as they passed the Legislature back to the Governor. Gov. Youngkin now has thirty days to sign or veto the measures. With the 2025 session at an end, his action will be the final word on the bills. 

For more information, contact NACDS’ Jill McCormack at 717-592-8977.

SB 875 and HB 2610 are now on Gov. Glenn Youngkin’s (R) desk. The bills require the Department of Medical Assistance Services (DMAS) to contract a single PBM to manage the pharmacy benefit under Medicaid Managed Care. Additionally, they would streamline the program and require pass-through pricing and reasonable pharmacy reimbursement. NACDS is currently engaged in both grassroots and grasstops campaigns with members and partners to urge the Governor to sign the bills. The Governor’s deadline to act is midnight on March 24.

Also in Virginia, the Department of Health released a clinician letter outlining requirements for reporting COVID test results.

For more information, contact NACDS’ Jill McCormack at 717-592-8977.

NACDS issued a NACDS RxIMPACT action alert for SB 875 and HB 2610, and urges members with operations in the Commonwealth to contact Gov. Glenn Youngkin (R) to express how critical these bills are to patient access and pharmacy viability. Should he sign the bills, Virginia would join Ohio and Kentucky as the third state to reform PBM practices in Medicaid Managed Care under a single PBM. The bills had bipartisan support and overwhelmingly passed the General Assembly a few weeks ago.

For more information, contact NACDS’ Jill McCormack at 717-592-8977.

After an intense advocacy effort compressed into a 60-day legislative session, pharmacy scored a major victory in Richmond this session with the passage of SB 875 and HB 2610, companion Medicaid Managed Care PBM reform bills. The bills overwhelmingly passed the General Assembly in a bipartisan vote. The bills would require the Medicaid managed care plans to contract with a single PBM under terms set by the Department of Medical Assistance Services (DMAS). The contract would require:  

• clear statements of the PBM’s fiduciary duty to the state; 

• pass-through pricing; 

• a common formulary, reimbursement methodologies and dispensing fees negotiated by DMAS; and 

• transparency in drug pricing.  

NACDS issued an NACDS RxIMPACT action alert and urges members with operations in the Commonwealth to contact Gov. Glenn Youngkin (R) to express how critical these bills are to patient access and pharmacy viability. Should he sign the bill, Virginia would join Ohio and Kentucky as the third state to reform PBM practices in Medicaid Managed Care under a single PBM. 

For more information, contact NACDS’ Jill McCormack at 717-592-8977.

Legislation that would require Medicaid to hire a single PBM to manage the pharmacy benefit has advanced. Both HB 2610 and SB 875 passed their respective chambers and advanced significantly in the opposite chamber. They are now poised to go to the Conference Committee to work out the remaining details, including the implementation date. NACDS cautions that the Department of Medical Assistance Services (DMAS) has been resistant to the legislation, though Gov. Glenn Youngkin (R) has not officially taken a stance. We will continue to work with in-state partners and members over the next month to advocate for the bill or bills to become law.

Also in Virginia, Gov. Glenn Youngkin (R) issued Executive Order 45  on February 16, declaring a state of emergency due to winter weather and flooding. In response, the Board of Pharmacy has implemented emergency waivers. They will remain in effect for the duration of Executive Order 45, which is effective for 30 days from February 10, unless sooner amended or rescinded. Existing emergency regulations plus those implemented because of the declaration waivers are as follows:

• Pursuant to 18VAC110-20-320, an authorized refill may be dispensed early provided the pharmacist documents a valid reason for the necessity of the early refill.
• Emergency Waiver: a prescription for a drug controlled by Schedule III-V with no remaining refills may be refilled one time without authorization from the prescriber, if after reasonable effort has been made to contact him, the pharmacist ascertains that he is not available and the patient’s health would be in imminent danger without the benefits of the drug. Authorization to refill under this subdivision also exists when the pharmacist only has access to the label on a prescription container. The pharmacist shall inform the patient of the prescriber’s unavailability and that the refill is being made without his authorization.
• A prescription for a drug controlled by Schedule II may be dispensed pursuant to the emergency allowance in 18VAC110-20-290.
• Emergency Waiver: A one-time early dispensing of a Schedule II prescription for a chronic condition that is due for dispensing within the next 7 days is authorized. Dispensers must document the reason for the early refill.

For more information, contact NACDS’ Jill McCormack at 717-592-8977.

Two bills that would require DMAS (Department of Medical Assistance Services) to contract directly with a SPBM to manage the Medicaid managed care pharmacy benefit are quickly advancing this session. NACDS testified in favor of SB 875, sponsored by Sen. Aaron Rouse (D), that was later approved by both the Education and Health Committee and the Finance Committee. The bill now heads to the Senate Floor for a vote. In the House, The Health and Human Services Committee approved HB 2610 and advanced it to the Appropriation Committee. Identical fiscal notes were issued for the bills and they include cost savings estimates. NACDS is working with members, in-state partners and DMAS to support this effort.

For more information, contact NACDS’ Jill McCormack at 717-592-8977.

The Department of Health (VDH) issued a clinician’s letter related to an increase in pneumonia and pertussis cases in the Commonwealth. This and other provider communications are also available on the VDH webpage.

Also in Virginia, the Department of Health and Human Services issued a report to the Governor and General Assembly recommending that the state not move forward with a Drug Importation Program. The report is the result of a legislatively mandated workgroup on “The Feasibility of a Wholesale Prescription Drug Importation Program” that found that there was no guarantee of cost savings by implementing an importation program and that the better course of action was to wait and see if other states’ programs move forward with any positive outcomes.

For more information, contact NACDS’ Jill McCormack at 717-592-8977.

The Department of Medical Assistance Services (DMAS) is currently conducting a pharmacy cost of dispensing study. Surveys were delivered to pharmacies on September 12 and are due back to Myers & Stauffer on October 17. The statute requires that the Medicaid Fee-For-Service (FFS) Professional Dispensing Fee be determined by a study completed “at least every five years”. DMAS’ slide deck has more detail. The current FFS Professional Dispensing Fee is $10.65.

For more information, contact NACDS’ Jill McCormack at 717-592-8977.

The Department of Medical Assistance Services (DMAS) held an initial virtual meeting with pharmacy associations to discuss the upcoming pharmacy cost-of-dispensing survey (slide deck). The survey instrument has not been finalized; however, Myers & Stauffer intends to send it to pharmacies on September 12. Additional informational webinars for all pharmacy stakeholders are tentatively scheduled for September 24 and September 26.

For more information, contact NACDS’ Jill McCormack at 717-592-8977.