A. Notwithstanding any provision of § 38.2-3407 to the contrary, no insurerproposing to issue preferred provider policies or contracts shall prohibitany person receiving pharmacy benefits furnished thereunder from selecting,without limitation, the pharmacy of his choice to furnish such benefits. Thisright of selection extends to and includes pharmacies that are nonpreferredproviders and that have previously notified the insurer, by facsimile orotherwise, of their agreement to accept reimbursement for their services atrates applicable to pharmacies that are preferred providers, including anycopayment consistently imposed by the insurer, as payment in full. Eachinsurer shall permit prompt electronic or telephonic transmittal of thereimbursement agreement by the pharmacy and ensure prompt verification to thepharmacy of the terms of reimbursement. In no event shall any personreceiving a covered pharmacy benefit from a nonpreferred provider which hassubmitted a reimbursement agreement be responsible for amounts that may becharged by the nonpreferred provider in excess of the copayment and theinsurer's reimbursement applicable to all of its preferred pharmacy providers.
B. No such insurer shall impose upon any person receiving pharmaceuticalbenefits furnished under any such policy or contract:
1. Any copayment, fee or condition that is not equally imposed upon allindividuals in the same benefit category, class or copayment level, whetheror not such benefits are furnished by pharmacists who are nonpreferredproviders;
2. Any monetary penalty that would affect or influence any such person'schoice of pharmacy; or
3. Any reduction in allowable reimbursement for pharmacy services related toutilization of pharmacists who are nonpreferred providers.
C. For purposes of this section, a prohibited condition or penalty shallinclude, without limitation: (i) denying immediate access to electronicclaims filing to a pharmacy that is a nonpreferred provider and that hascomplied with subsection D or (ii) requiring a person receiving pharmacybenefits to make payment at point of service, except to the extent suchconditions and penalties are similarly imposed on preferred providers.
D. Any pharmacy that wishes to be covered by this section shall, if requestedto do so in writing by an insurer, within 30 days of the pharmacy's receiptof the request, execute and deliver to the insurer the direct serviceagreement or preferred provider agreement that the insurer requires all ofits preferred providers of pharmacy benefits to execute. Any pharmacy thatfails to timely execute and deliver such agreement shall not be covered bythis section with respect to that insurer unless and until the pharmacyexecutes and delivers the agreement.
E. The Commission shall have no jurisdiction to adjudicate controversiesarising out of this section.
F. Nothing in this section shall limit the authority of an insurer proposingto issue preferred provider policies or contracts to select a single mailorder pharmacy provider as the exclusive provider of pharmacy services thatare delivered to the covered person's address by mail, common carrier, ordelivery service. The provisions of this section shall not apply to suchcontracts. As used in this subsection, "mail order pharmacy provider" meansa pharmacy permitted to conduct business in the Commonwealth whose primarybusiness is to dispense a prescription drug or device under a prescriptivedrug order and to deliver the drug or device to a patient primarily by mail,common carrier, or delivery service.
A. Notwithstanding any provision of § 38.2-3407 to the contrary, no insurerproposing to issue preferred provider policies or contracts shall prohibitany person receiving pharmacy benefits furnished thereunder from selecting,without limitation, the pharmacy of his choice to furnish such benefits. Thisright of selection extends to and includes pharmacies that are nonpreferredproviders and that have previously notified the insurer, by facsimile orotherwise, of their agreement to accept reimbursement for their services atrates applicable to pharmacies that are preferred providers, including anycopayment consistently imposed by the insurer, as payment in full. Eachinsurer shall permit prompt electronic or telephonic transmittal of thereimbursement agreement by the pharmacy and ensure prompt verification to thepharmacy of the terms of reimbursement. In no event shall any personreceiving a covered pharmacy benefit from a nonpreferred provider which hassubmitted a reimbursement agreement be responsible for amounts that may becharged by the nonpreferred provider in excess of the copayment and theinsurer's reimbursement applicable to all of its preferred pharmacy providers.
B. No such insurer shall impose upon any person receiving pharmaceuticalbenefits furnished under any such policy or contract:
1. Any copayment, fee or condition that is not equally imposed upon allindividuals in the same benefit category, class or copayment level, whetheror not such benefits are furnished by pharmacists who are nonpreferredproviders;
2. Any monetary penalty that would affect or influence any such person'schoice of pharmacy; or
3. Any reduction in allowable reimbursement for pharmacy services related toutilization of pharmacists who are nonpreferred providers.
C. For purposes of this section, a prohibited condition or penalty shallinclude, without limitation: (i) denying immediate access to electronicclaims filing to a pharmacy that is a nonpreferred provider and that hascomplied with subsection D or (ii) requiring a person receiving pharmacybenefits to make payment at point of service, except to the extent suchconditions and penalties are similarly imposed on preferred providers.
D. Any pharmacy that wishes to be covered by this section shall, if requestedto do so in writing by an insurer, within 30 days of the pharmacy's receiptof the request, execute and deliver to the insurer the direct serviceagreement or preferred provider agreement that the insurer requires all ofits preferred providers of pharmacy benefits to execute. Any pharmacy thatfails to timely execute and deliver such agreement shall not be covered bythis section with respect to that insurer unless and until the pharmacyexecutes and delivers the agreement.
E. The Commission shall have no jurisdiction to adjudicate controversiesarising out of this section.
F. Nothing in this section shall limit the authority of an insurer proposingto issue preferred provider policies or contracts to select a single mailorder pharmacy provider as the exclusive provider of pharmacy services thatare delivered to the covered person's address by mail, common carrier, ordelivery service. The provisions of this section shall not apply to suchcontracts. As used in this subsection, "mail order pharmacy provider" meansa pharmacy permitted to conduct business in the Commonwealth whose primarybusiness is to dispense a prescription drug or device under a prescriptivedrug order and to deliver the drug or device to a patient primarily by mail,common carrier, or delivery service.
A. Notwithstanding any provision of § 38.2-3407 to the contrary, no insurerproposing to issue preferred provider policies or contracts shall prohibitany person receiving pharmacy benefits furnished thereunder from selecting,without limitation, the pharmacy of his choice to furnish such benefits. Thisright of selection extends to and includes pharmacies that are nonpreferredproviders and that have previously notified the insurer, by facsimile orotherwise, of their agreement to accept reimbursement for their services atrates applicable to pharmacies that are preferred providers, including anycopayment consistently imposed by the insurer, as payment in full. Eachinsurer shall permit prompt electronic or telephonic transmittal of thereimbursement agreement by the pharmacy and ensure prompt verification to thepharmacy of the terms of reimbursement. In no event shall any personreceiving a covered pharmacy benefit from a nonpreferred provider which hassubmitted a reimbursement agreement be responsible for amounts that may becharged by the nonpreferred provider in excess of the copayment and theinsurer's reimbursement applicable to all of its preferred pharmacy providers.
B. No such insurer shall impose upon any person receiving pharmaceuticalbenefits furnished under any such policy or contract:
1. Any copayment, fee or condition that is not equally imposed upon allindividuals in the same benefit category, class or copayment level, whetheror not such benefits are furnished by pharmacists who are nonpreferredproviders;
2. Any monetary penalty that would affect or influence any such person'schoice of pharmacy; or
3. Any reduction in allowable reimbursement for pharmacy services related toutilization of pharmacists who are nonpreferred providers.
C. For purposes of this section, a prohibited condition or penalty shallinclude, without limitation: (i) denying immediate access to electronicclaims filing to a pharmacy that is a nonpreferred provider and that hascomplied with subsection D or (ii) requiring a person receiving pharmacybenefits to make payment at point of service, except to the extent suchconditions and penalties are similarly imposed on preferred providers.
D. Any pharmacy that wishes to be covered by this section shall, if requestedto do so in writing by an insurer, within 30 days of the pharmacy's receiptof the request, execute and deliver to the insurer the direct serviceagreement or preferred provider agreement that the insurer requires all ofits preferred providers of pharmacy benefits to execute. Any pharmacy thatfails to timely execute and deliver such agreement shall not be covered bythis section with respect to that insurer unless and until the pharmacyexecutes and delivers the agreement.
E. The Commission shall have no jurisdiction to adjudicate controversiesarising out of this section.
F. Nothing in this section shall limit the authority of an insurer proposingto issue preferred provider policies or contracts to select a single mailorder pharmacy provider as the exclusive provider of pharmacy services thatare delivered to the covered person's address by mail, common carrier, ordelivery service. The provisions of this section shall not apply to suchcontracts. As used in this subsection, "mail order pharmacy provider" meansa pharmacy permitted to conduct business in the Commonwealth whose primarybusiness is to dispense a prescription drug or device under a prescriptivedrug order and to deliver the drug or device to a patient primarily by mail,common carrier, or delivery service.
