38.2-4209.1 - Pharmacies; freedom of choice.
§ 38.2-4209.1. Pharmacies; freedom of choice.
A. Notwithstanding any provision of § 38.2-4209, no corporation providingpreferred provider subscription contracts shall prohibit any person receivingpharmaceutical benefits thereunder from selecting, without limitation, thepharmacy of his choice to furnish such benefits. This right of selectionextends to and includes pharmacies that are nonpreferred providers and thathave previously notified the corporation, by facsimile or otherwise, of theiragreement to accept reimbursement for their services at rates applicable topharmacies that are preferred providers, including any copayment consistentlyimposed by the corporation, as payment in full. Each corporation shall permitprompt electronic or telephonic transmittal of the reimbursement agreement bythe pharmacy and ensure payment verification to the pharmacy of the terms ofreimbursement. In no event shall any person receiving a covered pharmacybenefit from a nonpreferred provider which has submitted a reimbursementagreement be responsible for amounts that may be charged by the nonpreferredprovider in excess of the copayment and the corporation's reimbursementapplicable to all of its preferred pharmacy providers.
B. No such corporation shall impose upon any person receiving pharmaceuticalbenefits furnished under any such 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 a corporation, within 30 days of the pharmacy'sreceipt of the request, execute and deliver to the corporation the directservice agreement or preferred provider agreement that the corporationrequires all of its preferred providers of pharmacy benefits to execute. Anypharmacy that fails to timely execute and deliver such agreement shall not becovered by this section with respect to that corporation unless and until thepharmacy executes 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 a corporation issuingpreferred provider policies or contracts to select a single mail orderpharmacy provider as the exclusive provider of pharmacy services that aredelivered 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.
(1994, c. 963; 1995, c. 467; 2010, cc. 157, 357.)