2025 SESSION

INTRODUCED

25102253D

HOUSE BILL NO. 2258

Offered January 13, 2025

Prefiled January 7, 2025

A BILL to direct the Bureau of Insurance to study step therapy protocols for health benefit plans; report.

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Patron—Delaney

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Referred to Committee on Labor and Commerce

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Be it enacted by the General Assembly of Virginia:

1. § 1. The Bureau of Insurance of the State Corporation Commission (the Bureau) shall study the step therapy protocols for health benefit plans developed pursuant to § 38.2-3407.9:05 of the Code of Virginia. The study shall evaluate step therapy protocols developed by insurance companies, the references that are used to develop such protocols, and compliance with the provisions of § 38.2-3407.9:05 of the Code of Virginia. In conducting its study, the Bureau shall consider (i) the aggregate number of step therapy requests, acceptances, denials, appeals, and reversals; (ii) percentages of reversals of step therapy denials; (iii) the time frame for responses, reconsiderations, and final decisions regarding step therapy; (iv) the number of step therapy protocols that are introduced, revised, or removed each quarter; and (v) data on the specialties of step therapy protocols, such as those used specifically for oncology, rheumatology, ophthalmology, orthopedics, or neurosurgery. In conducting its study, the Bureau shall consider whether insurance companies should provide increased specificity on the areas of medications, procedures, imaging, and other services related to step therapy. The Bureau shall submit an executive summary of the study and a report of its findings and recommendations to the Governor and General Assembly no later than November 1, 2025. The executive summary and report shall be submitted as provided in the procedures of the Division of Legislative Automated Systems for the processing of legislative documents and reports no later than the first day of the 2026 Regular Session of the General Assembly and shall be posted on the General Assembly's website.