VA HB481

Insurance carriers must have a licensed physician review and approve any denial of a prior authorization request for prescription drugs; if a physician is unavailable, a licensed pharmacist may conduct the review.

For health care services prior authorization denials, the adverse determination must be reviewed and approved by a licensed physician, a licensed mental health provider (for mental health services if no physician is available), or a licensed dentist (for dental services if no physician is available).

The bill amends Virginia Code sections 38.2-3407.15:2 and 38.2-3407.15:8 governing carrier contracts and prior authorization requirements.

Exemptions apply to Medicare, Medicaid, CHIP, federal employee plans, TRICARE, workers' compensation, and certain other specialized insurance coverages.

The provisions regarding health care services take effect January 1, 2027.