HB1109 • 2026

Managed care organizations & pharmacy benefits manager; data collection and reporting requirements.

<p class=ldtitle>A BILL to amend the Code of Virginia by adding in Article 1 of Chapter 10 of Title 32.1 a section numbered 32.1-331.07, relating to managed care organizations; pharmacy benefits manager; data collection and reporting requirements; civil penalty.</p>

Healthcare Labor

Enacted

This bill passed the Legislature and reached final enactment based on the latest official action.

Sponsor: Hodges
Last action: 2026-02-18
Official status: Failed
Effective date: Not listed

Plain English Breakdown

The bill text specifies that penalties can include fines up to $10,000 and suspension from providing medical assistance services but does not provide further details.

Data Collection and Reporting for Health Care Organizations

This bill requires managed care organizations and pharmacy benefits managers to use standard methods to collect and report data about drug costs, rebates, and other financial information to the Department of Medical Assistance Services and Centers for Medicare and Medicaid Services.

What This Bill Does

Requires managed care organizations and pharmacy benefits managers to follow standardized methodologies for collecting and reporting data on expenditures, rebates, and cost components to the Department of Medical Assistance Services and Centers for Medicare and Medicaid Services.
Mandates that these organizations undergo independent audits every two years to check if their reporting is accurate.
Establishes a compliance unit within the Department of Medical Assistance Services to ensure all required entities comply with the new rules and provides training and guidance on compliance.
Allows for penalties, including fines up to $10,000 and suspension from providing medical assistance services, for non-compliance.

Who It Names or Affects

Managed care organizations
Pharmacy benefits managers

Terms To Know

managed care organization: A company that provides health insurance and manages medical services for its members.
pharmacy benefits manager: An entity that administers prescription drug programs for health plans or employers.

Limits and Unknowns

The bill does not specify the exact penalties beyond a maximum fine of $10,000.
It is unclear how public disclosure requirements will be enforced and what information will be made available to the public.

Bill History

2026-02-18 House
Left in Committee Appropriations
2026-02-13 Health & Human Resources
Subcommittee recommends laying on the table (5-Y 2-N)
2026-02-10 Health & Human Resources
Assigned HAPP sub: Health & Human Resources
2026-02-10 Health and Human Services
Reported from Health and Human Services and referred to Appropriations (22-Y 0-N)
2026-02-09 House
Fiscal Impact Statement from Department of Planning and Budget (HB1109)
2026-01-23 Social Services
Assigned sub: Social Services
2026-01-14 House
Prefiled and ordered printed; Offered 01-14-2026 26103692D
2026-01-14 Health and Human Services
Referred to Committee on Health and Human Services

Official Summary Text

Managed care organizations; pharmacy benefits manager; data collection and reporting requirements; civil penalty.
Requires the Department of Medical Assistance Services to develop, and managed care organizations and pharmacy benefits managers to comply with, standardized methodologies for the collection and reporting of data related to expenditures, rebates, and the source of all cost components to the Department and the Centers for Medicare and Medicaid Services. The bill requires managed care organizations to solicit and undergo an independent audit of their reporting practices every two years and directs the Department to establish a compliance unit that may impose penalties on noncompliant managed care organizations and pharmacy benefits managers.

Current Bill Text

Read the full stored bill text

A BILL to amend the Code of Virginia by adding in Article 1 of Chapter 10 of Title 32.1 a section numbered
32.1-331.07
, relating to managed care organizations; pharmacy benefits manager; data collection and reporting requirements; civil penalty.

Be it enacted by the General Assembly of Virginia:

1. That the Code of Virginia is amended by adding in Article 1 of Chapter 10 of Title 32.1 a section numbered
32.1-331.07
as follows:

§ 32.1
-331.07.
Managed care organization and pharmacy benefits manager
;

data collection and reporting requirements
; civil
penalty
.

A.
Managed
care organizations and pharmacy benefits managers shall utilize standardized methodologies for collecting and reporting data to the
Department of Medical Assistance Servic
es and
Centers for Medicare and Medicaid Services
. Such d
ata shall include a detailed breakdown of expenditures, rebates, and the source of all cost components.
The Department of Medical Assistance Services shall establish
such standardized methodologies for collecting and reporting data by regulation, which shall include
reporting
specific metrics related to drug spending, utilization rates, and prescription volumes
in a timely manner.

B. All transactions related to drug pricing, rebates negotiated by pharmacy benefits managers, and reimbursements
shall
be
included in the reporting required pursuant to subsection A and shall be
disclosed publicly
to ensure
transparency in cost-sharing arrangements between pharmacy benefits managers, managed care o
rganizations, and pharmacies.

C. Managed care organizations shall solicit and undergo an independent audit of their data reporting practices every two
years
. Such audit shall evaluate compliance with this section and the accuracy of reported costs related to drug pricing and reimbursements.
Managed care organizations shall report the results of the audit to the Department of Medical Assistance Services and the Centers for Medicare and Medicaid Services. The Department of Medical Assistance Services may implement corrective actions for any managed care or
ganization whose independent audit pursuant to this section reveals any instances of significant discrepancies or inaccuracies of reported costs related to drug pricing and reimbursements.

D.
The Department of Medical Assistance Services shall establish a compliance unit responsible for overseeing the accuracy of data reported pursuant to this section and ensure that all entities
required to submit data pursuant to this section comply with the provisions of this section.

1.
Such compliance unit shall provide training and guidance to managed care organizations and pharmacy benefit
s managers on compliance with the provisions of this section and improving their data reporting capabilities.

2.
Such compliance unit may impose penalties on any managed care organization or pharmacy benefits manager
, including:

a. Civil penalties proportional to the degree of inaccurate reporting. Such civil penalty shall not exceed $10,000, shall be collected by the compliance unit established pursuant to thi
s subsection, and shall be deposited into the general fund
;

b. Suspension of participation by the managed care organization or pharmacy benefits manager in administration of medical assistance services until
such managed care organization or pharmacy benefits manager achieves adequate compliance with the reporting requirements of this section; and

c.
Imposition of mandatory corrective action plans to rectify issues identified in independent audits conducted pursuant to subsection C.