HB625 • 2026

Health insurance; limit on cost-sharing payments for prescription drugs under certain plans.

An Act to amend the Code of Virginia by adding a section numbered 38.2-3407.15:9, relating to health insurance; limit on cost-sharing payments for prescription drugs under certain plans.

Enacted

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

Sponsor: Henson
Last action: 2026-04-13
Official status: Acts of Assembly Chapter
Effective date: Not listed

Plain English Breakdown

Checked against official source text during the last sync.

Limiting Cost-Sharing Payments for Prescription Drugs

This act sets limits on how much people have to pay out-of-pocket for prescription drugs under certain health insurance plans.

What This Bill Does

Sets a limit of $150 per month for platinum level coverage, $200 for gold level, $250 for silver level, and $300 for bronze level on how much people must pay out-of-pocket for prescription drugs.
Requires health insurance companies to offer at least one plan in each metal level (platinum, gold, silver, bronze) that follows these limits.
Ensures plans are clearly named and marketed so consumers can easily find them.

Who It Names or Affects

People with individual or small group health insurance plans
Health insurance companies offering such plans

Terms To Know

Cost-sharing payment: The total amount a covered person is required to pay at the point of sale in order to receive a prescription drug that is covered under their health plan.
Metal level of coverage: Different levels of health insurance plans, such as platinum, gold, silver, and bronze, which offer different amounts of coverage.

Limits and Unknowns

The bill does not specify what happens if the limits make a plan ineligible for certain tax benefits.
This act will start applying to new policies on January 1, 2028.

Amendments

These notes stay tied to the official amendment files and metadata from the legislature.

HB625AC

2026-03-10 • Conference

Conference Report

Plain English: The amendment recommends rejecting a previous Senate proposal and accepting a new substitute amendment to address disagreements about House Bill No. 625.

Rejects the Senate's original amendment in nature of a substitute (26108395D).
Accepts a new Amendment in the Nature of a Substitute (26109295D) to resolve disagreements.

The official text does not provide details about the content of the accepted amendment, making it hard to explain specific changes.
Further information on the actual substance of Amendment in the Nature of a Substitute (26109295D) is needed for a complete explanation.

HB625AHC1

2026-02-04 • Committee

Subcommittee #1 Subcommittee Amendment

Plain English: The amendment changes a specific date in the bill from 2027 to 2028 and adds that the bill's provisions will only take effect if it is passed again during the 2027 session.

Changes the year '2027' to '2028' at a specific point in the bill text.
Adds a clause stating that the bill’s provisions will not become effective unless the same or similar legislation is passed again during the 2027 session.

The amendment does not provide details about what happens if the bill is not reenacted in 2027, which limits understanding of its full impact.

HB625AH1

2026-02-05 • Committee

Labor and Commerce Amendment

Plain English: The amendment changes a specific date in the bill from 2027 to 2028 and adds a condition that the bill's provisions will only take effect if it is reenacted by the 2027 Session of the General Assembly.

Changes the year '2027' to '2028' in the original bill text.
Adds a clause stating that the bill’s provisions will not become effective unless it is reenacted by the 2027 Session of the General Assembly.

The amendment does not provide details on what specific changes are being made to health insurance plans regarding prescription drug cost-sharing payments, as this information remains in the original bill text.

HB625H1

2026-03-10 • Conference

Conference Report Substitute

Plain English: The amendment sets limits on how much a person has to pay out-of-pocket for prescription drugs under different types of health insurance plans.

Sets a maximum cost-sharing payment limit for prescription drugs at $150 per 30-day supply for platinum level coverage, $200 for gold level, $250 for silver level, and $300 for bronze level.
Requires these limits to apply before and after any deductible is met.

The amendment does not specify how the cost-sharing payment limit interacts with other health insurance regulations or plans that qualify as Health Savings Account-eligible High Deductible Health Plans.

Bill History

2026-04-13 Governor
Approved by Governor-Chapter 641 (effective 7/1/2026)
2026-04-13 Governor
Approved by Governor-Chapter 641 (effective 7/1/2026)
2026-04-13 Governor
Acts of Assembly Chapter text (CHAP0641)
2026-04-13 House
Fiscal Impact Statement from State Corporation Commission (HB625)
2026-03-31 House
Enrolled Bill communicated to Governor on March 31, 2026
2026-03-31 Governor
Governor's Action Deadline 11:59 p.m., April 13, 2026
2026-03-31 House
Signed by Speaker
2026-03-31 House
Enrolled Bill communicated to Governor on March 31, 2026
2026-03-31 Governor
Governor's Action Deadline 11:59 p.m., April 13, 2026
2026-03-30 Senate
Signed by President
2026-03-30 House
Enrolled
2026-03-30 House
Bill text as passed House and Senate (HB625ER)
2026-03-11 Senate
Conference report agreed to by Senate (39-Y 0-N 0-A)
2026-03-10 House
Floor substitute printed 26109295D-H1 (Henson)
2026-03-10 House
Floor substitute printed 26109295D-H1 (Henson)
2026-03-10 Conference
Conference Report released
2026-03-10 Conference
Conference Report released
2026-03-10 House
Conference report agreed to by House (63-Y 33-N 0-A)
2026-03-09 House
Conferees appointed by House
2026-03-09 House
House Conferees: Henson, Ward, McLaughlin
2026-03-06 Senate
Conferees appointed by Senate
2026-03-06 Senate
Senate Conferees: Perry, Rouse, Stanley
2026-03-06 Senate
Senate Conferees:
2026-03-05 House
House acceded to request
2026-03-04 Senate
Senate requested conference committee
2026-03-04 Commerce and Labor
Fiscal Impact Statement from State Corporation Commission (HB625)
2026-03-04 Senate
Senate insisted on amendment Block Vote (40-Y 0-N 0-A)
2026-03-02 House
Senate substitute rejected by House (2-Y 97-N 0-A)
2026-02-26 Senate
Read third time
2026-02-26 Senate
Engrossed by Senate - committee substitute
2026-02-26 Commerce and Labor
Commerce and Labor Substitute agreed to
2026-02-26 Senate
Passed Senate with substitute (37-Y 3-N 0-A)
2026-02-25 Senate
Rules suspended
2026-02-25 Senate
Passed by for the day
2026-02-25 Senate
Constitutional reading dispensed Block Vote (on 2nd reading) (40-Y 0-N 0-A)
2026-02-25 Senate
Passed by for the day Block Vote (Voice Vote)
2026-02-24 Commerce and Labor
Committee substitute printed 26108395D-S1
2026-02-23 Commerce and Labor
Reported from Commerce and Labor with substitute (11-Y 4-N)
2026-02-12 Senate
Constitutional reading dispensed (on 1st reading)
2026-02-12 Commerce and Labor
Referred to Committee on Commerce and Labor
2026-02-11 House
Read third time and passed House (63-Y 35-N 0-A)
2026-02-10 House
Read second time
2026-02-10 House
committee amendment agreed to
2026-02-10 House
Engrossed by House as amended
2026-02-09 House
Read first time
2026-02-05 Labor and Commerce
Reported from Labor and Commerce with amendment(s) (15-Y 7-N)
2026-02-03 Subcommittee #1
Subcommittee failed to recommend reporting (4-Y 5-N)
2026-02-03 Subcommittee #1
Reconsidered by Labor and Commerce (Voice Vote)
2026-02-03 Subcommittee #1
Subcommittee recommends reporting with amendment(s) (6-Y 3-N)
2026-01-20 Subcommittee #1
Assigned HCL sub: Subcommittee #1
2026-01-13 House
Prefiled and ordered printed; Offered 01-14-2026 26101225D
2026-01-13 Labor and Commerce
Referred to Committee on Labor and Commerce

Official Summary Text

Health insurance; limit on cost-sharing payments for prescription drugs under certain plans.
Requires each carrier that offers a health plan in either the individual or small group market to ensure that at least one health plan in each of the bronze, silver, gold, and platinum levels of coverage in each rating area in the individual and small group market conform with the following: (i) a plan that offers a platinum level of coverage shall limit a person's cost-sharing payment for prescription drugs covered under the plan to an amount that does not exceed $150 per 30-day supply of the prescription drug; (ii) a plan that offers a gold level of coverage shall limit a person's cost-sharing payment for prescription drugs covered under the plan to an amount that does not exceed $200 per 30-day supply of the prescription drug; (iii) a plan that offers a silver level of coverage shall limit a person's cost-sharing payment for prescription drugs covered under the plan to an amount that does not exceed $250 per 30-day supply of the prescription drug; and (iv) a plan that offers a bronze level of coverage shall limit a person's cost-sharing payment for prescription drugs covered under the plan to an amount that does not exceed $300 per 30-day supply of the prescription drug. The bill requires that any plans offered to meet its requirements are (a) clearly and appropriately named to aid the consumer or plan sponsor in the plan selection process and (b) marketed in the same manner as other plans offered by the carrier. The bill's provisions apply to any individual or group accident and sickness insurance policy, any individual or group accident and sickness subscription contract, and any health care plan for health care services delivered, issued for delivery, or renewed in the Commonwealth on or after January 1, 2028. This bill is identical to SB 161.

Current Bill Text

Read the full stored bill text

An Act to amend the Code of Virginia by adding a section numbered
38.2-3407.15:9
, relating to health insurance; limit on cost-sharing payments for prescription drugs under certain plans.
Be it enacted by the General Assembly of Virginia:
1. That the Code of Virginia is amended by adding a section numbered
38.2-3407.15:9
as follows:
§
38.2-3407.15:9
. Limit on cost-sharing payments for prescription drugs under certain plans.
A. As used in this section:
"Carrier" has the same meaning as provided in subsection A of §
38.2-3407.15
.
"Cost-sharing payment" means the total amount a covered person is required to pay at the point of sale in order to receive a prescription drug that is covered under the covered person's health plan.
"Covered person" means a policyholder, subscriber, participant, or other individual covered by a health plan.
"Health plan" means any health benefit plan, as defined in §
38.2-3438
, that provides coverage for prescription drugs.
B. Notwithstanding any other provision of law, each carrier that offers a health plan in either the individual or small group market shall ensure that at least one health plan in each metal level of coverage offered by the carrier, as defined in 45 C.F.R. § 156.140, in each rating area in the individual and small group market conform with the following:
1. A plan that offers a platinum level of coverage, as defined in 45 C.F.R. § 156.140, shall limit a person's cost-sharing payment for prescription drugs covered under the plan to an amount that does not exceed $150 per 30-day supply of the prescription drug;
2. A plan that offers a gold level of coverage, as defined in 45 C.F.R. § 156.140, shall limit a person's cost-sharing payment for prescription drugs covered under the plan to an amount that does not exceed $200 per 30-day supply of the prescription drug;
3. A plan that offers a silver level of coverage, as defined in 45 C.F.R. § 156.140, shall limit a person's cost-sharing payment for prescription drugs covered under the plan to an amount that does not exceed $250 per 30-day supply of the prescription drug; and
4. A plan that offers a bronze level of coverage, as defined in 45 C.F.R. § 156.140, shall limit a person's cost-sharing payment for prescription drugs covered under the plan to an amount that does not exceed $300 per 30-day supply of the prescription drug.
The limits described in subdivisions 1 through 4 shall apply at any point in the benefit design, including before and after any applicable deductible is reached.
C. Any health plan offered to meet the requirements of subsection B shall be (i) clearly and appropriately named to aid the consumer or plan sponsor in the plan selection process and (ii) marketed in the same manner as other plans offered by the health insurance carrier.
D. No health plan offered pursuant to subsection B shall count against any limit on plan options established by the Commission or the Virginia Health Benefits Exchange.
E. If the application of the provisions of this section would result in a health plan's ineligibility to qualify as a Health Savings Account-qualified High Deductible Health Plan under 26 U.S.C. § 223, then the requirements of this section shall not apply with respect to the deductible of such health plan until after the enrollee has satisfied the minimum deductible under 26 U.S.C. § 223.
2. That the provisions of this act shall apply to any individual or group accident and sickness insurance policy, any individual or group accident and sickness subscription contract, and any health care plan for health care services delivered, issued for delivery, or renewed in the Commonwealth on and after January 1, 2028.