SB161 • 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: Perry
Last action: 2026-04-13
Official status: Acts of Assembly Chapter
Effective date: Not listed

Plain English Breakdown

The official source does not specify that the act ensures clear naming of health insurance plans for consumer choice, although it requires such plans to be marketed in a manner aiding selection.

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 have to 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.

Who It Names or Affects

People with individual or small group health insurance plans who need prescription drugs.
Health insurance companies offering these plans in Virginia.

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 types of health plans, like platinum, gold, silver, and bronze, which offer different levels of benefits and costs.

Limits and Unknowns

The rules start on January 1, 2028.
Does not apply to Health Savings Account-qualified High Deductible Health Plans until after the minimum deductible is met.

Amendments

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

SB161AC

2026-03-10 • Conference

Conference Report

Plain English: The amendment proposes to reject a previous version of Senate Bill No. 161 and accept a new substitute amendment.

Rejects the House Amendment in the Nature of a Substitute (26108163D).
Accepts a new Amendment in the Nature of a Substitute (26109293D) to address disagreements.

The specific details and content of the new substitute amendment are not provided, making it hard to explain its exact changes.
Without the full text of the new amendment, we cannot describe what concrete changes it will make to the bill.

SB161AC1

2026-03-11 • Conference

Conference Report

Plain English: The amendment proposes to reject a previous version of Senate Bill No. 161 and accept a new substitute amendment.

Rejects the House Amendment in the Nature of a Substitute (26108163D).
Accepts a new Amendment in the Nature of a Substitute (26109293D) to address disagreements.

The specific details and content of the new substitute amendment are not provided, making it hard to explain its exact changes.
Without the full text of the new amendment, we cannot describe what concrete changes it will make to the bill.

SB161ASC1

2026-01-26 • Committee

Commerce and Labor Amendment

Plain English: The amendment changes the year from 2027 to 2028 in a specific line of the bill.

Changes the year from 2027 to 2028 in the bill's text.

This amendment only specifies changing one date and does not provide context on what this change means for the overall bill.

SB161AS1

2026-02-03 • Committee

Commerce and Labor Amendment

Plain English: The amendment changes the year from 2027 to 2028 in a specific line of the bill.

Changes the implementation date for certain provisions from January 1, 2027, to January 1, 2028.

The amendment only specifies changing one year and does not provide details about what happens between these dates or other specifics of the bill.

SB161S1

2026-03-11 • 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 in platinum, gold, silver, and bronze level health plans: $150, $200, $250, and $300 per 30-day supply respectively.
Requires these limits to apply at any point during the benefit period, including before or after a deductible is met.

The amendment does not specify how plans will be named or marketed beyond requiring clarity for consumers and plan sponsors.

Bill History

2026-04-13 Governor
Approved by Governor-Chapter 642 (effective 7/1/2026)
2026-04-13 Governor
Approved by Governor-Chapter 642 (effective 7/1/2026)
2026-04-13 Governor
Acts of Assembly Chapter text (CHAP0642)
2026-03-31 Senate
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 Senate
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 Senate
Enrolled
2026-03-30 Senate
Bill text as passed Senate and House (SB161ER)
2026-03-11 Conference
Conference Report released
2026-03-11 Conference
Conference Report released
2026-03-11 Conference
Conference Report released
2026-03-11 Conference
Conference Report released
2026-03-11 Conference
Conference Report released
2026-03-11 Conference
Conference Report released
2026-03-10 House
Conference report agreed to by House (63-Y 33-N 0-A)
2026-03-09 Senate
Conference report agreed to by Senate (38-Y 2-N 0-A)
2026-03-06 Conference
Conference Report released
2026-03-06 Senate
Floor substitute printed 26109293D-S1 (Perry)
2026-03-06 Conference
Conference Report released
2026-03-05 House
Conferees appointed by House
2026-03-05 House
House Conferees: Henson, Ward, McLaughlin
2026-03-03 Senate
Conferees appointed by Senate
2026-03-03 Senate
Senate Conferees: Perry, Rouse, Stanley
2026-03-03 Senate
Senate acceded to request Block Vote (40-Y 0-N 0-A)
2026-03-03 Labor and Commerce
Fiscal Impact Statement from State Corporation Commission (SB161)
2026-02-27 House
House insisted on substitute
2026-02-27 House
House requested conference committee
2026-02-26 Senate
House substitute rejected by Senate (0-Y 40-N 0-A)
2026-02-24 House
Read third time
2026-02-24 House
committee substitute agreed to
2026-02-24 House
Engrossed by House - committee substitute
2026-02-24 House
Passed House with substitute (64-Y 34-N 0-A)
2026-02-23 House
Read second time
2026-02-19 Labor and Commerce
Reported from Labor and Commerce with substitute (14-Y 6-N)
2026-02-19 Labor and Commerce
Committee substitute printed 26108163D-H1
2026-02-12 House
Placed on Calendar
2026-02-12 House
Read first time
2026-02-12 Labor and Commerce
Referred to Committee on Labor and Commerce
2026-02-06 Senate
Read third time and passed Senate (34-Y 6-N 0-A)
2026-02-05 Senate
Read second time
2026-02-05 Senate
Engrossed by Senate as amended (Voice Vote)
2026-02-05 Commerce and Labor
Commerce and Labor Amendment agreed to
2026-02-05 Senate
Engrossed by Senate (Voice Vote)
2026-02-04 Senate
Rules suspended
2026-02-04 Senate
Passed by for the day
2026-02-04 Senate
Passed by for the day
2026-02-04 Senate
Passed by for the day
2026-02-04 Senate
Constitutional reading dispensed Block Vote (on 1st reading) (40-Y 0-N 0-A)
2026-02-04 Senate
Passed by for the day Block Vote (Voice Vote)
2026-02-02 Commerce and Labor
Reported from Commerce and Labor with amendment (9-Y 4-N)
2026-01-26 Senate
Senate committee offered
2026-01-25 Senate
Fiscal Impact Statement from State Corporation Commission (SB161)
2026-01-07 Senate
Prefiled and ordered printed; Offered 01-14-2026 26101280D
2026-01-07 Commerce and Labor
Referred to Committee on Commerce and Labor

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 HB 625.

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.