SB257 • 2026

Health insurance; requirements for certain opioid antagonists.

An Act to amend the Code of Virginia by adding a section numbered 38.2-3407.18:1, relating to health insurance; requirements for certain opioid antagonists.

Enacted

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

Sponsor: Favola
Last action: 2026-04-08
Official status: Acts of Assembly Chapter
Effective date: Not listed

Plain English Breakdown

The effective date is not specified in the provided official source material, only the start date for applicability (January 1, 2027).

Health Insurance Requirements for Opioid Antagonists

This act requires health insurance plans in Virginia to cover at least one opioid antagonist used for overdose reversal without prior authorization or step therapy requirements, starting January 1, 2027.

What This Bill Does

Requires health insurers and health maintenance organizations to include coverage for at least one opioid antagonist used for overdose reversal.
Ensures that the cost-sharing for an opioid antagonist is on the lowest tier of the prescription drug formulary.
Exempts coverage from prior authorization or step therapy requirements.

Who It Names or Affects

Health insurers
Corporations providing health care subscription plans
Health maintenance organizations

Terms To Know

Opioid antagonist: A drug that can reverse the effects of an opioid overdose.
Prior authorization: A requirement by insurance companies to get approval before a treatment or medication is covered.

Limits and Unknowns

The act does not apply to short-term travel, accident-only, limited disease policies, Medicare plans, and similar state or federal government plans.
It applies only to health care services delivered, issued for delivery, or renewed in the Commonwealth of Virginia on and after January 1, 2027.

Bill History

2026-04-08 Governor
Approved by Governor-Chapter 424 (effective 7/1/2026)
2026-04-08 Governor
Acts of Assembly Chapter text (CHAP0424)
2026-04-01 Senate
Fiscal Impact Statement from Department of Planning and Budget (SB257)
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 (SB257ER)
2026-03-12 House
Read third time
2026-03-12 House
committee substitute rejected
2026-03-12 House
committee substitute agreed to
2026-03-12 House
Engrossed by House - committee substitute
2026-03-12 House
Passed House with substitute Block Vote (96-Y 0-N 0-A)
2026-03-12 Senate
House substitute agreed to by Senate (39-Y 1-N 0-A)
2026-03-11 House
Read second time
2026-03-10 Appropriations
Fiscal Impact Statement from Department of Planning and Budget (SB257)
2026-03-09 Appropriations
Reported from Appropriations with substitute (22-Y 0-N)
2026-03-09 Appropriations
Committee substitute printed 26109143D-H2
2026-03-05 Appropriations
House committee offered
2026-03-04 Labor and Commerce
Fiscal Impact Statement from Department of Planning and Budget (SB257)
2026-02-27 Health & Human Resources
Assigned HAPP sub: Health & Human Resources
2026-02-27 Labor and Commerce
Committee substitute printed 26108572D-H1
2026-02-26 Labor and Commerce
Reported from Labor and Commerce with substitute and referred to Appropriations (21-Y 0-N)
2026-02-24 Subcommittee #1
Assigned HCL sub: Subcommittee #1
2026-02-24 Subcommittee #1
Subcommittee recommends reporting with substitute and referring to Appropriations (6-Y 0-N)
2026-02-24 Subcommittee #1
House subcommittee offered
2026-02-19 House
Placed on Calendar
2026-02-19 House
Read first time
2026-02-19 Labor and Commerce
Referred to Committee on Labor and Commerce
2026-02-16 Senate
Read third time and passed Senate (37-Y 1-N 0-A)
2026-02-13 Senate
Read second time
2026-02-13 Senate
Engrossed by Senate - committee substitute (Voice Vote)
2026-02-13 Commerce and Labor
Committee substitute agreed to (Voice Vote)
2026-02-13 Senate
Engrossed by Senate (Voice Vote)
2026-02-12 Senate
Rules suspended
2026-02-12 Senate
Passed by for the day
2026-02-12 Senate
Constitutional reading dispensed Block Vote (on 1st reading) (40-Y 0-N 0-A)
2026-02-12 Senate
Passed by for the day Block Vote (Voice Vote)
2026-02-11 Finance and Appropriations
Reported from Finance and Appropriations (15-Y 0-N)
2026-02-04 Commerce and Labor
Fiscal Impact Statement from Department of Planning and Budget (SB257)
2026-02-03 Commerce and Labor
Committee substitute printed 26106753D-S1
2026-02-02 Commerce and Labor
Reported from Commerce and Labor with substitute and rereferred to Finance and Appropriations (10-Y 2-N 1-A)
2026-02-02 Senate
Senate committee offered
2026-01-23 Senate
Fiscal Impact Statement from Department of Planning and Budget (SB257)
2026-01-12 Senate
Prefiled and ordered printed; Offered 01-14-2026 26104746D
2026-01-12 Commerce and Labor
Referred to Committee on Commerce and Labor

Official Summary Text

Health insurance; requirements for certain opioid antagonists.
Requires each health insurer, corporation providing health care subscription plans, and health maintenance organization whose policy, contract, or plan includes coverage for prescription drugs to include coverage for at least one opioid antagonist used for overdose reversal dispensed pursuant to an oral, written, or standing order of a prescriber and ensure that cost-sharing for at least one opioid antagonist used for overdose reversal is included on the lowest cost tier of the insurer's, corporation's, or health maintenance organization's prescription drug formulary. The bill provides that such coverage shall be exempt from any prior authorization or step therapy requirement on coverage of benefits. As introduced, this bill was a recommendation of the Joint Commission on Health Care. This bill is identical to HB 795.

Current Bill Text

Read the full stored bill text

An Act to amend the Code of Virginia by adding a section numbered
38.2-3407.18:1
, relating to health insurance; requirements for certain opioid antagonists.
Be it enacted by the General Assembly of Virginia:
1. That the Code of Virginia is amended by adding a section numbered
38.2-3407.18:1
as follows:
§
38.2-3407.18:1
. Requirements for certain opioid antagonists.
A. Notwithstanding the provisions of §
38.2-3419
, subdivision A 1 of §
38.2-6506
, or any other provision of law, each insurer proposing to issue individual or group accident and sickness insurance policies providing hospital, medical, and surgical or major medical coverage on an expense-incurred basis; each corporation providing individual or group accident and sickness subscription contracts; and each health maintenance organization providing a health care plan for health care services whose policy, contract, or plan, including any certificate or evidence of coverage issued in connection with such policy, contract, or plan, shall include coverage for at least one opioid antagonist used for overdose reversal dispensed pursuant to an oral, written, or standing order of a prescriber and shall ensure that cost-sharing for at least one opioid antagonist used for overdose reversal is included on the lowest cost tier of the insurer's, corporation's, or health maintenance organization's prescription drug formulary.
B. No insurer, corporation, or health maintenance organization shall impose any prior authorization or step therapy requirement on coverage of benefits provided pursuant to this section.
C. The provisions of this section shall not apply to short-term travel, accident-only, limited or specified disease policies, or contracts designed for issuance to persons eligible for coverage under Title XVIII of the Social Security Act, known as Medicare, or any other similar coverage under state or federal governmental plans or to short-term nonrenewable policies of not more than six months' duration.
2. That the provisions of this act shall apply to any individual or group accident and sickness insurance policy, individual or group accident and sickness subscription contract, or health care plan for health care services delivered, issued for delivery, or renewed in the Commonwealth on and after January 1, 2027.
3. That to the extent the health benefit or any portion thereof described in
38.2-3407.18:1
of the Code of Virginia, as created by this act, is included in the Commonwealth's current essential health benefits benchmark plan, as defined in §
30-343.1
of the Code of Virginia, the mandate to provide coverage of such health benefit or portion of the health benefit shall not apply to the individual and small group markets.