Virginia law eases prior authorisations

Virginia has changed its prior authorization law so some prescription approvals will stay in force longer instead of dropping off mid-treatment. (lis.virginia.gov, lis.virginia.gov) Governor Abigail Spanberger approved House Bill 736 on April 6, 2026. The bill takes effect July 1, 2026, and rewrites part of Virginia Code section 38.2-3407.15:2. (lis.virginia.gov, lis.virginia.gov) Prior authorization is the insurer’s advance approval before a patient can get certain covered drugs. Virginia’s law now says that once an approval is in place and the prescription has been scheduled, provided, or delivered, the carrier must honor it for at least six months on an initial authorization and 12 months on a continued authorization. (justia.com, lis.virginia.gov, lis.virginia.gov) Before this bill, Virginia already barred insurers from revoking or restricting an approved prescription authorization in most cases, but the statute did not set a minimum length for how long that approval had to last. House Bill 736 adds that floor. (justia.com, lis.virginia.gov, beckerspayer.com) The law still lets carriers reopen an approval in specific cases. Those exceptions include fraud or misrepresentation, final action by the United States Food and Drug Administration or another regulator, manufacturer notices about patient efficacy issues, and situations where extra safety or efficacy monitoring is clinically appropriate or recommended. (lis.virginia.gov, lis.virginia.gov, beckerspayer.com) The bill’s chief patron was Delegate Michelle Lopes Maldonado, a Democrat from the 20th District. It cleared the Senate 39-0 on March 5 after moving through the House earlier in the session. (lis.virginia.gov) Maldonado told 29News that continuity in prescription medication is tied to patient health and treatment outcomes. That is the problem the bill targets when people stay on the same drug over time. (newsbreak.com) Virginia kept the state’s existing response deadlines for insurers in the same section of law: 24 hours for urgent requests and two business days for a fully completed standard request. The new measure leaves those timing rules in place while adding a minimum approval period after a drug is authorized. (justia.com, lis.virginia.gov) The change lands as federal officials are also pushing to streamline prior authorization. The Centers for Medicare and Medicaid Services published a proposed rule on April 10, 2026, aimed at making drug prior authorization more transparent and interoperable across several insurance markets. (cms.gov, federalregister.gov) For Virginia patients already using a drug that has been approved, the practical change is simple: the approval now comes with a state-set minimum lifespan, unless one of the law’s listed exceptions applies. (lis.virginia.gov, lis.virginia.gov)