SB 642 Virginia Senate · 2026 Regular Session

Health insurance; coverage of medications prescribed for treatment of cancer & diseases of blood.

Summary
Health insurance; treatment of cancer and certain diseases; coverage of certain medications. Requires an insurer, corporation providing preferred provider subscription contracts, or health maintenance organization that provides coverage for drugs approved by the Food and Drug Administration and prescribed for the treatment of cancer or diseases of the blood to allow, at the patient's direction, (i) provider-administered drugs for such treatment to be dispensed by an in-network treating provider consistent with a provider agreement; (ii) provider-administered drugs for such treatment to be dispensed by an in-network treating provider when there is a documented delay of at least three days in the delivery of a medication from the designated specialty pharmacy; and (iii) self-administered drugs for such treatment to be sent to the pharmacy of the patient's choosing.
Bill status passed 3 of 5 stages cleared
Introduction
Jan 2026
Committee Review
Mar 2026
Senate Passage
Feb 2026
House of Delegates Passage
Governor
Introduced Jan 14, 2026 Last action Mar 2, 2026
Maddy AI version diff · 2 comparisons

What changed between versions

Commerce and Labor Substitute Finance and Appropriations Substitute · 5 edits
MODERATE
The bill was amended from a Senate Commerce and Labor Substitute to a Senate Finance and Appropriations Substitute. The primary substantive change is the addition of a new section (38.2-3407.23) that specifically requires coverage for medications prescribed for cancer and diseases of the blood, including provider-administered drugs and patient-directed delivery options. The original text was reformatted with different spacing and line breaks, but the core legislative language remained consistent across the three sections covering pharmacies and freedom of choice.
Scope change
The bill's scope expanded by adding a new section that specifically addresses coverage requirements for cancer and blood disease medications, while the existing pharmacy freedom-of-choice provisions were retained without substantive policy changes.
REQUIREMENT

New section 38.2-3407.23 requires insurers, corporations, and health maintenance organizations to allow provider-administered cancer and blood disease drugs to be dispensed by in-network treating providers, either routinely or when there is a documented three-day delay from specialty pharmacy delivery.

New section 38.2-3407.23 requires self-administered cancer and blood disease drugs to be sent to the pharmacy of the patient's choosing, consistent with existing pharmacy freedom-of-choice provisions.

DEFINITION

New section 38.2-3407.23 explicitly defines 'prescribed for the treatment of cancer or diseases of the blood' to include supportive therapies like anti-emetics, antibiotics, and pain medications.

PAYMENT

Payment rates for new cancer drug coverage provisions reference 'national average drug acquisition cost' instead of 'wholesale acquisition cost' used in the original pharmacy freedom-of-choice sections.

TECHNICAL

The document underwent significant reformatting with different spacing, line breaks, and character positioning between the two versions, though the substantive legislative text remained consistent.

Floor votes · Senate Jan 28, 2026

How they voted

390
Passed
Total votes 39
Jan 28, 2026
D Democratic20
20 Yea
100% Yea
R Republican19
19 Yea
100% Yea
Vote distribution
All Yea All Nay Mixed No data
Full legislative history

Actions timeline

Total actions
32
Key actions
9
Committee
12
Mar 2, 2026
Committee
Assigned HAPP sub: Compensation and Retirement
lower
Feb 26, 2026
Lower · Passed
Reported from Labor and Commerce and referred to Appropriations (18-Y 3-N)
lower
Feb 24, 2026
Lower · Passed
Subcommittee recommends reporting and referring to Appropriations (8-Y 0-N)
lower
Feb 20, 2026
Committee
Assigned HCL sub: Subcommittee #1
lower
Feb 19, 2026
Committee
Referred from Health and Human Services and referred to Labor and Commerce (Voice Vote)
lower
Feb 13, 2026
Committee
Referred to Committee on Health and Human Services
lower
Feb 10, 2026
Upper · Passed
Read third time and passed Senate (40-Y 0-N 0-A)
upper
Feb 9, 2026
Upper · Passed
Committee substitute reconsidered
upper
Feb 5, 2026
Upper · Passed
Reported from Finance and Appropriations with substitute (15-Y 0-N)
upper
Jan 29, 2026
Committee
Rereferred to Finance and Appropriations
upper
Jan 28, 2026
Upper · Passed
Passed by for the day
upper
Jan 28, 2026
Upper · Passed
Passed by for the day Block Vote (Voice Vote)
upper
Jan 27, 2026
Upper · Passed
Senate committee offered
upper
Jan 26, 2026
Upper · Passed
Reported from Commerce and Labor with substitute (15-Y 0-N)
upper
Jan 14, 2026
Committee
Referred to Committee on Commerce and Labor
upper
1 primary · 1 co-sponsor

Sponsors