Pharmacy benefits managers; requirements, application of law, report, delayed effective date.

The document structure was changed from a House Committee substitute to a Delegate Callsen floor amendment, including updated line numbers and a new bill number (26108552D), but the legislative text itself was not altered.

All new definitions for terms like 'Aggregate retained rebate percentage,' 'Pass-through pricing model,' and 'Spread pricing' were deleted.

The requirement for carriers to use a 'pass-through pricing model' and the prohibition on 'spread pricing' were removed.

The deadline for reversing and resubmitting claims was changed from 365 days to one year.

Detailed quarterly reporting requirements for rebate amounts and administrative fees were deleted.

The requirement for pharmacy benefits managers to direct 100% of manufacturer rebates to offset patient costs or reduce premiums was removed.

Added a new Section 38.2-3465 containing detailed definitions for key terms such as 'retained rebate,' 'pass-through pricing model,' 'spread pricing,' and 'contract pharmacy' to ensure consistent application of the law.

Modified the prohibited conduct section to explicitly require carriers to use a 'pass-through pricing model' and to offer contractual arrangements limiting income to specific fees, preventing hidden profit margins.

Added a strict requirement that 100% of prescription drug manufacturer rebates must be directed to either the health plan or the consumer at the point of sale to reduce deductibles and copayments.

Updated the list of amended statutes to include § 38.2-3465 and § 38.2-3468, broadening the legislative changes beyond just the prohibited conduct and scope sections.

The mandate to select and contract a single 'State Pharmacy Benefits Manager' to administer all Medicaid pharmacy benefits was deleted.

Rebate distribution rules were updated to allow carriers to pass 100% of rebates directly to covered individuals at the point of sale to reduce deductibles or copayments.

The timeframe for reversing and resubmitting pharmacy claims was extended from 90 days to one year.

The bill no longer amends the definitions section (§ 38.2-3465) or the examination and reporting section (§ 38.2-3468) found in the introduced version.