Virginia Limits Prior Authorization for Prescription Drugs, Prohibits Restrictions on In-Network Referrals

On April 6, 2026, Gov. Spanberger signed a pair of laws prohibiting health insurers from imposing certain treatment limitations:

• HB736 limits the frequency with which an insurer may require prior authorization for prescription drugs. Under the law, once a prior authorization request is approved, the duration of an initial authorization must be no less than six months, and the duration of a continued authorization must be no less than 12 months. An insurer may not revoke an authorization unless additional safety or efficacy monitoring is clinically appropriate or recommended by a regulatory agency. This legislation is effective for all carrier contracts entered into, amended, or renewed on or after January 1, 2027. For the full text of the prior authorization legislation, please see the HB736 enacted text.

• HB424/SB745 bars an insurer from prohibiting an in-network provider from referring services to an in-network clinical laboratory or in-network pathology service provider. However, the restriction does not apply to referrals that would otherwise violate state or federal laws against provider self-referrals. The legislation is effective July 1, 2026. For the full text of the in-network referral legislation, please see the HB424 enacted text.

Employers that sponsor fully insured group health plans in Virginia should consult with their carriers and amend their plans as necessary to conform to the new legislation. ERISA self-insured group health plans are generally exempt from state insurance laws.