Subcommittee approves bill to require physician or pharmacist review for insurer denials
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Summary
HB481, amended to require a licensed physician for adverse determinations and allow pharmacists to review prescription denials, was reported by the subcommittee after unanimous committee support and testimony from physician groups and the Virginia Association of Health Plans.
The subcommittee reported House Bill 481 with a substitute that would require carriers to have a licensed physician sign off on adverse determinations for services and permit a pharmacist to sign off where the denial concerns a prescription.
Delegate Hope, sponsor of HB481, said the current process forces physicians into lengthy appeals with insurance staff who may lack clinical credentials and that the change would place peer review earlier in the prior‑authorization process. "Delays in prior authorization are more than just red tape. They are safety risks," the sponsor said.
Health‑care groups supported the bill; David May (Virginia Academy of Family Physicians) and Scott Castro (Medical Society of Virginia) testified in favor. The Virginia Association of Health Plans noted it had worked with the sponsor on language, and one industry representative thanked stakeholders for collaboration.
The substitute was approved and the bill reported (roll recorded as unanimous). The committee recorded online clinical testimony in support, including Dr. Bruce Silverman emphasizing prior authorization’s burden on clinicians and patients.
