Gov. Abigail Spanberger (D) signed a bipartisan package of healthcare affordability bills at the Inova Schar Cancer Institute in Fairfax County May 13, advancing measures aimed at reducing prescription drug costs, limiting insurance-related delays in care and expanding covered health benefits for Virginians. Signed as part of Spanberger’s broader Affordable Virginia Plan, the bills sought to address rising healthcare costs through changes affecting medication pricing, insurance practices and patient coverage, according to several legislators.
“Because of the bills I signed today, when your family needs care, you can get it,” Spanberger wrote in a statement May 13 on X. “From capping the monthly out-of-pocket cost of insulin at $35 to cracking down on prior authorization delays, we are taking action to bring down healthcare costs.”
The legislative package included measures passed with bipartisan support in the Virginia General Assembly that sought to reduce healthcare expenses by establishing monthly caps for certain out-of-pocket prescription drug costs, limiting how often insurers can require patients to renew coverage approvals for ongoing treatments and expanding insurance protection for essential medications and diabetes-related medical equipment.
When asked by The Cavalier Daily how the bills may affect U.Va. Health, Eric Swensen, public information officer for U.Va. Health, wrote in an email that the legislation collectively addressed several barriers patients encounter when seeking healthcare in Virginia.
“These bipartisan bills represent a meaningful step toward improving affordability and access to care,” Swensen wrote. “Collectively, they focus on reducing out-of-pocket costs, improving predictability for patients managing ongoing treatment needs and reducing delays in care.”
Swensen added that other provisions in the package addressed insurance-related barriers to care, including delays in treatment approval, reimbursement and claims practices that can increase patient costs and expanded coverage for services patients have historically paid without assistance from their insurance plans.
Lawmakers who sponsored and supported the measures said the package represented broader efforts to address affordability concerns across Virginia’s healthcare system. Sen. Saddam Salim (D) wrote in a statement May 14 on X that the legislation moved the Commonwealth toward reducing financial barriers for patients.
“Affordability in healthcare is our goal, and each of these bills brings Virginia a few steps closer,” Salim wrote.
Among the bills passed was House Bill 1214 introduced by Del. Karrie Delaney (D), which capped out-of-pocket insulin costs at $35 for a 30-day supply under state-regulated health plans. The legislation also created a separate $35 monthly cap for diabetes-related supplies and equipment such as continuous glucose monitors and insulin pumps. Delaney wrote in a statement on X that HB 1214 aimed to reduce financial burdens for individuals with diabetes — who often face recurring costs with both medication and treatment devices.
“Not only does HB 1214 cap the cost of insulin at $35 a month, but the cost of the supplies and equipment used to manage diabetes will be capped at this price too,” Delaney wrote. “As the mother of a [type 1 diabetic] child, I am all too familiar with just how costly equipment like CGMs or insulin pumps can be.”
House Bill 625, introduced by Del. Rozia Henson (D), and Senate Bill 161, introduced by Sen. Russet Perry (D), required insurers participating in Virginia’s Insurance Marketplace to offer plans limiting monthly out-of-pocket prescription drug costs. Virginia’s Insurance Marketplace is a system through which residents can purchase private health insurance plans independently.
Under HB 625 and SB 161, platinum plans — which generally carry the highest monthly premiums but lowest out-of-pocket costs — must cap prescription drug costs at $150 for a 30-day supply. Gold plans cap costs at $200, silver plans cap at $250 and bronze plans — which typically have the lowest premiums but highest out-of-pocket costs — cap at $300. The caps apply regardless of whether a patient has met their deductible — which is the amount they must pay for covered care before insurance begins paying covered medical expenses.
“[Spanberger] signed HB 625, capping co-pays on life-saving prescriptions, so Virginians won’t choose between rent and the medication keeping them alive,” Henson wrote in a statement May 14 on X. “Proud to carry this with [Perry]. Thanks to every advocate, patient and family who pushed this across the finish line.”
The healthcare affordability package also included House Bill 736, introduced by Del. Michelle Maldonado (D), which amended Virginia’s existing prior authorization requirements by establishing minimum approval periods for prescription drug authorizations, where none previously existed in Virginia law. Prior authorization is a process requiring healthcare providers to receive approval from insurers before certain medications, procedures or services are covered by insurance.
Prior to HB 736, Virginia law did not set minimum time periods for prescription drug prior authorizations. This meant authorization lengths could vary by insurer but prevented insurers from revoking approved prescription drug authorizations in certain situations after treatment had already begun. HB 736 now requires insurers to honor initial authorizations for at least six months and continued authorizations for at least 12 months.
HB 736 also limits when insurers may revoke or modify prior authorizations because of situations like fraud, new safety or efficacy concerns or updated regulations from agencies such as the U.S. Food and Drug Administration.
Additional legislation included House Bill 328, introduced by Del. Richard “Rip” Sullivan (D), which expanded Virginia’s Essential Health Benefits Benchmark Plan to include coverage for services such as infertility treatment, doula care, hearing aids and donor breast milk. The benchmark plan establishes a minimum set of services insurance plans in Virginia must cover. HB 328 will increase access to services some patients have historically paid for out-of-pocket.
House Bill 484, introduced by Del. Irene Shin (D), and Senate Bill 164, introduced by Sen. Jeremy McPike (D), were companion bills designed to limit insurers from downcoding certain healthcare claims. Downcoding occurs when insurers reclassify healthcare claims into lower-paying billing categories, which can reduce reimbursement rates and shift financial burdens onto healthcare providers and patients. The bills also require insurers to notify healthcare providers when a claim is downcoded and allow providers to request a review of the decision.
The healthcare affordability package was signed May 13 — days before Spanberger vetoed the Affordable Medicine Act May 19. The Affordable Medicine Act would have established a Virginia Prescription Drug Affordability Panel to monitor prescription drug prices, collect pricing data from manufacturers and pharmacy benefit managers and authorize state oversight on drug pricing practices.
The Affordable Medicine Act also uses the federal Medicare “maximum fair price” as a benchmark for limiting prices on certain high-cost drugs and establishes enforcement procedures, including penalties for excessive pricing or restricting drug availability in Virginia. Spanberger wrote in her veto statement May 19 that while she hopes to lower prescription drug costs for Virginians, “evidence” from other states show that prescription drug affordability panels are often expensive and do not work as effectively as intended.
In a joint statement released on X May 20 following the veto, Sen. Creigh Deeds (D) and Delaney wrote that they were “incredibly disappointed” by the decision, arguing that the legislation could have provided broader relief for Virginians struggling with prescription drug costs.
Deeds and Delaney wrote that while the General Assembly passed legislation during the 2026 session to cap insulin costs and reform pharmacy benefit manager practices, the “Affordable Medicine Act could have saved Virginians $95 million annually, starting in 2027.”
According to the statement, Deeds and Delaney wrote that they continue to hear from Virginians forced to choose between purchasing medication and paying for basic necessities, and wrote that they remain committed to pursuing policies aimed at reducing prescription drug costs across the Commonwealth.
“[Deeds and I] are disappointed by the Governor’s veto of the Affordable Medicine Act, but we are not deterred,” Delaney wrote on X. “We remain committed to the idea that cost should never be a barrier to life-saving medication and will continue to work towards policy solutions to help all Virginians.”
Many of the bills will take effect July 1, allowing Virginians to begin seeing lower prescription drug costs and expanded insurance protections later this summer. However, some provisions — including HB 736’s prior authorization changes — will not take effect until Jan. 1, 2027.
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