Prior Authorization in Virginia
Virginia enacted SB 543 (2020) requiring step therapy exception protections. The law mandates exceptions for contraindications, prior treatment failures, and expected inefficacy. Virginia requires PA decisions within 2 business days for prescription drugs and 1 business day for urgent requests.
Key Facts About PA in Virginia
- ✓ Standard Rx PA decisions required within 2 business days; urgent within 1 business day
- ✓ Step therapy exception protections enacted in 2020
- ✓ External review available through the VA Bureau of Insurance
- ✓ Anthem BCBS Virginia is a major carrier
Quick Stats
- Typical Appeal Filing Window: 30 days
- External Review Available: Yes
- Major Payers: 4
Top Payers in Virginia
RxCheckUp generates payer-specific Letters of Medical Necessity for each of these Virginia carriers:
Anthem BCBS VirginiaAetnaUnitedHealthcareCigna