A clinician must sign off when your health plan denies care as unnecessary

Many health plans make your doctor ask permission before they will cover a drug, test, or treatment. This is called prior authorization. Under this Virginia law, a plan cannot deny one of those requests on clinical grounds—such as medical necessity, appropriateness, or effectiveness—until the denial has been reviewed and approved by a licensed physician or an allowed substitute when no physician is available.

For prescription drugs, that rule has applied since July 1, 2026. If no physician is available, a licensed pharmacist can review and approve the denial instead. Starting January 1, 2027, the same rule covers other health care services. For mental health care, a licensed mental health provider can do the review if no physician is available, and for dental care, a licensed dentist can. You do not have to apply for this protection because the rule is written into provider contracts. It applies to plans and contracts governed by Virginia insurance law, with exceptions for certain coverage and HMOs. Self-insured employer plans are generally governed by federal law, so they usually fall outside it.

Del. Patrick Hope, an Arlington Democrat, carried the bill. It drew almost no opposition. The House passed it 97–0, and the Senate passed a revised version 39–0. The House then accepted the Senate’s changes 98–1. Gov. Abigail Spanberger signed it on April 13, 2026.