Starting in 2028, you can choose a health plan with capped drug copays

Many health plans charge a percentage of a drug’s price instead of a set copay, so a costly medicine can leave you with a big, unpredictable bill at the pharmacy counter. Starting with policies delivered, issued for delivery, or renewed on or after Jan. 1, 2028, this Virginia law will require capped options. In every rating area where an insurer sells individual or small-group coverage, it must offer at least one capped plan at every metal level it already offers. The limit for each covered drug per 30-day supply will be $150 on platinum, $200 on gold, $250 on silver, and $300 on bronze.

If you enroll in one of these plans, the cap will apply before and after you meet your deductible. You will not apply for a separate benefit; you will need to choose a capped plan when shopping for individual coverage, including on Virginia’s Insurance Marketplace, or be enrolled through a small employer that selects one. Health savings account-qualified high-deductible plans have a narrow exception before the federal minimum deductible is met.

Del. Rozia Henson carried HB 625 in the House, and Sen. Russet Perry carried the identical Senate bill, SB 161. Patient groups, including the American Cancer Society Cancer Action Network, backed the bills. Gov. Abigail Spanberger approved both laws on April 13, 2026, and held a ceremonial signing in May. Her office says they passed with support from both parties.