Four axes from current statute and agency guidance. Teal bar = substitution/assistance/access in place; amber = permissive or absent.
| Generic substitution mandate | Mandatory by statute |
| State Pharmaceutical Assistance Program | No broad SPAP |
| 90-day fills permitted | Allowed |
| PMP mandatory prescriber query | Required by statute |
Virginia mandates generic substitution. Under Va. Code § 54.1-3408.03, a pharmacist shall dispense a therapeutically equivalent drug product unless the prescriber writes "brand medically necessary" or "dispense as written" on the prescription in their own handwriting (or its electronic equivalent). The substitute must be on the Orange Book as therapeutically equivalent.
The Virginia Department of Medical Assistance Services (DMAS) maintains the Virginia Medicaid Preferred Drug List. Most Medicaid members are enrolled in Cardinal Care Managed Care (Aetna, Anthem HealthKeepers, Molina, Sentara, UnitedHealthcare, Optima), which must cover all PDL drugs but apply utilization management. Non-preferred drugs require prior authorization from the prescriber.
Preferred Drug List: View current PDL
Prior authorization contact: Virginia Medicaid Pharmacy: 1-800-932-6648
Virginia does not operate a Medicare-recognized SPAP. Low-income Virginians use Medicare Part D Extra Help (LIS), Virginia Medicaid (if eligible), manufacturer Patient Assistance Programs, and VICAP (Virginia Insurance Counseling and Assistance Program) for Medicare enrollment counseling. The state also operates ADAP for HIV antiretrovirals.
Eligibility: No state SPAP. VICAP is the state SHIP (Part D enrollment counseling only).
Virginia permits 90-day fills of non-controlled chronic medications at retail and mail-order pharmacies. Out-of-state pharmacies must hold a Nonresident Pharmacy permit from the Virginia Board of Pharmacy. Virginia requires e-prescribing for Schedule II-V controlled substances since July 2020 under Va. Code § 54.1-3408.02. Federal CSA refill limits apply.
Virginia operates a Prescription Monitoring Program administered by the Department of Health Professions. Under Va. Code § 54.1-2522.1, prescribers must check the PMP before initiating a treatment of more than seven days with a Schedule II-IV opioid. Dispensers must report controlled-substance dispensing within 24 hours.
PMP portal: Virginia Prescription Monitoring Program (PMP)
Virginia hosts a substantial 340B network including VCU Health, UVA Health, Sentara, Inova, FQHCs throughout the state, and Ryan White clinics. Uninsured Virginians may access discounted outpatient drugs by establishing care at a covered entity. Use HRSA OPAIS filtered to Virginia.
Find a 340B clinic in Virginia: HRSA OPAIS database (VA filter)
Our sister site OmniRx maintains a federal-side patient assistance program directory covering manufacturer PAPs, foundation copay assistance, GoodRx-style discount cards, and 340B locators applicable nationwide.
Once the law side is clear, the next question is which pharmacy actually has the cheapest fill. Use the RxGrab Pharmacy Finder to compare CostPlus Drugs, Costco, Walmart, Amazon Pharmacy, and other discount pharmacies on your specific medication, and read our generic vs brand explainer for the bioequivalence rules behind every substitution.
Yes by default they must under Va. Code § 54.1-3408.03, unless your prescriber wrote "brand medically necessary" or "dispense as written."
No active SPAP. Use federal Extra Help (Part D LIS), Virginia Medicaid if eligible, manufacturer PAPs. VICAP helps with Medicare enrollment.
Cardinal Care is Virginia's rebranded Medicaid managed-care program (unifying Medallion 4.0 + CCC Plus + FAMIS as of 2024). All Cardinal Care managed-care plans use the state's unified Medicaid PDL.
Yes for opioid treatments exceeding seven days under Va. Code § 54.1-2522.1, and e-prescribing is required for Schedule II-V since July 2020.