Virginia

Quick Facts

Key Provisions

• A direct primary care agreement is explicitly defined as not being a contract of insurance and is therefore not subject to the provisions of the Virginia insurance code or regulation by the State Corporation Commission as insurance. (Va. Code § 38.2-6401)
• All DPC arrangements must be documented in a written agreement between the primary care provider and the patient or their legal representative. (Va. Code § 38.2-6402.A)
• The agreement must clearly describe the scope of primary care services covered by the periodic fee, the amount of the fee, and any potential charges for services not included in the membership. (Va. Code § 38.2-6402.A.1-2)
• A prominent statement in boldface type must be included in the agreement, clarifying that the DPC agreement is not health insurance and does not satisfy any individual health insurance mandate requirements. (Va. Code § 38.2-6402.A.5)
• The agreement must state that either party may terminate the contract. A provider must give at least 30 days' written notice to terminate, while a patient may terminate at any time, effective upon notice to the provider. (Va. Code § 38.2-6402.A.4)
• Upon termination by the patient, the provider is required to refund all unearned periodic fees that have been paid in advance by the patient. (Va. Code § 38.2-6402.A.4)
• The law defines a 'primary care provider' eligible to enter into these agreements as a physician licensed to practice medicine in Virginia under Chapter 29 of Title 54.1. (Va. Code § 38.2-6400)

Medication Dispensing

In Virginia, DPC practices may be able to dispense medications directly to their patients, though this function is governed by the Virginia Board of Medicine and Board of Pharmacy regulations rather than the DPC-specific law. Generally, a physician licensed in Virginia can dispense medications they prescribe to their own patients if they register with the Board of Pharmacy as a 'dispensing physician.' They must comply with all relevant state and federal laws regarding drug storage, packaging, labeling, and record-keeping. This capability allows DPC providers to offer medications at or near wholesale cost, a common benefit of the DPC model, but they must adhere to strict regulatory standards to ensure patient safety.