From the clinic to the Capitol

A team of VCU School of Medicine faculty and medical students helped turn a common frustration for patients with eye disease into a new Virginia law.

Virginia House Bill 490, which took effect on July 1, requires health insurance providers to cover early refills of prescription eye drops when the medication is already covered by the patient’s plan, at least 85% of the previous bottle has been used and the prescribing clinician authorizes the refill. The law addresses a longstanding challenge for patients who often exhaust eye drop bottles before insurance companies allow a refill.

Evan Silverstein, M.D., a pediatric ophthalmologist and associate professor in the Department of Ophthalmology who helped advocate for the bill, said he got involved with the legislative process because he wants to help patients beyond the scope of his own clinic.

“You can impact patients one-on-one when you see them in your chair, but when you see an issue affecting multiple patients, you want to be able to help out on a bigger scale,” Silverstein said. “Legislation like this can really make a difference for patients across the entire state, rather than just helping one patient at a time.”

When refill delays become treatment gaps 

Eye drops can be more complicated than pills to administer and track, as they can’t be counted or divided into precise doses. Patients frequently miss their eye or accidentally squeeze out multiple drops at once, and Silverstein noted that it can take several attempts for a caregiver to get the proper dosage into a child’s eye.

Surbhi Bansal, M.D., a glaucoma specialist and associate professor of ophthalmology who led the legislation effort, said she hears from patients on a weekly basis that they ran out of the drops that help manage their chronic disease. Often, they have been so discouraged by repeated calls to the pharmacy and insurance denials that by the time they’re back in Bansal’s exam room for a check-up, they’ve missed days or weeks of their medication.

Not only is it a frustrating experience for the patient, Bansal said, but treatment gaps can impede her ability to make an informed, accurate assessment about the patient’s condition, which can lead to permanent vision loss.

“They come in for a pressure check, but they’re out of their drops, so how are we supposed to make a clinical judgment?” Bansal said “Is it controlled, progressing, not controlled? That is where this legislation work started.”

Nearly 30 other states had already passed similar bills, and the years-long advocacy of organizations like the American Academy of Ophthalmology laid the groundwork for HB490. After submitting a legislation proposal to the Richmond Academy of Medicine, Bansal recruited the help of Silverstein and three medical students and began compiling names of patients who were willing to testify in case a bill went to the General Assembly.  

The group worked with Jesse Lynch, a lobbyist for the Virginia Society of Eye Physicians and Surgeons, and Patrick Hope, a Virginia delegate from the 1st District, to draft the bill and get it in front of lawmakers. The bill was prefiled and ordered in January 2026, went through multiple committees, passed both chambers in March and was signed by the governor on April 6. It went into effect on July 1, and compliance is mandatory for insurance carriers starting January 1, 2027.

Giving patients a voice 

For Michelle Lam, a fourth-year medical student who plans to be a psychiatrist, working on the project introduced her to legislation and advocacy, a side of medicine that she had never experienced. She helped with administrative tasks like sending emails to government offices, and her favorite contribution involved what she loves most about healthcare — connecting with patients.

Between clinical rotations during her M3 year, Lam called patients and caregivers who had volunteered to testify over the phone in support of the bill. In one testimony, a woman whose dad has Parkinson’s disease shared how challenging it was to administer his eye drops due to his tremors, and how often the bottle ran dry before their insurance approved a refill.

Lam said she loved “just talking to people and hearing their stories,” and both their frustration and their eagerness to help improve the system were palpable.

“The eye drops are wonderful, but I am having a lot of trouble getting [them],” one patient told Lam on a recorded call. “I run out each time, and I know the drops do me good, but I don’t get enough for it to do me good. I wish we could get help with it.”  

Participating in this process not only helped solidify Lam’s desire to pursue psychiatry, where she can continue listening to patients share their life stories, but it sparked an interest in healthcare advocacy.

“I often find myself frustrated by the many barriers patients must overcome to receive the care they need, and I have seen how meaningful advocacy can be in addressing those barriers,” Lam said. “It is deeply rewarding to know that my efforts made a difference for the patients I spoke with, and this is work I hope to continue in the future.”

Bansal echoed that sentiment, noting that it was “a very interesting process of our democracy to go through” that now has a direct impact on the patients she sees every day. Now, when patients tell her that they’ve run out, she has good news to share.

“I certainly mention it to anyone who tells me that they were unable to fill their eye drops, and they’re elated and so appreciative,” Bansal said. “It feels so good, coming full circle and closing the loop.”

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The School of Medicine communications team is always looking to highlight student success, faculty achievement, cutting-edge research and innovative initiatives around the MCV Campus. If you have an idea for a story, please submit your pitch to laura.ingles@vcuhealth.org.