Bill Summary – FastDemocracy

WEST VIRGINIA LEGISLATURE
REGULAR SESSION
                Introduced Senate Bill 831
         By Senators Takubo and Maroney [Introduced February 16, 2024; referred to the Committee on Health and Human Resources]
     Intr SB                                         2024R3941
  A BILL to amend and reenact §33-15-4t of the Code of West Virginia, 1931, as amended; to
            amend and reenact §33-16-3ee of said code; to amend and reenact §33-24-7t of said
            code; to amend and reenact §33-25-8q of said code; and to amend and reenact §33-25A-
            8t of said code, all relating to financial assistance available for a prescription drug; defining
            terms; and providing for civil penalties.
     Be it enacted by the Legislature of West Virginia:
     ARTICLE              15.         ACCIDENT             AND           SICKNESS              INSURANCE.
     §33-15-4t.                 Fairness in             Cost-Sharing Calculation.
            (a) As used in this section:
            "Cost sharing" means any copayment, coinsurance, or deductible required by or on behalf
  of an insured in order to receive a specific health care item or service covered by a health plan.
            "Drug" means the same as the term is defined in §30-5-4 of this code.
            "Person" means a natural person, corporation, mutual company, unincorporated
  association, partnership, joint venture, limited liability company, trust, estate, foundation, nonprofit
  corporation, unincorporated organization, or government or governmental subdivision or agency.
            "Health care service" means an item or service furnished to any individual for the purpose
  of preventing, alleviating, curing, or healing human illness, injury, or physical disability.
           "Health plan" means a policy, contract, certification, or agreement offered or issued by an
 insurer to provide, deliver, arrange for, pay for, or reimburse any of the costs of health care
 services.
           "Pharmacy benefits manager" means the same as that term is defined in §33-51-3 of this
 code.
           "Third party administrator" means the same as that term is defined in §33-46-2 of this code.
           (b) When calculating an insured's contribution to any applicable cost sharing requirement,
 including, but not limited to, the annual limitation on cost sharing subject to 42 U.S.C. § 18022(c)
 and 42 U.S.C. § 300gg-6(b)
                                                           1
     Intr SB                                       2024R3941
           (1) An insurer or pharmacy benefits manager shall include any cost sharing amounts paid
 by the insured or on behalf of the insured by another person. and
           (2) A pharmacy benefits manger shall include any cost sharing amounts paid by the
 insured or on behalf of the insured by another person
           (c) The annual limitation on cost sharing provided for under 42 U.S.C. § 18022(c)(1) shall
 apply to all health care services covered under any health plan offered or issued by an insurer in
 this state.
           (d) An insurer, pharmacy benefits manager, or third-party administrator may not directly or
 indirectly set, alter, implement, or condition the terms of health plan coverage, including the benefit
 design, based in part or entirely on information about the availability or amount of financial or
 product assistance available for a prescription drug.
           (c) (e) The commissioner is authorized to propose rules for legislative approval in
 accordance with §29A-3-1 et seq. of this code to implement the provisions of this section.
           (d) (f) This section is effective for policy, contract, plans, or agreements beginning on or
 after January 1, 2020 January 1, 2025. This section applies to all policies, contracts, plans, or
 agreements, subject to this article that are delivered, executed, issued, amended, adjusted, or
 renewed in this state on or after the effective date of this section.
           (e) (g) If under federal law application of subsection (b) of this section would result in
 Health Savings Account ineligibility under Section 223 of the Internal Revenue Code, this
 requirement shall apply only for Health Savings Account-qualified High Deductible Health Plans
 with respect to the deductible of such a plan after the enrollee has satisfied the minimum
 deductible under Section 223 of the Internal Revenue Code: Provided, That with respect to items
 or services that are preventive care pursuant to Section 223(c)(2)(C) of the Internal Revenue
 Code, the requirements of subsection (b) of this section shall apply regardless of whether the
 minimum deductible under Section 223 of the Internal Revenue Code has been satisfied.
           (h) In addition to the penalties and other enforcement provisions of this chapter, any person
                                                        2
     Intr SB                                       2024R3941
 who violates this section is subject to civil penalties of up to $10,000 per violation. Imposition of
 civil penalties shall be pursuant to an order of the commissioner issued after notice and hearing.
 The commissioner's order may require a person found to be in violation of this section to make
 restitution to persons aggrieved by violations of this section.
     ARTICLE           16.     GROUP          ACCIDENT         AND        SICKNESS          INSURANCE.
     §33-16-3ee.                Fairness in            Cost-Sharing Calculation.
            (a) As used in this section:
            "Cost sharing" means any copayment, coinsurance, or deductible required by or on behalf
  of an insured in order to receive a specific health care item or service covered by a health plan.
            "Drug" means the same as the term is defined in §30-5-4 of this code.
            "Person" means a natural person, corporation, mutual company, unincorporated
  association, partnership, joint venture, limited liability company, trust, estate, foundation, nonprofit
  corporation, unincorporated organization, or government or governmental subdivision or agency.
            "Health care service" means an item or service furnished to any individual for the purpose
  of preventing, alleviating, curing, or healing human illness, injury, or physical disability.
           "Health plan" means a policy, contract, certification, or agreement offered or issued by an
 insurer to provide, deliver, arrange for, pay for, or reimburse any of the costs of health care
 services.
           "Pharmacy benefits manager" means the same as that term is defined in §33-51-3 of this
 code.
           "Third party administrator" means the same as that term is defined in §33-46-2 of this code.
           (b) When calculating an insured's contribution to any applicable cost sharing requirement,
 including, but not limited to, the annual limitation on cost sharing subject to 42 U.S.C. § 18022(c)
 and 42 U.S.C. § 300gg-6(b)
           (1) An insurer or pharmacy benefits manager shall include any cost sharing amounts paid
 by the insured or on behalf of the insured by another person. and
                                                          3
     Intr SB                                       2024R3941
           (2) A pharmacy benefits manger shall include any cost sharing amounts paid by the
 insured or on behalf of the insured by another person
           (c) The annual limitation on cost sharing provided for under 42 U.S.C. § 18022(c)(1) shall
 apply to all health care services covered under any health plan offered or issued by an insurer in
 this state.
           (d) An insurer, pharmacy benefits manager, or third-party administrator may not directly or
 indirectly set, alter, implement, or condition the terms of health plan coverage, including the benefit
 design, based in part or entirely on information about the availability or amount of financial or
 product assistance available for a prescription drug.
           (c) (e) The commissioner is authorized to propose rules for legislative approval in
 accordance with §29A-3-1 et seq. of this code to implement the provisions of this section.
           (d) (f) This section is effective for policy, contract, plans, or agreements beginning on or
 after January 1, 2020 January 1, 2025. This section applies to all policies, contracts, plans, or
 agreements, subject to this article that are delivered, executed, issued, amended, adjusted, or
 renewed in this state on or after the effective date of this section.
           (e) (g) If under federal law application of subsection (b) of this section would result in
 Health Savings Account ineligibility under Section 223 of the Internal Revenue Code, this
 requirement shall apply only for Health Savings Account-qualified High Deductible Health Plans
 with respect to the deductible of such a plan after the enrollee has satisfied the minimum
 deductible under Section 223 of the Internal Revenue Code: Provided, That with respect to items
 or services that are preventive care pursuant to Section 223(c)(2)(C) of the Internal Revenue
 Code, the requirements of subsection (b) of this section shall apply regardless of whether the
 minimum deductible under Section 223 of the Internal Revenue Code has been satisfied.
           (h) In addition to the penalties and other enforcement provisions of this chapter, any person
 who violates this section is subject to civil penalties of up to $10,000 per violation. Imposition of
 civil penalties shall be pursuant to an order of the commissioner issued after notice and hearing.
                                                        4
     Intr SB                                       2024R3941
 The commissioner's order may require a person found to be in violation of this section to make
 restitution to persons aggrieved by violations of this section.
     ARTICLE         24.   HOSPITAL           SERVICE    CORPORATIONS,            MEDICAL        SERVICE
               CORPORATIONS,           DENTAL      SERVICE       CORPORATIONS             AND        HEALTH
               SERVICE                                                                 CORPORATIONS.
     §33-24-7t.               Fairness in             Cost-Sharing Calculation.
            (a) As used in this section:
            "Cost sharing" means any copayment, coinsurance, or deductible required by or on behalf
  of an insured in order to receive a specific health care item or service covered by a health plan.
            "Drug" means the same as the term is defined in §30-5-4 of this code.
            "Person" means a natural person, corporation, mutual company, unincorporated
  association, partnership, joint venture, limited liability company, trust, estate, foundation, nonprofit
  corporation, unincorporated organization, or government or governmental subdivision or agency.
            "Health care service" means an item or service furnished to any individual for the purpose
  of preventing, alleviating, curing, or healing human illness, injury, or physical disability.
           "Health plan" means a policy, contract, certification, or agreement offered or issued by an
 insurer to provide, deliver, arrange for, pay for, or reimburse any of the costs of health care
 services.
           "Pharmacy benefits manager" means the same as that term is defined in §33-51-3 of this
 code.
           "Third party administrator" means the same as that term is defined in §33-46-2 of this code.
           (b) When calculating an insured's contribution to any applicable cost sharing requirement,
 including, but not limited to, the annual limitation on cost sharing subject to 42 U.S.C. § 18022(c)
 and 42 U.S.C. § 300gg-6(b)
           (1) An insurer or pharmacy benefits manager shall include any cost sharing amounts paid
                                                         5
     Intr SB                                       2024R3941
 by the insured or on behalf of the insured by another person. and
           (2) A pharmacy benefits manger shall include any cost sharing amounts paid by the
 insured or on behalf of the insured by another person
           (c) The annual limitation on cost sharing provided for under 42 U.S.C. § 18022(c)(1) shall
 apply to all health care services covered under any health plan offered or issued by an insurer in
 this state.
           (d) An insurer, pharmacy benefits manager, or third-party administrator may not directly or
 indirectly set, alter, implement, or condition the terms of health plan coverage, including the benefit
 design, based in part or entirely on information about the availability or amount of financial or
 product assistance available for a prescription drug.
           (c) (e) The commissioner is authorized to propose rules for legislative approval in
 accordance with §29A-3-1 et seq. of this code to implement the provisions of this section.
           (d) (f) This section is effective for policy, contract, plans, or agreements beginning on or
 after January 1, 2020 January 1, 2025. This section applies to all policies, contracts, plans, or
 agreements, subject to this article that are delivered, executed, issued, amended, adjusted, or
 renewed in this state on or after the effective date of this section.
           (e) (g) If under federal law application of subsection (b) of this section would result in
 Health Savings Account ineligibility under Section 223 of the Internal Revenue Code, this
 requirement shall apply only for Health Savings Account-qualified High Deductible Health Plans
 with respect to the deductible of such a plan after the enrollee has satisfied the minimum
 deductible under Section 223 of the Internal Revenue Code: Provided, That with respect to items
 or services that are preventive care pursuant to Section 223(c)(2)(C) of the Internal Revenue
 Code, the requirements of subsection (b) of this section shall apply regardless of whether the
 minimum deductible under Section 223 of the Internal Revenue Code has been satisfied.
           (h) In addition to the penalties and other enforcement provisions of this chapter, any person
 who violates this section is subject to civil penalties of up to $10,000 per violation. Imposition of
                                                        6
     Intr SB                                      2024R3941
 civil penalties shall be pursuant to an order of the commissioner issued after notice and hearing.
 The commissioner's order may require a person found to be in violation of this section to make
 restitution to persons aggrieved by violations of this section.
     ARTICLE                  25.             HEALTH               CARE                CORPORATIONS.
     §33-25-8q.                Fairness in             Cost-Sharing Calculation.
            (a) As used in this section:
            "Cost sharing" means any copayment, coinsurance, or deductible required by or on behalf
  of an insured in order to receive a specific health care item or service covered by a health plan.
            "Drug" means the same as the term is defined in §30-5-4 of this code.
            "Person" means a natural person, corporation, mutual company, unincorporated
  association, partnership, joint venture, limited liability company, trust, estate, foundation, nonprofit
  corporation, unincorporated organization, or government or governmental subdivision or agency.
            "Health care service" means an item or service furnished to any individual for the purpose
  of preventing, alleviating, curing, or healing human illness, injury, or physical disability.
           "Health plan" means a policy, contract, certification, or agreement offered or issued by an
 insurer to provide, deliver, arrange for, pay for, or reimburse any of the costs of health care
 services.
           "Pharmacy benefits manager" means the same as that term is defined in §33-51-3 of this
 code.
           "Third party administrator" means as that term is defined in §33-46-2 of this code.
           (b) When calculating an insured's contribution to any applicable cost sharing requirement,
 including, but not limited to, the annual limitation on cost sharing subject to 42 U.S.C. § 18022(c)
 and 42 U.S.C. § 300gg-6(b)
           (1) an insurer or pharmacy benefits manager shall include any cost sharing amounts paid
 by the insured or on behalf of the insured by another person. and
           (2) A pharmacy benefits manger shall include any cost sharing amounts paid by the
                                                         7
     Intr SB                                       2024R3941
 insured or on behalf of the insured by another person
           (c) The annual limitation on cost sharing provided for under 42 U.S.C. § 18022(c)(1) shall
 apply to all health care services covered under any health plan offered or issued by an insurer in
 this state.
           (d) An insurer, pharmacy benefits manager, or third-party administrator may not directly or
 indirectly set, alter, implement, or condition the terms of health plan coverage, including the benefit
 design, based in part or entirely on information about the availability or amount of financial or
 product assistance available for a prescription drug.
           (c) (e) The commissioner is authorized to propose rules for legislative approval in
 accordance with §29A-3-1 et seq. of this code to implement the provisions of this section.
           (d) (f) This section is effective for policy, contract, plans, or agreements beginning on or
 after January 1, 2020 January 1, 2025. This section applies to all policies, contracts, plans, or
 agreements, subject to this article that are delivered, executed, issued, amended, adjusted, or
 renewed in this state on or after the effective date of this section.
           (e) (g) If under federal law application of subsection (b) of this section would result i