This bill aims to amend the Code of West Virginia by introducing a new article, designated as Article 64, which focuses on protecting patient access to physician-administered medications. It defines key terms such as "covered individual" and "physician-administered drug," and establishes that health insurance issuers and pharmacy benefit managers cannot refuse to authorize or pay for these medications when provided by participating providers. Additionally, the bill prohibits insurers from denying coverage based on the source of the physician-administered drugs, as long as medical necessity criteria are met, and mandates that patients should not incur additional fees beyond their designated cost-sharing amounts.

Furthermore, the bill outlines exceptions that allow health insurance issuers to establish different copayments for drugs obtained from non-participating providers and to deny coverage based on medical necessity criteria. It also allows for the establishment of specialty care centers of excellence based on quality measures. Violations of this section are classified as unfair practices, subjecting violators to penalties under the Unfair Trade Practices and Consumer Protection Law. Any conflicting contract provisions would be rendered null and void in the state.

Statutes affected:
Introduced Version: 33-64-1