This bill amends the Code of West Virginia to improve fairness in cost-sharing calculations for health plans. It requires pharmacy benefits managers to include all cost-sharing amounts paid by the insured or on their behalf when determining the insured's contribution to cost-sharing requirements. The bill also establishes that the annual limitation on cost-sharing applies to all health plans in the state and prohibits insurers, pharmacy benefits managers, and third-party administrators from changing health plan coverage terms based on the availability of financial assistance for prescription drugs.

Additionally, the bill introduces new definitions for terms such as "health care service," "health plan," and "third-party administrator," and clarifies that cost-sharing encompasses copayments, coinsurance, and deductibles. It imposes civil penalties of up to $10,000 for violations, with the potential for restitution for affected individuals. The amendments will take effect for policies and agreements beginning on or after January 1, 2026, and the commissioner is authorized to propose rules for legislative approval to implement these changes.

Statutes affected:
Introduced Version: 33-15-4t, 33-16-3ee, 33-24-7t, 33-25-8q, 33-25A-8t
Committee Substitute: 33-15-4t, 33-16-3ee, 33-24-7t, 33-25-8q, 33-25A-8t
Engrossed Committee Substitute: 33-15-4t, 33-16-3ee, 33-24-7t, 33-25-8q, 33-25A-8t