This bill amends the Code of West Virginia to improve fairness in cost-sharing calculations for health plans. It requires that pharmacy benefits managers and insurers account for any cost-sharing amounts paid by the insured or on their behalf when determining the insured's contribution to cost-sharing requirements. Additionally, the bill establishes that the annual limitation on cost-sharing will apply to all health plans issued in the state. It also 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.

The legislation introduces new definitions for terms such as "health care service," "health plan," and "third-party administrator," and imposes civil penalties of up to $10,000 for violations. The amendments are set to take effect for policies and agreements beginning on or after January 1, 2026. Overall, the bill aims to ensure that insured individuals are treated fairly in their cost-sharing obligations and that their contributions are accurately calculated without discrimination based on external financial assistance.

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