This bill amends the West Virginia Public Employees Insurance Act by introducing new definitions and establishing a special investigating unit within the Public Employees Insurance Agency (PEIA). It defines "specialty drug" as medications for chronic or complex conditions requiring special handling and "telehealth services" as various forms of remote healthcare delivery. The bill clarifies the responsibilities of the PEIA director, particularly in contract execution and oversight of pharmacy benefits management, to enhance transparency and accountability. Additionally, it grants the Insurance Commissioner investigative authorities to improve oversight and mandates competitive bidding for insurance coverage, along with detailed reporting on pharmacy claims and reimbursements.

Furthermore, the legislation aims to strengthen the oversight of pharmacy benefit managers (PBMs) associated with PEIA. It requires the director to submit an annual report to the Joint Committee on Health regarding financial interactions between PBMs and pharmacy providers, including discrepancies in payments. New requirements for PBMs include disclosing comprehensive operational data and prohibiting practices that restrict beneficiaries' access to prescription drugs. The bill mandates that PBMs reimburse West Virginia pharmacies at or above the national average drug acquisition cost and introduces penalties for violations. Overall, the legislation seeks to enhance the efficiency, integrity, and transparency of pharmacy benefit management within the PEIA framework.

Statutes affected:
Introduced Version: 5-16-2, 5-16-9, 5-16-12a