This bill amends sections of the Code of West Virginia to regulate pharmacy benefit managers (PBMs) and enhance pharmacy purchasing practices for the West Virginia Medicaid program and the Public Employees Insurance Agency (PEIA). It introduces new regulations requiring PBMs to conduct an annual dispensing fee study and limits the amounts they can charge, specifically prohibiting contracts with West Virginia Medicaid and PEIA that do not comply with these regulations. Additionally, PBMs are restricted from charging health care payors more than the national average drug acquisition cost for prescription drugs and must calculate cost-sharing for covered individuals based on the net price after rebates. The bill also includes provisions to prevent discrimination against 340B entities and mandates detailed reporting on claims and reimbursements.

Moreover, the bill requires the PEIA and Medicaid to implement a pharmacy cost containment tool by July 1, 2026, which will provide prescribing providers with information on the lowest net cost pharmaceutical options and address polypharmacy rates when clinically appropriate. The vendor managing this tool must be independent of existing PBM contracts and is responsible for ensuring cost-effective outcomes, including calculating drug manufacturer rebates. The contract for the pharmacy cost containment tool must include an itemized monthly activity and savings report, along with a total net savings guarantee. Overall, the bill aims to enhance transparency, fairness, and cost-effectiveness in pharmacy benefit management for state health programs.

Statutes affected:
Introduced Version: 5-16-9, 33-51-9, 9-5-34, 33-51-14