This bill amends several sections of the Code of West Virginia to enhance the regulation of pharmacy benefits management (PBM) within the Public Employees Insurance Agency and Medicaid program. Key provisions include the requirement for an annual dispensing fee study and the prohibition of contracts with PBMs that own or have affiliate pharmacies in West Virginia. The bill mandates the implementation of a pharmacy cost containment tool by July 1, 2026, which will involve prescribing providers in making cost-effective pharmaceutical decisions. Additionally, it introduces new reporting requirements for PBMs, including quarterly reports on claims processed and reimbursements to pharmacy providers, and ensures that reimbursements to West Virginia pharmacies are not below the national average drug acquisition cost plus a professional dispensing fee.

Moreover, the bill establishes definitions for terms related to pharmacy operations and prohibits PBMs from charging health care payors more than the national average drug acquisition cost for prescription drugs. It mandates that cost-sharing for covered individuals be calculated at the point of sale based on the price after all rebates, ensuring that excess rebates are passed on to health plans to lower premiums. The Office of the Insurance Commissioner is required to conduct an annual study on the cost of dispensing outpatient prescription drugs, with findings reported to legislative committees. Overall, the legislation aims to create a more transparent and equitable framework for pharmacy benefits management and reimbursement practices in West Virginia.

Statutes affected:
Introduced Version: 5-16-9, 33-51-3, 33-51-9, 9-5-34, 33-51-14