The bill amends the West Virginia Code to improve the management and oversight of pharmaceutical benefits within the Public Employees Insurance Agency (PEIA) and Medicaid programs. Key provisions include making the PEIA subject to the Pharmacy Audit Integrity Act, requiring competitive bidding for pharmacy cost containment vendors, and establishing a pilot program for Medicaid to assess cost containment strategies. It mandates that pharmacy benefit managers (PBMs) disclose detailed financial information regarding claims and reimbursements, ensuring that reimbursements to West Virginia pharmacies are not less than the national average drug acquisition cost plus a professional dispensing fee. Additionally, the bill introduces limitations on PBM ownership structures and prohibits them from reimbursing pharmacies at rates lower than their own charges.

The legislation also establishes rights for pharmacies and pharmacists to inform patients about lower-cost alternatives without facing penalties from PBMs. It prohibits PBMs from collecting cost shares exceeding the total submitted charges by pharmacies and ensures that reimbursements to 340B entities are not lower than those for similar non-340B pharmacies. Furthermore, the bill requires that patients' cost-sharing for prescription drugs reflects all rebates received by the PBM, aiming to lower health plan premiums. A study by the Office of the Insurance Commissioner is mandated to analyze the cost of dispensing outpatient prescription drugs in West Virginia, with findings to be reported biennially. Overall, the bill seeks to enhance transparency, accountability, and fairness in pharmaceutical benefit management for state employees and Medicaid recipients.

Statutes affected:
Introduced Version: 5-16-9, 33-51-3, 33-51-9, 9-5-34, 33-51-14
Committee Substitute: 5-16-9, 33-51-3, 33-51-9, 9-5-34, 33-51-14
Engrossed Committee Substitute: 5-16-9, 33-51-3, 33-51-9, 9-5-34, 33-51-14
Enrolled Committee Substitute: 5-16-9, 33-51-3, 33-51-9, 9-5-34, 33-51-14