This bill amends various sections of 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. The bill also establishes that the annual limitation on cost-sharing applies to all health plans issued in the state and 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.

Additionally, the bill introduces definitions for key terms such as "health care service," "health plan," and "third-party administrator," and imposes civil penalties of up to $10,000 for violations, with provisions for restitution to affected individuals. The amendments are set to take effect for policies and agreements beginning on or after January 1, 2027, and the commissioner is authorized to propose rules for legislative approval to implement these changes.

Statutes affected:
Introduced Version: 33-15-4t, 33-16-3ee, 33-24-7t, 33-25-8q, 33-25A-8t