This bill amends various sections of the West Virginia Code 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, as defined by federal law, applies to all health plans in the state. Additionally, it 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.

New definitions for terms such as "health care service," "health plan," and "third-party administrator" are introduced, and civil penalties of up to $10,000 are imposed for violations of these provisions. The amendments will 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 ensure effective enforcement of these changes.

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