This bill proposes the addition of a new section, 9-5-29b, to the Code of West Virginia, which authorizes the Department of Human Services to establish a pilot program for external reference pricing of high-cost prescription drugs within the state Medicaid program. The program aims to set maximum reimbursement rates for selected drugs based on the lowest prices from comparable industrialized nations or through federally recognized pricing methodologies. The pilot will focus on a limited number of drugs identified as having a significant cost impact, while ensuring that access to medically necessary medications is preserved.

The bill outlines specific provisions for the pilot program, including the ability for the department to negotiate supplemental rebates with manufacturers and establish exceptions to prevent drug shortages. The program is set to last for a maximum of three years, with annual reports required to evaluate cost savings, drug availability, manufacturer participation, and recommendations for the program's future. Importantly, the bill clarifies that participation by private insurers is not mandated, and existing pharmaceutical benefit contracts outside the Medicaid program will remain unchanged.

Statutes affected:
Introduced Version: 9-5-29b