This bill amends the Code of West Virginia to improve fairness in cost-sharing calculations for health care services under health plans. It requires that pharmacy benefits managers and insurers include 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 issued 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.

To clarify the legislation, the bill introduces new definitions for terms such as "health care service," "health plan," and "third-party administrator." It imposes civil penalties of up to $10,000 for violations of these provisions, which will be enforced through an order from the commissioner after a notice and hearing. The amendments are set to take effect for policies and agreements beginning on or after January 1, 2027, ensuring that the new regulations apply to future contracts and plans in the state. Overall, the bill aims to ensure that insured individuals are treated fairly in their cost-sharing obligations and that their contributions are accurately calculated.

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