SB 852
Relating to regulation of pharmacy benefit managers
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- Passed Senate
- Passed House of Delegates
- To Governor
- Became Law
Bill overview
This bill aims to regulate pharmacy benefit managers (PBMs) in West Virginia. It seeks to ensure transparency in reimbursement practices by requiring PBMs to base their payments on the national average drug acquisition cost, plus a dispensing fee. The bill also addresses potential discrimination against 340B pharmacies and clarifies how cost sharing is calculated at the point of sale, specifying that cash payments are considered full payment. It includes an exemption allowing reimbursement less than the national average if specific requirements are met, and establishes a process for pharmacies to challenge reimbursement methodologies.
Key provisions
- Requires PBMs to reimburse pharmacies based on the national average drug acquisition cost plus a dispensing fee.
- Prohibits PBMs from discriminating against 340B pharmacies in reimbursement practices.
- Clarifies how cost sharing is calculated at the point of sale, with cash payments considered full payment.
- Establishes a process for pharmacies to challenge PBM reimbursement methodologies.
- Requires PBMs to file their reimbursement methodologies with the commissioner and protect them as confidential.
- Specifies that rebates received by PBMs must be factored into the cost sharing for insureds.
- Defines a minimum percentage of rebates that must be passed on to health plans to reduce premiums.
- Prohibits PBMs from imposing retroactive fees or basing reimbursement on patient outcomes.
Who is affected
- Pharmacy Benefit Managers (PBMs)
- Pharmacies
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