2026 Regular Session
HB 5109
Update the regulation of pharmacy benefit managers
In Committee
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- Passed House of Delegates
- Passed Senate
- To Governor
- Became Law
Bill overview
This bill updates the definition of pharmacy benefits management (PBM) in West Virginia law. It clarifies the roles and responsibilities of pharmacy benefits managers, auditing entities, and pharmacy services administration organizations. The bill also defines related terms such as ‘340B entity,’ ‘affiliate,’ and ‘network,’ aiming to provide greater clarity and oversight within the pharmacy industry.
Key provisions
- Defines ‘pharmacy benefits management’ to include procurement, claims processing, and administration of pharmacy benefits.
- Establishes definitions for key terms like ‘pharmacy benefits manager,’ ‘auditing entity,’ and ‘pharmacy services administration organization.’
- Clarifies the role of ‘affiliates’ within the pharmacy and PBM landscape.
- Defines ‘340B entity’ and its relationship to drug discount programs.
- Outlines the responsibilities of a ‘network’ in providing prescription services.
- Includes definitions for ‘maximum allowable cost,’ ‘national average drug acquisition cost,’ and ‘specialty drug.’
- Addresses ‘point-of-sale fees’ and ‘rebates’ within the context of pharmacy operations.
- Defines ‘pharmacy record’ and ‘retroactive fee’ to provide clarity on record-keeping and reimbursement practices.
Who is affected
- Pharmacies
- Pharmacy Benefits Managers
- Health Benefit Plans
- Prescription Drug Consumers
- Pharmacists
Notable changes
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