HB 5430
Relating to pharmaceutical benefits
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Sign in to take action- Introduced
- Passed House of Delegates
- Passed Senate
- To Governor
- Became Law
Bill overview
This bill aims to regulate pharmacy benefit managers (PBMs) in West Virginia to lower prescription drug costs for residents. It requires an annual study of dispensing fees, limits what PBMs can charge, prohibits certain contracts, and mandates the implementation of a pharmacy cost containment tool. The bill also seeks to ensure fair reimbursement rates for West Virginia pharmacies and protect patients’ choices regarding drug providers.
Key provisions
- Requires an annual study of pharmacy dispensing fees.
- Limits the amounts charged by pharmacy benefit managers.
- Prohibits certain pharmacy benefit manager contracts, particularly with Medicaid and the Public Employees Insurance Agency.
- Mandates the implementation of a pharmacy cost containment tool.
- Requires PBMs to report quarterly data on claims processed and reimbursements paid.
- Sets minimum reimbursement rates for pharmacies, tied to national average drug acquisition costs.
- Prohibits discrimination in reimbursement based on a pharmacy’s participation in the 340B drug discount program.
- Requires a pharmacy benefits manager to offer a health plan the option of charging such health plan the same price for a prescription drug as it pays a pharmacy for the prescription drug.
Who is affected
- West Virginia residents
- Pharmacy Benefit Managers (PBMs)
- Pharmacies
- Health Benefit Plans
- West Virginia Public Employees Insurance Agency
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