HB 5470
Relating to financial or product assistance for prescription drugs
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- Passed House of Delegates
- Passed Senate
- To Governor
- Became Law
Bill overview
This bill aims to ensure fairness in how health insurance plans calculate cost-sharing amounts for prescription drugs. It requires pharmacy benefit managers to include any cost-sharing paid by insureds or others when determining a patient’s contribution. The bill also establishes an annual limit on cost-sharing, prevents insurers from changing coverage based on financial assistance availability, and creates penalties for non-compliance. It updates several sections of West Virginia’s code related to health insurance and cost-sharing.
Key provisions
- Requires pharmacy benefit managers to include cost-sharing amounts paid by insureds or others when calculating contributions.
- Establishes an annual limit on cost-sharing for health plans.
- Prohibits insurers, pharmacy benefit managers, and third-party administrators from altering plan terms based on financial assistance availability.
- Defines key terms related to cost-sharing and health plans.
- Authorizes civil penalties of up to $10,000 per violation for non-compliance.
- Provides for restitution to those harmed by violations.
- Applies the annual limitation on cost-sharing to all health plans in the state.
- Specifies effective dates for various provisions of the bill.
Who is affected
- Insured individuals
- Health insurance companies
- Pharmacy benefit managers
- Third-party administrators
- West Virginia residents
Notable changes
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