Bill > HB5365

This bill updates the authority of the Public Employees Insurance Agency (PEIA) by introducing new regulations for pharmacy benefit managers (PBMs), which are companies that manage prescription drug benefits on behalf of health insurers. Specifically, the bill requires PBMs to be transparent and to report detailed financial information quarterly to the PEIA, including amounts charged to the agency, reimbursements to pharmacies, and the spread between these amounts. It also mandates that PBMs cannot reimburse West Virginia pharmacies less than the national average drug acquisition cost plus a dispensing fee, and prohibits them from unreasonably designating drugs as "specialty drugs" to limit beneficiary access or imposing more restrictive terms for purchasing from local pharmacies compared to mail-order pharmacies. Furthermore, the bill grants the Insurance Commissioner the authority to examine, regulate, and enforce compliance with these provisions by PBMs serving the PEIA, with potential penalties for violations, and establishes a special investigation unit within the PEIA to look into fraud and abuse.

Budget and Finance, Business and Industry

http://www.wvlegislature.gov/Bill_Status/Bills_history.cfm?input=5365&year=2026&sessiontype=RS&btype=bill