Bill > SB907

This bill aims to regulate pharmacy benefit managers (PBMs), which are companies that manage prescription drug benefits on behalf of health insurers, by establishing new rules for their operations and contracts, particularly concerning West Virginia Medicaid and the Public Employees Insurance Agency (PEIA). Key provisions include requiring PBMs to provide pharmacies with information about lower-cost drug alternatives and prohibiting them from penalizing pharmacies for discussing these options or selling cheaper alternatives outside of insurance. The bill also limits the amount PBMs can charge pharmacies for patient cost-sharing, ensuring it doesn't exceed the pharmacy's submitted charges, and prevents PBMs from reimbursing 340B entities (pharmacies that serve low-income communities) at a lower rate than other pharmacies or imposing discriminatory fees. Furthermore, PBMs are prohibited from reimbursing pharmacies less than the national average drug acquisition cost plus a $10.49 dispensing fee, or less than what they reimburse themselves or affiliates for the same drug. The bill mandates an annual study on the cost of dispensing outpatient prescription drugs in West Virginia and requires PBMs to file their reimbursement methodologies with the commissioner, treating them as confidential. It also prohibits PBMs from deriving revenue from pharmacies or insured individuals for PBM services, except for processing deductibles and copayments, and prevents them from using group purchasing organizations to avoid these regulations. For PEIA and Medicaid, the bill prohibits contracting with PBMs that own or have affiliated pharmacies in West Virginia and mandates the implementation of a pharmacy cost containment tool by July 1, 2026, to help prescribers identify lower-cost drug options and reduce polypharmacy (the use of multiple medications).

Health and Social Services

http://www.wvlegislature.gov/Bill_Status/Bills_history.cfm?input=907&year=2026&sessiontype=RS&btype=bill