Bill > HB5430

This bill makes several changes to pharmaceutical benefits in West Virginia, primarily impacting the Public Employees Insurance Agency (PEIA) and Medicaid. It requires PEIA to subject its pharmacy benefit managers (PBMs) to the Pharmacy Audit Integrity Act, which governs how PBMs operate. The bill also limits the amounts PBMs can charge for prescription drugs to healthcare payors and health benefit plans, generally capping charges at the national average drug acquisition cost or the amount the PBM pays the pharmacy, with specific rules for state-administered plans. Furthermore, it prohibits PBMs from owning pharmacies licensed in West Virginia or having affiliated pharmacies, with an exception for Medicare-eligible retirees. The bill mandates that by July 1, 2026, PEIA and Medicaid must implement a "pharmacy cost containment tool" to provide prescribing providers with information on lower-cost drug options and strategies to reduce polypharmacy (the use of multiple medications), ensuring the vendor for this tool is separate from any PBM contract and guarantees savings. Additionally, it requires the Office of the Insurance Commissioner to conduct a study on the cost of dispensing outpatient prescription drugs in West Virginia, with reports due by December 1, 2026, and biennially thereafter.

Health and Social Services

http://www.wvlegislature.gov/Bill_Status/Bills_history.cfm?input=5430&year=2026&sessiontype=RS&btype=bill