Bill > HB5482

This bill aims to protect patient access to clinician-administered drugs, which are prescription medications that cannot be easily self-administered and are typically given by a healthcare professional in a clinical setting. It prohibits health insurance issuers, pharmacy benefit managers (companies that manage prescription drug benefits), and their agents from refusing to authorize, approve, or pay for these drugs and related services for covered individuals, who are defined by existing law. Specifically, insurers cannot deny or reduce payment for these drugs if medical necessity criteria are met, even if the drug is obtained from a pharmacy outside the insurer's network, as long as it meets federal supply chain security standards. The bill also prevents insurers from charging patients extra fees for clinician-administered drugs when they are not dispensed by a pharmacy chosen by the health plan, and it ensures patients can choose where to obtain these medications without interference or financial incentives from the insurer. While insurers can establish centers of excellence for specific drugs based on quality measures, they cannot force patients to use a home infusion pharmacy or an infusion site outside their provider's office, nor can they require specialty pharmacies to dispense medications directly to patients for transport to a healthcare provider. Violating these provisions will be considered an unfair trade practice, subject to penalties under existing consumer protection laws, and any conflicting contract provisions will be void.

Health and Social Services

http://www.wvlegislature.gov/Bill_Status/Bills_history.cfm?input=5482&year=2026&sessiontype=RS&btype=bill