Bill > HB5483

This bill ensures that financial or product assistance for prescription drugs is available by requiring that when calculating an insured person's out-of-pocket costs, known as "cost sharing" (which includes copayments, coinsurance, and deductibles), insurers and pharmacy benefits managers must count any amounts paid by the insured or on their behalf by another person. It also mandates that the federal annual cost-sharing limit applies to all health plans in the state and prohibits insurers, pharmacy benefits managers, or third-party administrators (entities that manage health plan benefits on behalf of an insurer) from adjusting health plan coverage or benefits based on the availability or amount of financial assistance for a prescription drug. The bill also establishes that violations can result in civil penalties of up to $10,000 per violation, with the possibility of restitution to affected individuals, and clarifies that these provisions apply to policies and agreements starting January 1, 2027, with an initial effective date of January 1, 2020, for certain aspects.

Budget and Finance, Business and Industry

http://www.wvlegislature.gov/Bill_Status/Bills_history.cfm?input=5483&year=2026&sessiontype=RS&btype=bill