Bill > HB5470

This bill, titled "Relating to tax on healthcare managed care organizations," aims to align West Virginia's regulations with new federal requirements concerning how healthcare costs are calculated for insured individuals. Specifically, it clarifies that when determining an insured person's contribution towards their "cost sharing" – which includes copayments, coinsurance, and deductibles for healthcare services – insurers and pharmacy benefits managers must count any amounts paid by the insured or on their behalf by another person. The bill also mandates that the annual limit on cost sharing, as outlined in federal law (42 U.S.C. § 18022(c)(1)), applies to all covered health care services. Furthermore, it prohibits insurers, pharmacy benefits managers, and third-party administrators from altering health plan terms based on the availability of financial assistance for prescription drugs. The bill introduces penalties for violations, including civil penalties of up to $10,000 per violation, and allows for restitution to affected individuals. These changes are intended to ensure fairness in how patients contribute to their healthcare expenses and are effective for policies beginning on or after January 1, 2027, with provisions for potential earlier application.

Budget and Finance

http://www.wvlegislature.gov/Bill_Status/Bills_history.cfm?input=5470&year=2026&sessiontype=RS&btype=bill