Bill > SB1028

This bill aims to ensure that financial or product assistance for prescription drugs is available and that health plans and related entities, such as pharmacy benefits managers (companies that manage prescription drug benefits for health insurers) and third-party administrators (companies that handle administrative tasks for health plans), do not use information about this assistance to negatively impact coverage or benefit design. Specifically, it mandates that when calculating an insured person's out-of-pocket costs for healthcare services, any amounts paid by the insured or on their behalf by another person, including assistance programs, must be counted towards their "cost sharing" obligations, which are the copayments, coinsurance, or deductibles required by a health plan. The bill also clarifies that the federal annual limitation on cost sharing applies to all covered health care services in the state and prohibits insurers, pharmacy benefits managers, and third-party administrators from altering health plan terms based on the availability of drug assistance. The state's insurance commissioner is authorized to create rules to implement these provisions, and violations can result in civil penalties of up to $10,000 per violation, with the possibility of requiring restitution to affected individuals. These changes are set to take effect for policies beginning on or after January 1, 2027.

Health and Social Services

http://www.wvlegislature.gov/Bill_Status/Bills_history.cfm?input=1028&year=2026&sessiontype=RS&btype=bill