PBM regulation legislation introduced

Senator Ryan Ferns (R-Ohio) is lead sponsor of Senate Bill 322 in the West Virginia Senate calling for regulation of the pharmacy benefit manager (PBM) industry.  Co-sponsoring the proposed legislation are Senators Ron Stollings (D-Boone), Charles Trump (R-Morgan) and Ed Gaunch (R-Kanawha).  WVPA Executive Director Richard Stevens requested the legislation be introduced following meeting with legislators during 2015.

A brief description of the legislation includes: regulation of PBMs by the Insurance Commissioner; providing PBMs conducting audits for public health programs are not exempt from pharmacy audit restrictions; setting forth duties of PBMs; requiring audits by PBMs; setting forth requirements for audits conducted by PBMs; providing internal review process applicable to disputed findings of PBM upon audit; requiring PBMs to provide notice to purchasers, pharmacists and pharmacies of information relating to maximum allowable costs; and requiring PBMs to establish a process relating to the appropriate use of maximum allowable costs.

Senate Bill 322 is first referred to the Senate Health Committee, chaired by Senators Ferns, then the Senate Finance Committee if approved by the Health Committee.