Pharmacy Audit Integrity and Transparency Act Agreed-To

A conference committee of the Senate and House of Delegates met March 10 in the Senate chambers and agreed to provisions of Senate Bill 46, which gives some relief to retail pharmacies from egregious actions by pharmacy benefit managers (PBMs)

Sought passage by the West Virginia Pharmacists Association, the bill was first passed the Senate but was then amended by the House, causing the conference committee to resolve the differences.   WVPA Executive Director Richard Stevens participated in the conference committee meeting.  Below is language of Senate Bill 46, as agreed to by the committee.

“(a) A pharmacy, a pharmacist and a pharmacy technician shall have the right to provide a covered individual with information related to lower cost alternatives and cost share for such covered individual to assist health care consumers in making informed decisions.  Neither a pharmacy, a pharmacist nor a pharmacy technician shall be penalized by a pharmacy benefit manager for discussing information about drug costs or for selling a lower cost alternative to a covered individual, if one is available, without using a health insurance policy.

“(b) A pharmacy benefit manager shall not collect from a pharmacy, a pharmacist or a pharmacy technician a cost share charged to a covered individual that exceeds the total submitted charges by the pharmacy or pharmacist to the pharmacy benefit manager.

“(c) A pharmacy benefit manager may only directly or indirectly charge or hold a pharmacy, a pharmacist or a pharmacy technician responsible for a fee related to the adjudication of a claim if: (1) The total amount of the fee is identified, reported and specifically explained for each line item on the remittance advice of the adjudicated claim; or (2) The total amount of the fee is apparent at at the point of sale and not adjusted between the point of sale and the issuance of the remittance advice.

“(d) This section shall not apply with respect to claims under an employee benefit plan under the Employee Retirement Income Security Act of 1974 or Medicare Part D.”

The bill will be sent Governor Jim Justice for his signing into law.  Pharmacists are requested to call the Governor’s office 304-558-2000 and leave a message requesting the Governor sign Senate Bill 46 into law.