The West Virginia Legislature passed Senate Bill 46 on the last day of the session, March 10, creating the Pharmacy Audit Integrity and Transparency Act which was supported and sought for passage by the West Virginia Pharmacists Association. Below is the language of the new law.
Chapter 33, Article 51, Section 9:
(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 in this or for 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 the point of sale and not adjusted between the point of sale and the issuance of the remittance advice.
(d) This section does not apply with respect to claims under an employee benefit plan under the Employee Retirement Income Security Act of 1974 or Medicare Part D.
