Introduced January 31, Senate Bill 489 adds to current insurance laws relating to the Pharmacy Audit Integrity Act and the regulation of pharmacy benefit managers, including requiring PBMs to obtain a license from the Insurance Commissioner before doing business in West Virginia.
It sets forth terms and fees for licensure of PBMs, and authorizes the Insurance Commissioner to promulgate rules for legislative approval relating to licensing, fees, application, financial standards and reporting requirement of PBMs.
PBMs will have to provide an reasonably adequate network, and have a fiduciary duty to certain third parties.
The proposal clarifies that an auditing entity engaged by the PBM may not seek a charge-back or recoupment from a pharmacy or pharmacist except in cases of fraud or other intentional misrepresentation, dispensing in excess of the benefit design, prescription not filled in accordance with the prescriber’s order, or actual overpayment to the pharmacy.
A PBM may not reimburse a pharmacy or pharmacist for prescription drug or pharmacy services below a certain cost plus dispensing fee.
The proposal also prohibits a PBM from reimbursing a pharmacy or pharmacist for a prescription drug or pharmacy service in an amount less than the amount a PBM reimburses its affiliates.
