Pharmacy Audit Integrity Act advances through WV legislature

House Bill 4058, introduced January 8 by the Legislature, provides that a person or organization may not establish or operate as a pharmacy benefits manager in the State of West Virginia without first obtaining a license from the Insurance Commission.

An application fee not to exceed $10,000 is to be paid the Insurance Commission by a pharmacy benefits manager, accompanied by evidence of financial responsibility in an amount of $1 million.

The Insurance Commissioner shall establish the licensing fees, application, financial standards, and reporting requirements of pharmacy benefit managers.

A pharmacy benefit manager’s network shall not be comprised only of mail-order benefits but must have a mix of mail-order benefits and physical stores in this state.

The Commissioner shall audit the records of a pharmacy benefit manager to determine compliance.

A person who violates this article or legislative rules implemented by the Commissioner may be fined not less than $1,000 and not more than $10,000 per violation.

The requirements of this rule do not apply to the coverage of prescription drugs under a plan that is subject to the Employee Retirement Income Security Act of 1974 or any information relating to such coverage.