Pharmacy Audit Integrity Act

House Bill 4058 was passed by the West Virginia Senate and House of Delegates , and sent to Governor Jim Justice for his signature February 24. Provisions of the new legislation are below.

A person or organization may not establish or operate as a pharmacy benefit manager (PBM) in West Virginia without first obtaining a license from the Insurance Commissioner.

The term of licensure of a PBM shall be for two years. The Commissioner shall determine the amount of the initial application fee and the renewal application fee for the registration.

The amount of the initial application fee and renewal application fees must be sufficient to fund the Insurance Commissioner’s duties in relation to his/her responsibilities, but a single fee may not exceed $10,000.

Each application for a license and subsequent renewal for a license shall be accompanied by evidence of financial responsibility in an amount of $1 million.

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

A PBM shall provide a pharmacy benefit manager’s network report describing the PBM’s network and the mix of mail-order to physical stores in a time and manner required by rule issued by the Insurance Commissioner.

The Commissioner shall enforce and may examine or audit the books and records of a PBM to determine if the PBM is in compliance.

A person who violates this provision of this article or the legislative rules implementing its provisions may be fined not less than $1,000 and not more than $10,000 per violation.