PHARMACY AUDIT INTEGRITY ACT: Licensure of Pharmacy Benefit Managers

House Bill 4058 was sought by the West Virginia Pharmacists Association requiring any person or organization attempting to establish or operate as a pharmacy benefit manager (PBM) in West Virginia to first obtain a license from the West Virginia Insurance Commissioner.

Passed by the House and Senate, Governor Jim Justice approved House Bill 4058, which is to become effective May 18, 2020.

PBMs are to complete criteria, approved by the Commissioner before beginning business, including application fees and renewal applications.

The term of license for a PBM is two years. Each application for a license, and subsequent renewal for a license, shall be accompanied by evidence of financial responsibility in the amount of $1 million.

The Insurance Commission shall propose legislative rules establishing the licensing, fees, application, financial standards and reporting requirements of PBMs.

A PBM shall not be comprised only of mail-order benefits, but must have a mix of mail-order benefits and physical stores in West Virginia.

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

A person who violates the provisions of this new law may be fined not less than $1,000 and not more than $10,000 per violation.