2021 Legislative Updates

Update 3/11 HB 2263 passed the House and the Senate Health and Human Services committee. Please e-mail your support to your Senator TODAY! We are one step closer!

Click on the links for each bill of interest, and track the bills of interest to you using the WV Legislature’s Personal Bill Tracking feature (below).

Of extreme interest to many, House Bill 2263 was introduced in the House of Delegates.  This bill updates regulation on PBMs and will be opposed by PBMs. The full text of the bill can be found here:  

There are several important provisions in this bill, summarized below:

1) Reimbursement floor of NADAC + $10.49 dispensing fee.  Similar to reimbursement action taken by WV Medicaid in 2017, PBMs may not reimburse pharmacies in an amount less than NADAC + a professional dispensing fee of $10.49.  If NADAC is not available, WAC + $10.49 may be used.  This reimbursement change will not apply to Medicare.  A PBM may not reimburse pharmacies less than it reimburses itself or an affiliate pharmacy.  This change will take effect on January 1, 2022.

2) “Any Willing Pharmacy” language protecting patient freedom of choice for pharmacy services.  PBMs may not prohibit or limit patient choice of pharmacy if that pharmacy agrees to participate as a contract provider according to the terms offered.  PBMs may not impose any copay, fee, or condition not equally imposed on all beneficiaries.  PBMs may not impose monetary advantages (higher copays, reductions in reimbursement, or promotions) or penalties that would affect beneficiary choice.  PBMs may not require exclusive mail order services.

3) ERISA exemption removal – following the recent Supreme Court of the United States ruling in Rutledge v. PCMA, this will allow the Pharmacy Audit Integrity Act to apply to ERISA plans in West Virginia.

4) Prohibitions against patient steering and preferential treatment for “affiliate” pharmacies, meaning pharmacies that share investment or ownership interests with a PBM.

5) Shared Rebates provisions, which mandate that PBMs offer health plans the ability to receive 100% of all rebates received from drug manufacturers and mandate annual reporting on rebates and other payments that PBMs may receive.  PBMs must offer health plans the option of charging the health plan the same price for a drug that it pays a pharmacy.  A separate provision mandates PBMs to charge state health plans (such as PEIA) the same price for drugs that it pays to pharmacies for those drugs.

6) Additions to the PEIA Transparency Report Requirement.  PEIA consistent states that drug spending is its #1 item.  Thus, an item this expensive and important must be fully transparent.

7) The Insurance Commissioner shall not approve any PBM or health plan providing pharmaceutical services which does not confirm, and any covered beneficiary or pharmacy harmed by a violation may maintain a cause of action to enjoin the continuance of the violation.

Overall, this is a very strong bill for pharmacies and patients in West Virginia.  The bill has been referenced to the House Health Committee, with no second reference, which means it could be sent to the House Floor for a vote very soon.

Please contact your Senators in support of House Bill 2263 using contact information at this link:

Bills Potentially Impacting Pharmacy

SB 1  Providing for parity of payment for telehealth services between service in-person and service provided through telehealth platform 

SB 3  Relating to COVID Liability

SB 40  Ensuring insurance coverage for residents with preexisting conditions

SB 68  Relating to excise tax on tobacco products

SB 83  Regulating pharmacy services administrative organizations

SB 84  Relating to allocation of premiums for employers and employees in PEIA

SB 113  Creating Wholesale Prescription Drug Importation Program

SB 118  Require parental notification of minors being prescribed contraceptives

SB 120  Requiring wholesale drug distributors to report certain information to WV Board of Pharmacy

SB 124  Relating to insulin cost management

HB 2004  Permit a licensed health care professional from another state to practice in this state through telehealth when registered with the appropriate West Virginia board

HB 2005  Relating to health care costs

HB 2085  Relating to tobacco usage restrictions

HB 2087  Relating to requiring the Office of Health Facility Licensure and Certification to inspect office-based medication-assisted treatment programs at least every 24 months

HB 2166  Decreasing cost of prescription drugs

HB 2186  Tobacco usage restrictions

HB  2219  Requiring RPh to check CSMP

HB 2241  Affordable Medicaid Buy-In

HB  2251  Reorganization of Professional Boards

HB 2254  Tobacco tax in border counties

HB 2262  Checking CSMP

HB 2263  PBM update

Update 3/11 HB 2263 will be brought to the Senate floor sometime this week. Please e-mail your support to Senators TODAY!

HB  2265  Pharmacy collaborative practice

HB 2266  Insurance for pregnant women

HB 2271  Childhood immunizations

HB  2284  Drug importation

HB 2289  Compulsory immunizations

HB 2291  Marijuana