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