HB 5483 requires health insurers and pharmacy benefits managers (PBMs) to include all cost-sharing payments (like copays or deductibles) made by patients or others when calculating a patient's total out-of-pocket costs for prescription drugs. It applies annual cost-sharing limits to all health plans sold in West Virginia and prohibits insurers or PBMs from altering coverage terms based on whether a patient has financial assistance for a drug. The bill directly affects patients using prescription drugs, insurers, PBMs, and third-party administrators, ensuring their coverage terms remain unchanged regardless of available drug financial help. Violations carry civil penalties up to $10,000 per incident, with restitution required for affected patients. The law takes effect for new plans on or after January 1, 2027.
HB 5109 updates West Virginia's regulations for pharmacy benefit managers (PBMs) by clarifying key definitions and duties in the Pharmacy Audit Integrity Act. The bill directly affects pharmacies, PBMs, health benefit plans, and patients by standardizing terms like "pharmacy benefits management" (which includes claims processing, network management, and rebate administration) and defining "affiliate" relationships to prevent conflicts of interest. Key mechanisms include requiring clear disclosure of how PBMs determine reimbursement rates (like "maximum allowable cost") and restricting certain ownership ties between PBMs and pharmacies. The changes aim to increase transparency in prescription drug pricing and billing practices without altering coverage rules. This is a definitional update, not a new benefit or funding measure.
HB 5149 establishes the West Virginia Prescription Drug Affordability Board to address high prescription drug costs for residents and health systems. The board will review pricing for all prescription drugs - including brand name, generic, biologic, and biosimilar drugs - and require transparency from manufacturers about drug costs. It directly affects West Virginia residents, state/local governments, health plans, healthcare providers, and pharmacies by creating a formal process to evaluate affordability challenges. The bill mandates the board to conduct cost studies, require manufacturer disclosures, and issue reports, aiming to reduce financial burdens on patients and the healthcare system.
HB 5365 regulates pharmacy benefit managers (PBMs) that provide prescription drug coverage services to West Virginia's Public Employees Insurance Agency (PEIA). The bill amends state code to create a special investigating unit within PEIA and grants the Insurance Commissioner authority to investigate PBM practices. It defines key terms related to PEIA operations and establishes oversight mechanisms for PBMs handling state employee health benefits. This bill directly affects PEIA and its contracted PBM providers, focusing on increasing transparency and accountability in prescription drug benefit management. The legislation is currently in committee review (House Banking and Insurance) after introduction on February 9, 2026.
HB 5430 regulates pharmacy benefit managers (PBMs) for West Virginia's Public Employees Insurance Agency (PEIA), directly affecting state employees covered by PEIA, PBMs, and pharmacies providing services to them. The bill requires PBMs to submit detailed quarterly reports on claim payments, including costs charged to PEIA versus amounts paid to pharmacies, and prohibits certain PBM contracts that limit transparency. It also mandates PBMs to implement a cost containment tool and requires a study on pharmacy pricing. The law aims to increase transparency in pharmacy billing and control costs for state health insurance programs.
HB 4309 authorizes the West Virginia Board of Pharmacy to implement an existing rule (15 CSR 07) governing the registration of pharmacy technicians. This bill directly affects pharmacy technicians who must register to work in the state, as it approves the Board's proposed regulatory framework. The key mechanism is the Board's authority to enforce specific registration requirements, including qualifications and renewal processes, under the existing rule. The bill does not create new standards but formally authorizes the Board's previously proposed rule for implementation.
SB 456 requires pharmacies in West Virginia to charge senior citizens (60 years or older) the lowest price available for their prescription drugs anywhere in the United States. Pharmacies must verify the senior's age and residency - using ID or contacting the prescriber - and allow family members or caregivers to obtain prescriptions on their behalf. If a pharmacy charges more than the lowest national price, seniors can sue for triple the amount of the overcharge or $500 (whichever is greater), plus attorney fees. The Attorney General can also enforce the law through existing unfair practice provisions.
SB 361 authorizes the West Virginia Board of Pharmacy to implement a rule regarding pharmacist recovery networks, which are programs enabling pharmacists to provide medication-assisted treatment for opioid use disorder. The rule, previously drafted and modified to address legislative concerns, is now formally approved by law. This procedural bill directly affects pharmacists and pharmacies by allowing the Board to establish standards for participation in recovery networks. It does not alter the rule's content but enables its implementation as part of pharmacy practice regulations.
SB 362 authorizes the West Virginia Board of Pharmacy to implement a rule (15 CSR 12) that sets standards for pharmacists, pharmacy interns, and pharmacy technicians administering immunizations. The rule, developed through the state's rule-making process and revised in 2025, outlines specific requirements for vaccine administration, including training and documentation. This bill does not expand or restrict immunization practices but formalizes the existing rule for enforcement. It directly affects pharmacists and pharmacy staff in West Virginia who provide vaccination services.
HB 4311 authorizes the West Virginia Board of Pharmacy to establish a rule (15 CSR 12) governing immunizations administered by pharmacists, pharmacy interns, and pharmacy technicians. This rule would define specific conditions and procedures for these healthcare providers to safely administer vaccines. The bill specifically approves a rule that was previously developed, modified following legislative review, and resubmitted to the State Register. The policy change formalizes the regulatory framework without altering current immunization practices or expanding provider roles.
