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West Virginia Enacts One of the Most Comprehensive Drug Pricing & Transparency Bills in the Nation

Posted: May 7, 2021

As prescription drug prices continue to rise, policymakers from across the country are looking for ways to lower costs for patients. West Virginia did more than look in 2021. Their state government enacted meaningful reform that now stands as the most comprehensive drug pricing law in the nation, and will directly lower prescription drug costs for patients.

Currently, drug manufacturers provide rebates to Pharmacy Benefit Managers (PBMs) for preferred placement on drug formularies that PBMs manage for health insurers. PBMs pass many of these rebate dollars back to plan sponsors, but often keep a substantial portion of these savings for themselves. The lack of transparency in this process prevents patients generating rebates through their utilization seldom see the benefits of these discounts.

House Bill 2263 changes that by requiring that a covered individual’s defined cost sharing for each prescription drug be calculated at the point-of-sale, based on a price that is reduced by an amount equal to at least 100% of all rebates received, or to be received, in connection with the dispensing or administration of the prescription drug.  Any rebate over and above the defined cost sharing would then be passed on to the health plan to reduce premiums. Overall, this will have significant impact by lowering prescription drug costs for patients.

The drug pricing reform law also:

  • Requires PBMs to be licensed by West Virginia
  • Requires PBMs to report on network adequacy
  • Protects pharmacists who tell patients about lower costs alternatives
  • Prevents clawbacks and spread pricing
  • Allows for patients to choose their own pharmacy

This new law now heads to the West Virginia Offices of the Insurance Commissioner for rule making and implementation. The CSRO will be reaching out to aid the office as it moves through the process.

CSRO has been monitoring and taking action to support state legislation that aims to reform the drug supply chain through increased transparency, enhanced accountability, and by closing loopholes used to bypass current and new regulations.

Over 160 pieces of drug pricing related legislation have been filed throughout the nation for the 2021 state session cycle. The CSRO government affairs team will continue to monitor and provide updates to membership as needed. We are happy to address any questions you may have, please email CSRO at info@csro.info.


Email us at info@csro.info.

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