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West VirginiaHB 54302026 Regular SessionHouseWALLET

Relating to pharmaceutical benefits

Sponsored By: Evan Worrell (Republican)

Signed by Governor

§5-16-9§9-5-34§33-51-3§33-51-9§33-51-14

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Bill Overview

Analyzed Economic Effects

4 provisions identified: 4 benefits, 0 costs, 0 mixed.

Stronger PBM rules to lower drug costs

Pharmacies and staff can tell you about cheaper drug options and sell them without using your insurance. PBMs cannot charge point‑of‑sale or retroactive fees, or tie pay to patient scores except agreed care fees. PBMs cannot charge a plan more than NADAC, or more than they paid the pharmacy when NADAC is missing. PBMs cannot penalize 340B providers or pay them less just for being 340B. PBMs cannot claw back more cost‑share from a pharmacy than the pharmacy billed, and the Insurance Commissioner can order repayments to harmed patients or pharmacies.

Higher minimum pay for WV pharmacies

Starting July 1, 2024, PEIA claims must pay West Virginia pharmacies at least NADAC plus the WV Medicaid dispensing fee. If NADAC is missing, pay at least WAC plus that fee. For other covered claims, PBMs must pay at least NADAC + $10.49, or WAC + $10.49 when NADAC is not available. When Medicaid uses a PBM, the PBM cannot pay a pharmacy less than it pays itself or an affiliate. PBMs must use the most recent monthly NADAC and file their reimbursement methods with the Insurance Commissioner.

New drug cost vendors for PEIA and Medicaid

By July 1, 2026, PEIA must hire a separate drug cost vendor, not a PBM. The vendor works to get the lowest net cost, counts rebates, gives monthly itemized reports, and guarantees total net savings. By July 1, 2026, Medicaid starts a one‑year pilot with a separate vendor. The pilot must be budget‑neutral for the state, and doctors do not have to change how they treat patients. If the pilot shows net savings, Medicaid may sign a longer contract.

Stronger PEIA oversight and network access

PBMs that work for PEIA must send detailed claim‑level reports every quarter. PBMs must also give PEIA, lawmakers, and study vendors the contract, pricing, network, rebate, and fee data they request. PEIA can terminate a PBM that withholds required data, and the Insurance Commissioner can discipline the PBM. PEIA PBM contracts are under state PBM law, except §33‑51‑9(e), and may not conflict with Medicare. PEIA must use provider networks that can serve members out of state, and the law defines key terms used to enforce these rules.

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Sponsors & Cosponsors

Sponsor

  • Evan Worrell

    Republican • House

Cosponsors

  • Mickey Petitto

    Republican • House

Roll Call Votes

All Roll Calls

Yes: 357 • No: 0

House vote • 3/13/2026

Effective from passage (Roll No. 505)

Yes: 97 • No: 0

House vote • 3/13/2026

House concurred in Senate amendment and passed bill (Roll No. 504)

Yes: 97 • No: 0

Senate vote • 3/10/2026

Effective from passage (Roll No. 413)

Yes: 34 • No: 0

Senate vote • 3/10/2026

Passed Senate (Roll No. 412)

Yes: 34 • No: 0

House vote • 2/20/2026

Passed House (Roll No. 153)

Yes: 95 • No: 0

Actions Timeline

  1. Approved by Governor 4/1/2026

    4/1/2026House

  2. To Governor 3/25/26

    3/25/2026House

  3. House Message received

    3/14/2026Senate

  4. To Governor 3/25/2026 - Senate Journal

    3/14/2026Senate

  5. Approved by Governor 4/1/2026 - Senate Journal

    3/14/2026Senate

  6. Approved by Governor 4/1/2026 - House Journal

    3/14/2026House

  7. House received Senate message

    3/13/2026House

  8. House concurred in Senate amendment and passed bill (Roll No. 504)

    3/13/2026House

  9. Effective from passage (Roll No. 505)

    3/13/2026House

  10. Communicated to Senate

    3/13/2026House

  11. Completed legislative action

    3/13/2026House

  12. On 3rd reading

    3/10/2026Senate

  13. Read 3rd time

    3/10/2026Senate

  14. Passed Senate (Roll No. 412)

    3/10/2026Senate

  15. Title amendment adopted

    3/10/2026Senate

  16. Effective from passage (Roll No. 413)

    3/10/2026Senate

  17. Senate requests House to concur

    3/10/2026Senate

  18. On 2nd reading

    3/9/2026Senate

  19. Read 2nd time

    3/9/2026Senate

  20. Committee amendment reported

    3/9/2026Senate

  21. Amendment to committee amendment adopted (Voice vote)

    3/9/2026Senate

  22. Committee amendment as amended adopted (Voice vote)

    3/9/2026Senate

  23. Reported do pass, with amendment

    3/6/2026Senate

  24. Immediate consideration

    3/6/2026Senate

  25. Read 1st time

    3/6/2026Senate

Bill Text

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