West Virginia agencies use drug cost tools and study pharmacy costs

PEIA must seek bids for a separate vendor to give prescribers drug cost and effectiveness information. The vendor must be separate from any state agency’s pharmacy benefit manager. Prescribers do not have to change their prescribing. PEIA may change its drug list based on the vendor’s recommendations. The vendor contract must guarantee total net savings and provide monthly reports on activity and savings. PEIA must issue the bid solicitation by July 1, 2026.

Medicaid must establish a one-year pilot using a separate vendor to share drug cost and effectiveness information with prescribers. The vendor must be separate from any state agency’s pharmacy benefit manager. Prescribers keep clinical discretion and do not have to change their prescribing. The pilot must not require Medicaid to violate existing contracts. Medicaid’s spending on the pilot may not exceed the savings it protects, and the vendor must agree to terms that tie fees to savings. The pilot must be established by July 1, 2026, and last one year.

The Insurance Commissioner must study the cost of dispensing outpatient prescription drugs in West Virginia and report findings. The commissioner must submit the study to legislative health and insurance committees. The study must gather information from licensed pharmacies and review similar studies from nearby states conducted within the previous two years. The study is due by December 1, 2026, and every two years after that. The commissioner must present the report by January 15, 2027, and every two years after that.

When Medicaid uses a pharmacy benefit manager, the manager may not pay a pharmacy less than it pays itself or an affiliate for the same drug or service. This applies to Medicaid when it has a pharmacy benefit manager managing its pharmacy contract.

PEIA pharmacy benefit manager contracts are subject to the Pharmacy Audit Integrity Act and Insurance Commissioner oversight. This applies to pharmacy benefit management contracts with the Public Employees Insurance Agency. The provision does not apply where it would conflict with Medicare.