Clarification Regarding Cost-Sharing for Insulin Drugs
August 30, 2022
On August 8, 2022, Insurance Commissioner McVey issued Bulletin 2022-09, which provides clarification related to the maximum cost-sharing that may be charged to a covered participant for insulin drugs. Existing law prohibits health insurance policies from charging a participant more than $100 cost-sharing per 30-day period for insulin drugs. Some insurers interpreted this to mean $100 per insulin drug category. For example, if a participant was prescribed both rapid-acting insulin and short-acting insulin during a 30-day period, the insurer was imposing $100 cost-sharing for each category for a total of $200. The bulletin clarifies that the maximum $100 cost-sharing applies to all combined insulin drug categories. In other words, in the above example, the participant could only be charged a $100 cost-sharing for both prescription categories combined.
As this is an interpretation of an existing law, it is considered effective immediately. Employer plan sponsors should be aware of the change in coverage and work with insurers to revise plan documents as necessary.
Bulletin 2022-09 »
January 19, 2022
On January 4, 2022, Insurance Commissioner McVey issued Insurance Bulletin 22-01, which provides an easy-to-understand summary of the federal No Surprise Billing provisions going into effect in 2022. The bulletin defines “surprise bills,” explains the new protections against surprise billing, provides examples to assist consumers in identifying the now prohibited practice, and confirms that the new law applies to both fully insured and self-insured plans. Lastly, it directs consumers to file an appeal with the insurer or plan when a claim is processed incorrectly for an emergency related expense or an out-of-network expense incurred at an in-network facility.
Employers may want to use the bulletin to educate themselves or their health plan participants of the new law’s protections and provisions.
Insurance Bulletin 22-01 »
Freedom of Consumer Choice for Pharmacy
January 19, 2022
On January 11, 2022, Insurance Commissioner McVey issued Insurance Bulletin 22-04, which provides guidance on HB 2263. The new law is effective for policies, plans, contracts and agreements executed or renewed on or after January 1, 2022. Pharmacy benefit managers (PBM’s) and health insurers providing prescription drug coverage are prohibited from the following practices:
- Providing a monetary advantage or imposing a monetary penalty on a participant for utilizing one in-network pharmacy over another in-network pharmacy.
- Requiring a participant to purchase prescriptions, including specialty drugs, through mail order.
- Failure to provide participants with a choice between purchasing prescriptions through a physical store in the state and through mail order.
- Failure to maintain an adequate network of pharmacies.
Importantly, the bulletin clarifies that the law applies not only to fully insured group health insurance policies providing prescription drug coverage but also to self-insured group health plans using a PBM that is subject to the state’s laws and is providing prescription drug coverage to West Virginia residents.
Employer plan sponsors should work with their health insurance carrier and/or PBM to ensure plan compliance.
Insurance Bulletin 22-04 »
January 04, 2022
Effective January 18, 2022, HB 335 restricts employment practices related to a vaccine requirement. If an employer requires employees to be vaccinated as a condition of employment, the employer must provide employees an exemption if: they certify that COVID-19 immunization is medically inadvisable, they have COVID-19 antibodies or they possess religious beliefs that prevent them from receiving COVID-19 immunization.
Importantly, if an employer is going to be subject to the federal requirement for private employers with 100 or more employees, that employer would have a conflict with state law for West Virginia employees who sought an exemption based solely on having COVID-19 antibodies. Under the federal requirement, employees are only provided the choice of vaccination or weekly testing. Given the conflict between state and federal law, employers are encouraged to seek outside counsel on this issue.
HB 335 »
State Insurance Update
November 10, 2020
Insurance Commissioner Dodrill issued Insurance Bulletin No. 20-15, which clarifies that group health insurance policies covering employees or residents of nursing homes must provide COVID-19 testing for those covered individuals without any cost sharing. While the DOL, HHS and Treasury have advised that COVID-19 testing to screen for general workplace health and safety is beyond the scope of the FFCRA or CARES Act, testing may be required to be covered for both symptomatic and asymptomatic individuals with known or suspected recent exposure.
Further, the Bureau for Public Health issued a memorandum requiring testing of any resident of, or healthcare personnel working in, a nursing home who has signs or symptoms of COVID19, as well as asymptomatic residents of such facilities when there is an outbreak in a facility or exposure. Thus, such testing shall be covered under the respective group health policies with no cost sharing to such participants. The bulletin clarifies this is an ongoing requirement and not simply one-time testing coverage.
Any plan sponsors that employ nursing home workers should be aware of this requirement.
Bulletin No. 20-15 »