Freedom of Consumer Choice for Pharmacy

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 »