HB 5379 — Relating to financial assistance available for a prescription drug

WEST VIRGINIA LEGISLATURE REGULAR SESSION IntroducedCommittee Substitute for House Bill 5379 By Delegates Summers and Tully [Introduced[Originating Januaryin 31,the 2024;Committee on Finance;

ReferredReported to the Committee on HealthFebruary and23, Human2024] ResourcesCS thenfor Finance] Intr HB 2024R34295379 A BILL to amend and reenact §33-15-4t of the Code of West Virginia, 1931, as amended;

to amend and reenact §33-15-4t of said code;

and to amend and reenact §33-25A-8t§33-25A- 8t of said code;code, all relating to cost sharing under health plans;

allrequiring relatingpharmacy benefits managers to financialinclude assistanceany availablecost forsharing aamounts prescriptionpaid drug;by insured or by another person when calculating insured's contribution to any applicable cost sharing requirement;

applying certain annual limitation on cost sharing to all health plans issued in this state;

preventing insurers, pharmacy benefits managers, and third-party administrators from changing the terms of health plan coverage based on the availability or amount of financial assistance available for a prescription drug;

and providing for civil penalties.penalties and authorizing restitution;

and providing effective date.

1 CS for HB 5379 "Pharmacy benefits manager" means the same as that term is defined in §33-51-3 of this code.

(b) When calculating an insured's contribution to any applicable cost sharing requirement, Intr HB 2024R3429 including, but not limited to, the annual limitation on cost sharing subject to 42 U.S.C.

(d) (f) This section is effective for policy, contract, plans, or agreements beginning on or after January 1, 20202020. January 1, 2025.

The amendments made to this section in 2024 are effective for policy, contract, plans, or agreements beginning on or after January 1, 2025.

2 CS for HB 5379 (e) (g) If under federal law application of subsection (b) of this section would result in Health Savings Account ineligibility under Section 223 of the Internal Revenue Code, this requirement shall apply only for Health Savings Account-qualified High Deductible Health Plans with respect to the deductible of such a plan after the enrollee has satisfied the minimum deductible under Section 223 of the Internal Revenue Code:

Provided, That with respect to items or services that are preventive care pursuant to Section 223(c)(2)(C) of the Internal Revenue Code, the requirements of subsection (b) of this section shall apply regardless of whether the Intr HB 2024R3429 minimum deductible under Section 223 of the Internal Revenue Code has been satisfied.

3 CS for HB 5379 "Health plan" means a policy, contract, certification, or agreement offered or issued by an insurer to provide, deliver, arrange for, pay for, or reimburse any of the costs of health care services.

§ 300gg-6(b) Intr HB 2024R3429 (1) an insurer or pharmacy benefits manager shall include any cost sharing amounts paid by the insured or on behalf of the insured by another person.

(d) (f) This section is effective for policy, contract, plans, or agreements beginning on or after January 1, 20202020. January 1, 2025.

ThisThe sectionamendments appliesmade to all policies, contracts, plans, or agreements, subject to this articlesection thatin 2024 are delivered,effective executed,for issued,policy, amended,contract, adjusted,plans, or renewedagreements inbeginning this state on or after theJanuary effective1, date2025. of this section.

This section applies to all 4 CS for HB 5379 policies, contracts, plans, or agreements, subject to this article that are delivered, executed, issued, amended, adjusted, or renewed in this state on or after the effective date of this section.

(h) In addition to the penalties and other enforcement provisions of this chapter, any person Intr HB 2024R3429 who violates this section is subject to civil penalties of up to $10,000 per violation.

5 CS for HB 5379 "Person" means a natural person, corporation, mutual company, unincorporated association, partnership, joint venture, limited liability company, trust, estate, foundation, nonprofit corporation, unincorporated organization, or government or governmental subdivision or agency.

§ 18022(c) Intr HB 2024R3429 and 42 U.S.C.

6 CS for HB 5379 (c) (e) The commissioner is authorized to propose rules for legislative approval in accordance with §29A-3-1 et seq.

(d) (f) This section is effective for policy, contract, plans, or agreements beginning on or after January 1, 20202020. January 1, 2025.

The amendments made to this section in 2024 are effective for policy, contract, plans, or agreements beginning on or after January 1, 2025.

Intr HB 2024R3429 (h) In addition to the penalties and other enforcement provisions of this chapter, any person who violates this section is subject to civil penalties of up to $10,000 per violation.

7 CS for HB 5379 "Person" means a natural person, corporation, mutual company, unincorporated association, partnership, joint venture, limited liability company, trust, estate, foundation, nonprofit corporation, unincorporated organization, or government or governmental subdivision or agency.

§ 300gg-6(b) (1) an insurer or pharmacy benefits manager shall include any cost sharing amounts paid Intr HB 2024R3429 by the insured or on behalf of the insured by another person.

8 CS for HB 5379 (c) (e) The commissioner is authorized to propose rules for legislative approval in accordance with §29A-3-1 et seq.

(d) (f) This section is effective for policy, contract, plans, or agreements beginning on or after January 1, 20202020. January 1, 2025.

The amendments made to this section in 2024 are effective for policy, contract, plans, or agreements beginning on or after January 1, 2025.

Imposition of Intr HB 2024R3429 civil penalties shall be pursuant to an order of the commissioner issued after notice and hearing.

9 CS for HB 5379 "Person" means a natural person, corporation, mutual company, unincorporated association, partnership, joint venture, limited liability company, trust, estate, foundation, nonprofit corporation, unincorporated organization, or government or governmental subdivision or agency.

and (2) A pharmacy benefits manger shall include any cost sharing amounts paid by the Intr HB 2024R3429 insured or on behalf of the insured by another person (c) The annual limitation on cost sharing provided for under 42 U.S.C.

10 CS for HB 5379 (c) (e) The commissioner is authorized to propose rules for legislative approval in accordance with §29A-3-1 et seq.

(d) (f) This section is effective for policy, contract, plans, or agreements beginning on or after January 1, 20202020. January 1, 2025.

The amendments made to this section in 2024 are effective for policy, contract, plans, or agreements beginning on or after January 1, 2025.

The commissioner's order may require a person found to be in violation of this section to make Intr HB 2024R3429 restitution to persons aggrieved by violations of this section.