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WEST VIRGINIA LEGISLATURE REGULAR SESSION Introduced House Bill 5379 By Delegates Summers and Tully [Introduced January 31, 2024;
WEST VIRGINIA LEGISLATURE REGULAR SESSION Committee Substitute for House Bill 5379 By Delegates Summers and Tully [Originating in the Committee on Finance;
Referred to the Committee on Health and Human Resources then Finance] Intr HB 2024R3429 A BILL to amend and reenact §33-15-4t of the Code of West Virginia, 1931, as amended;
Reported on February 23, 2024] CS for HB 5379 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 of said code;
and to amend and reenact §33-25A- 8t of said code, all relating to cost sharing under health plans;
all relating to financial assistance available for a prescription drug;
requiring pharmacy benefits managers to include any cost sharing amounts paid 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.
providing civil penalties and authorizing restitution;
and providing effective date.
"Pharmacy benefits manager" means the same as that term is defined in §33-51-3 of this code.
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.
(b) When calculating an insured's contribution to any applicable cost sharing requirement, 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, 2020 January 1, 2025.
(d) (f) This section is effective for policy, contract, plans, or agreements beginning on or after January 1, 2020.
The amendments made to this section in 2024 are effective for policy, contract, plans, or agreements beginning on or after January 1, 2025.
(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:
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.
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 minimum deductible under Section 223 of the Internal Revenue Code has been satisfied.
"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.
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.
§ 300gg-6(b) (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, 2020 January 1, 2025.
(d) (f) This section is effective for policy, contract, plans, or agreements beginning on or after January 1, 2020.
This section applies to all 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.
The amendments made to this section in 2024 are effective for policy, contract, plans, or agreements beginning on or after January 1, 2025.
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.
(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.
"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.
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.
§ 18022(c) and 42 U.S.C.
(c) (e) The commissioner is authorized to propose rules for legislative approval in accordance with §29A-3-1 et seq.
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, 2020 January 1, 2025.
(d) (f) This section is effective for policy, contract, plans, or agreements beginning on or after January 1, 2020.
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.
(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.
"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.
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.
§ 300gg-6(b) (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.
(c) (e) The commissioner is authorized to propose rules for legislative approval in accordance with §29A-3-1 et seq.
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, 2020 January 1, 2025.
(d) (f) This section is effective for policy, contract, plans, or agreements beginning on or after January 1, 2020.
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.
Imposition of civil penalties shall be pursuant to an order of the commissioner issued after notice and hearing.
"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.
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.
and (2) A pharmacy benefits manger shall include any cost sharing amounts paid by the insured or on behalf of the insured by another person (c) The annual limitation on cost sharing provided for under 42 U.S.C.
(c) (e) The commissioner is authorized to propose rules for legislative approval in accordance with §29A-3-1 et seq.
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, 2020 January 1, 2025.
(d) (f) This section is effective for policy, contract, plans, or agreements beginning on or after January 1, 2020.
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.
The commissioner's order may require a person found to be in violation of this section to make restitution to persons aggrieved by violations of this section.
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