West Virginia 2026 Session Status: Enacted 2 R cosponsors

HB 5430 — Relating to pharmaceutical benefits

Last action — Chapter 250, Acts, Regular Session, 2026

Track this bill free

No card. One bill, free forever — alerts when it moves.

  1. ✓
    Introduced
  2. ✓
    In Committee
  3. ✓
    Passed House of Delegates
  4. ✓
    Passed Senate
  5. ✓
    To Executive
  6. 6
    Enacted

This bill has been enacted into law. Introduced February 11, 2026. Enacted.

Prognosis

Likely to advance 74% · moderate confidence

Where this bill stands today.

Odds of enactment

High

How often bills like it became law.

  • Enacted

    Current position in the legislative process.

  • 2 sponsors

    1 primary, 1 co-sponsors signed on.

  • Single-party support

    Sponsorship is currently within one party (2 R).

  • Cleared a recorded vote

    Passed 6 recorded votes so far.

Prognosis reads this bill's own signals — stage, sponsorship breadth, committee status, recorded votes and cross-state momentum. Odds come from a model trained on which bills have become law.

In plain language

The bill addresses pharmaceutical benefits.

This legislation focuses on the management and provision of pharmaceutical benefits. It seeks to clarify rules and practices surrounding these benefits in the healthcare system.

What this means for you
  • Consumers: Consumers could see changes in how they access and manage their pharmaceutical benefits.
  • Healthcare: Healthcare providers may need to adapt to new guidelines regarding pharmaceutical benefits.

Summary

Relating to pharmaceutical benefits

Bill Text

What changed in the latest version

1 added · 1 removed

Plain-language change summary

In the latest amendment to Bill HB 5430, the title has been updated to clarify its focus on pharmaceutical benefits and to outline specific requirements for cost management within West Virginia's public insurance system. Changes include making the Public Employees Insurance Agency accountable to the Pharmacy Audit Integrity Act, ensuring that certain provisions do not conflict with Medicare, and introducing terms for contracts with cost containment vendors. Additionally, new definitions related to claims processing and pharmacy operations have been added to improve clarity. These changes are important as they aim to enhance transparency and efficiency in how pharmacy benefits are managed, ultimately benefiting both the state and its employees.

→
Previous
Latest
HB5430 SFA Helton # 3-9Dellinger  7965Senator Helton moved to amend the committee amendment on page 6, section 9, line 120, after the word "code" by changing the period to a comma and inserting the following:
HB5430 SFAT Helton # 3-9Dellinger  7965Senator Helton moved to amend the bill by striking out the title and substituting therefor a new title, to read as follows:Eng.
"and nothing in this subsection shall be applied to conflict with Medicare.";On page 8, section 3, line 15-16 by striking the definition of "Claim level information" and inserting a new definition of "Claim level information" to read as follows:"Claim level information" means data submitted by a pharmacy or required by a payor or claims processor to adjudicate a claim.;On page 11, section 3, lines 94-97, by striking out the definition of "Pharmacy services administration organization" and inserting in lieu thereof a new definition of "Pharmacy services administration organization" to read as follows:"Pharmacy services administration organization" means any entity that contracts with a pharmacy to assist with payor interactions and that may provide a variety of other administrative services, including contracting with pharmacy benefits managers on behalf of pharmacies and managing pharmacies’ claims payments from payors.;And, On page 12, section 3, by striking out lines 116-121 in their entirety.
Com.
  AdoptedRejected
Sub.
for House Bill 5430—A Bill to amend and reenact §5-16-9, §33-51-3, and §33-51-9 of the Code of West Virginia, 1931, as amended;
and to amend the code by adding two new sections, designated §9-5-34 and §33-51-14, relating to pharmaceutical benefits;
making the Public Employees Insurance Agency subject the Pharmacy audit Integrity Act;
providing exceptions;
providing specific provisions shall not be applied to conflict with Medicare;
requiring competitive bid solicitation for cost containment vendor;
setting forth terms for cost containment vendor contract;
requiring the Medicaid program to establish a time limited pilot program;
defining terms;
limiting amounts charged by pharmacy benefit managers;
addressing Public Employees Insurance Agency rebate;
prohibiting certain pharmacy benefit manager ownership structures;
requiring a study;
and requiring a report.     AdoptedRejected
⬇ Download PDF
View plain text versions (8)

How this bill changes current law

4 changes Share ↗

Compared against the W. Va. Code as published AI-generated reading aid — verify against the official bill.

The bill amends the West Virginia Public Employees Insurance Act to include new provisions on pharmacy benefits management and establishes a pharmacy cost containment vendor program.

  • West Virginia Code § 9-5-34

    (a) For purposes of this section, "pharmacy benefit manager" and "affiliate" have the meanings ascribed to those terms in §33-51-3 of this code.(b) To the extent that Medicaid has a pharmacy benefit manager managing its pharmacy contract, that pharmacy benefit manager may not reimburse a pharmacy or pharmacist for a prescription drug or pharmacy service in an amount less than the amount the pharmacy benefit manager reimburses itself or an affiliate for the same prescription drug or pharmacy service.(c) By July 1, 2026, the Medicaid program shall establish a one-year pilot program to implement a pharmacy cost containment vendor. This pilot program shall focus on actively engaging prescribing providers by presenting information regarding cost and effectiveness, including but not limited to, data on lowest net cost pharmaceutical options and clinically appropriate polypharmacy reduction strategies. This pilot program will not require Medicaid to alter or violate any terms of any existing contracts.

    New provisions are added to the Medicaid pharmacy benefit management section to prohibit certain types of reimbursements and to establish a pilot program for cost containment.

  • W. Va. Code § 5-16-9(f)

    The director shall include language in all contracts for pharmacy benefits management, as defined by §33-51-3 of this code, requiring the pharmacy benefit manager to report quarterly to the agency the following:(1) The overall total amount charged to the agency for all claims processed by the pharmacy benefit manager during the quarter;(2) The overall total amount of reimbursements paid to pharmacy providers during the quarter;(3) The overall total number of claims in which the pharmacy benefits manager reimbursed a pharmacy provider for less than the amount charged to the agency for all claims processed by the pharmacy benefit manager during the quarter; and(4) For all pharmacy claims, the total amount paid to the pharmacy provider per claim, including, but not limited to, the following:(A) The cost of drug reimbursement;(B) Dispensing fees;(C) Copayments;(D) The amount charged to the agency for each claim by the pharmacy benefit manager;(E) Date of service;(F) NDC-11;(G) Drug name;(H) Drug strength;(I) Quantity;(J) Days of therapy;(K) Rx count;(L) Mail/retail code;(M) Brand/generic indicator;(N) Specialty drug indicator;(O) Compound indicator;(P) Formulary indicator;(Q) Gross cost;(R) Member cost;(S) Plan cost;(T) Dispense as written;(U) Pharmacy NPI number;(V) Pharmacy Claim ID;(W) Prescriber NPI number;(X) Pharmacy name; and(Y) Ingredient cost. In the event there is a difference between the amount for any pharmacy claim paid to the pharmacy provider and the amount reimbursed to the agency, the pharmacy benefit manager shall report an itemization of all administrative fees, rebates, or processing charges associated with the claim.

    New reporting requirements for pharmacy benefit managers are established to increase accountability and transparency in cost management.

  • W. Va. Code § 5-16-9(i)(1)

    Effective with the changes made to this section during the regular session of the Legislature, 2024, a comprehensive pharmacy business intelligence study and analysis shall be conducted by an organization with expertise in studying and analyzing pharmacy benefit managers to determine what, if any, changes could be made to facilitate savings with respect to the Public Employees Insurance Agency's pharmacy benefit manager services. A final report, including recommendations, shall be presented no later than December 31, 2024, to the Public Employees Insurance Agency and the Joint Committee on Government and Finance.

    A pharmacy business intelligence study is mandated to identify potential savings opportunities in the management of pharmacy benefits.

  • W. Va. Code § 33-51-3(2)

    A pharmacy benefit manager shall not reimburse a West Virginia pharmacy or pharmacist for a prescription drug or pharmacy service in an amount less than the national average drug acquisition cost for a prescription drug or pharmacy service at the time the drug is administered or dispensed, plus a professional dispensing fee at least equal to the professional dispensing fee paid by West Virginia Medicaid for outpatient drugs. Increases to the professional dispensing fee may be set by the director in accordance with this subdivision: Provided, That if the national average drug acquisition cost is not available at the time a drug is administered or dispensed, a pharmacy benefit manager may not reimburse a West Virginia pharmacy or pharmacist in an amount that is less than the wholesale acquisition cost of the drug, as defined in 42 U.S.C. § 1395w-3a(c)(6)(B), plus a dispensing fee as described in this subdivision.

    New reimbursement standards for pharmacy benefit managers are established to ensure fair compensation for pharmacists.

Action History

  1. Chapter 250, Acts, Regular Session, 2026

  2. Approved by Governor 4/1/2026

  3. To Governor 3/25/26

  4. House Message received

  5. To Governor 3/25/2026 - Senate Journal

  6. Approved by Governor 4/1/2026 - Senate Journal

  7. Approved by Governor 4/1/2026 - House Journal

  8. House received Senate message

  9. House concurred in Senate amendment and passed bill (Roll No. 504)

  10. Effective from passage (Roll No. 505)

  11. Communicated to Senate

  12. Completed legislative action

  13. On 3rd reading

  14. Read 3rd time

  15. Passed Senate (Roll No. 412)

  16. Title amendment adopted

  17. Effective from passage (Roll No. 413)

  18. Senate requests House to concur

  19. On 2nd reading

  20. Read 2nd time

  21. Committee amendment reported

  22. Amendment to committee amendment adopted (Voice vote)

  23. Committee amendment as amended adopted (Voice vote)

  24. Reported do pass, with amendment

  25. Immediate consideration

  26. Read 1st time

  27. Introduced in Senate

  28. To Health and Human Resources

  29. To Health and Human Resources

  30. On 3rd reading, Special Calendar

  31. Read 3rd time

  32. Passed House (Roll No. 153)

  33. Communicated to Senate

  34. On 2nd reading, Special Calendar

  35. Read 2nd time

  36. Amendment reported by the Clerk

  37. Amendment adopted (Voice vote)

  38. On 1st reading, Special Calendar

  39. Read 1st time

  40. By substitute, do pass

  41. Markup Discussion

  42. Filed for introduction

  43. To Health and Human Resources

  44. Introduced in House

  45. To House Health and Human Resources

Sponsors

Sponsorship breakdown

Export CSV (upgrade) →

1 sponsors · 1 co-sponsors · 150 not signed on

Sponsors (1)

Co-sponsors (1)

Not signed on (150)

150 members have not signed on to this bill.

Show all 150 →

"Not signed on" means a member has not sponsored or co-sponsored this bill — it does not imply opposition. Members flagged Voted No have a recorded No vote on this bill.

Whip count is in markup. Polling the chamber and every recorded vote this session. Only the first open is slow. It’s instant for you after this. Calling the roll · Tallying · Engrossing

Votes

EFFECT FROM PASSAGE

Passed 97 Yea · 0 Nay · 2 Other
Party YeaNayPresentNot Voting
Republican 86002
Democrat 9000
Unaffiliated 2000
Total 97002
% of votes cast 98%0%0%2%
How each member voted (99)
Member Party Vote
Flanigan — Yea
Linville — Yea
Anitra Hamilton Democrat Yea
Evan Hansen Democrat Yea
Hollis Lewis Democrat Yea
John Williams Democrat Yea
Kayla Young Democrat Yea
Mike Pushkin Democrat Yea
Rick Garcia Democrat Yea
Sean Hornbuckle Democrat Yea
Shawn Fluharty Democrat Yea
Adam Burkhammer Republican Yea
Adam Vance Republican Yea
Andy Shamblin Republican Yea
Betsy Kelly Republican Yea
Bill Bell Republican Yea
Bill Ridenour Republican Yea
Bob Fehrenbacher Republican Yea
Bryan Smith Republican Not Voting
Bryan Ward Republican Yea
Carl "Bill" Roop Republican Yea
Carl Martin Republican Yea
Charles Sheedy Republican Yea
Chris Phillips Republican Yea
Christopher W. Toney Republican Yea
Chuck Horst Republican Yea
Clay Riley Republican Yea
D. Rolland Jennings Republican Yea
Dana Ferrell Republican Yea
Dave Foggin Republican Yea
David Cannon Republican Yea
David Green Republican Yea
David McCormick Republican Yea
Dean Jeffries Republican Yea
Doug Smith Republican Yea
Elias Coop-Gonzalez Republican Yea
Eric Brooks Republican Yea
Erica Moore Republican Yea
Evan Worrell Republican Yea
Gary G. Howell Republican Yea
Geno Chiarelli Republican Yea
George Miller Republican Yea
George Street Republican Yea
Gregory A. Watt Republican Yea
Guy Ward Republican Yea
Henry Dillon Republican Yea
Ian T. Masters Republican Yea
James Robert "JB" Akers II Republican Yea
Jarred Cannon Republican Yea
Jeff Campbell Republican Yea
Jeff Eldridge Republican Yea
Jeffrey Stephens Republican Yea
Jim Butler Republican Yea
Jimmy Willis Republican Yea
Joe Ellington Republican Yea
Joe Funkhouser Republican Yea
Joe Parsons Republican Yea
Joe Statler Republican Yea
John Jordan Republican Yea
John Paul Hott Republican Yea
Jonathan Kyle Republican Yea
Jonathan Pinson Republican Yea
Jordan Bridges Republican Yea
Jordan Maynor Republican Yea
Josh Holstein Republican Yea
Kathie Hess Crouse Republican Yea
Keith Marple Republican Yea
Laura Kimble Republican Yea
Lisa White Republican Yea
Lori Dittman Republican Yea
Margitta Mazzocchi Republican Yea
Mark Dean Republican Yea
Mark Zatezalo Republican Yea
Marshall W. Clay Republican Yea
Marty Gearheart Republican Yea
Matthew Rohrbach Republican Yea
Michael Amos Republican Yea
Michael Hite Republican Yea
Michael Hornby Republican Yea
Mickey Petitto Republican Not Voting
Pat McGeehan Republican Yea
Patrick Lucas Republican Yea
Phil Mallow Republican Yea
Ray Canterbury Republican Yea
Rick Hillenbrand Republican Yea
Roger Hanshaw Republican Yea
Roy Cooper Republican Yea
Ryan Browning Republican Yea
S. Chris Anders Republican Yea
Sarah Drennan Republican Yea
Scot C. Heckert Republican Yea
Stanley Adkins Republican Yea
Tresa Howell Republican Yea
Tristan Leavitt Republican Yea
Vacant1 Republican Yea
Vernon Criss Republican Yea
Walter Hall Republican Yea
Wayne Clark Republican Yea
William Anderson Republican Yea

Official roll call →

PASSAGE-SENATE AMENDED HB

Passed 97 Yea · 0 Nay · 2 Other
Party YeaNayPresentNot Voting
Republican 86002
Democrat 9000
Unaffiliated 2000
Total 97002
% of votes cast 98%0%0%2%
How each member voted (99)
Member Party Vote
Flanigan — Yea
Linville — Yea
Anitra Hamilton Democrat Yea
Evan Hansen Democrat Yea
Hollis Lewis Democrat Yea
John Williams Democrat Yea
Kayla Young Democrat Yea
Mike Pushkin Democrat Yea
Rick Garcia Democrat Yea
Sean Hornbuckle Democrat Yea
Shawn Fluharty Democrat Yea
Adam Burkhammer Republican Yea
Adam Vance Republican Yea
Andy Shamblin Republican Yea
Betsy Kelly Republican Yea
Bill Bell Republican Yea
Bill Ridenour Republican Yea
Bob Fehrenbacher Republican Yea
Bryan Smith Republican Not Voting
Bryan Ward Republican Yea
Carl "Bill" Roop Republican Yea
Carl Martin Republican Yea
Charles Sheedy Republican Yea
Chris Phillips Republican Yea
Christopher W. Toney Republican Yea
Chuck Horst Republican Yea
Clay Riley Republican Yea
D. Rolland Jennings Republican Yea
Dana Ferrell Republican Yea
Dave Foggin Republican Yea
David Cannon Republican Yea
David Green Republican Yea
David McCormick Republican Yea
Dean Jeffries Republican Yea
Doug Smith Republican Yea
Elias Coop-Gonzalez Republican Yea
Eric Brooks Republican Yea
Erica Moore Republican Yea
Evan Worrell Republican Yea
Gary G. Howell Republican Yea
Geno Chiarelli Republican Yea
George Miller Republican Yea
George Street Republican Yea
Gregory A. Watt Republican Yea
Guy Ward Republican Yea
Henry Dillon Republican Yea
Ian T. Masters Republican Yea
James Robert "JB" Akers II Republican Yea
Jarred Cannon Republican Yea
Jeff Campbell Republican Yea
Jeff Eldridge Republican Yea
Jeffrey Stephens Republican Yea
Jim Butler Republican Yea
Jimmy Willis Republican Yea
Joe Ellington Republican Yea
Joe Funkhouser Republican Yea
Joe Parsons Republican Yea
Joe Statler Republican Yea
John Jordan Republican Yea
John Paul Hott Republican Yea
Jonathan Kyle Republican Yea
Jonathan Pinson Republican Yea
Jordan Bridges Republican Yea
Jordan Maynor Republican Yea
Josh Holstein Republican Yea
Kathie Hess Crouse Republican Yea
Keith Marple Republican Yea
Laura Kimble Republican Yea
Lisa White Republican Yea
Lori Dittman Republican Yea
Margitta Mazzocchi Republican Yea
Mark Dean Republican Yea
Mark Zatezalo Republican Yea
Marshall W. Clay Republican Yea
Marty Gearheart Republican Yea
Matthew Rohrbach Republican Yea
Michael Amos Republican Yea
Michael Hite Republican Yea
Michael Hornby Republican Yea
Mickey Petitto Republican Not Voting
Pat McGeehan Republican Yea
Patrick Lucas Republican Yea
Phil Mallow Republican Yea
Ray Canterbury Republican Yea
Rick Hillenbrand Republican Yea
Roger Hanshaw Republican Yea
Roy Cooper Republican Yea
Ryan Browning Republican Yea
S. Chris Anders Republican Yea
Sarah Drennan Republican Yea
Scot C. Heckert Republican Yea
Stanley Adkins Republican Yea
Tresa Howell Republican Yea
Tristan Leavitt Republican Yea
Vacant1 Republican Yea
Vernon Criss Republican Yea
Walter Hall Republican Yea
Wayne Clark Republican Yea
William Anderson Republican Yea

Official roll call →

Roll Call

Passed 34 Yea · 0 Nay
Party YeaNayPresentNot Voting
Republican 29000
Democrat 4000
Unaffiliated 1000
Total 34000
% of votes cast 100%0%0%0%
How each member voted (34)
Member Party Vote
MR PRESIDENT — Yea
Anitra Hamilton Democrat Yea
Mike Woelfel Democrat Yea
Mike Woelfel Democrat Yea
Rick Garcia Democrat Yea
Ben Queen Republican Yea
Carl Martin Republican Yea
Chris Phillips Republican Yea
Chris Rose Republican Yea
Chris Rose Republican Yea
Dean Jeffries Republican Yea
Eric Tarr Republican Yea
Eric Tarr Republican Yea
Glenn Jeffries Republican Yea
Jack Woodrum Republican Yea
Jack Woodrum Republican Yea
Jay Taylor Republican Yea
Jimmy Willis Republican Yea
Mark R. Maynard Republican Yea
Mike Oliverio Republican Yea
Patricia Rucker Republican Yea
Patricia Rucker Republican Yea
Robbie Morris Republican Yea
Rollan A. Roberts Republican Yea
Rollan A. Roberts Republican Yea
Rupie Phillips Republican Yea
Rupie Phillips Republican Yea
Ryan Weld Republican Yea
Ryan Weld Republican Yea
Tom Takubo Republican Yea
Tom Takubo Republican Yea
Tom Willis Republican Yea
Trenton Barnhart Republican Yea
Trenton Barnhart Republican Yea

Official roll call →

PASSAGE

Passed 95 Yea · 0 Nay · 5 Other
Party YeaNayPresentNot Voting
Republican 84004
Democrat 9000
Unaffiliated 2001
Total 95005
% of votes cast 95%0%0%5%
How each member voted (100)
Member Party Vote
Flanigan — Yea
Linville — Yea
Kump — Not Voting
Anitra Hamilton Democrat Yea
Evan Hansen Democrat Yea
Hollis Lewis Democrat Yea
John Williams Democrat Yea
Kayla Young Democrat Yea
Mike Pushkin Democrat Yea
Rick Garcia Democrat Yea
Sean Hornbuckle Democrat Yea
Shawn Fluharty Democrat Yea
Adam Burkhammer Republican Yea
Adam Vance Republican Yea
Andy Shamblin Republican Yea
Betsy Kelly Republican Yea
Bill Bell Republican Yea
Bill Ridenour Republican Yea
Bob Fehrenbacher Republican Yea
Bryan Smith Republican Not Voting
Bryan Ward Republican Yea
Carl "Bill" Roop Republican Yea
Carl Martin Republican Yea
Charles Sheedy Republican Yea
Chris Phillips Republican Yea
Christopher W. Toney Republican Yea
Chuck Horst Republican Yea
Clay Riley Republican Yea
D. Rolland Jennings Republican Yea
Dana Ferrell Republican Yea
Dave Foggin Republican Yea
David Cannon Republican Yea
David Green Republican Yea
David McCormick Republican Yea
Dean Jeffries Republican Yea
Doug Smith Republican Yea
Elias Coop-Gonzalez Republican Yea
Eric Brooks Republican Yea
Erica Moore Republican Yea
Evan Worrell Republican Yea
Gary G. Howell Republican Yea
Geno Chiarelli Republican Yea
George Miller Republican Yea
George Street Republican Yea
Gregory A. Watt Republican Yea
Guy Ward Republican Yea
Henry Dillon Republican Yea
Ian T. Masters Republican Yea
James Robert "JB" Akers II Republican Yea
Jarred Cannon Republican Yea
Jeff Campbell Republican Yea
Jeff Eldridge Republican Yea
Jeffrey Stephens Republican Yea
Jim Butler Republican Yea
Jimmy Willis Republican Yea
Joe Ellington Republican Yea
Joe Funkhouser Republican Yea
Joe Parsons Republican Yea
Joe Statler Republican Yea
John Jordan Republican Yea
John Paul Hott Republican Yea
Jonathan Kyle Republican Yea
Jonathan Pinson Republican Yea
Jordan Bridges Republican Yea
Jordan Maynor Republican Yea
Josh Holstein Republican Yea
Kathie Hess Crouse Republican Yea
Keith Marple Republican Yea
Laura Kimble Republican Yea
Lisa White Republican Yea
Lori Dittman Republican Yea
Margitta Mazzocchi Republican Yea
Mark Dean Republican Not Voting
Mark Zatezalo Republican Yea
Marshall W. Clay Republican Yea
Marty Gearheart Republican Yea
Matthew Rohrbach Republican Yea
Michael Amos Republican Yea
Michael Hite Republican Yea
Michael Hornby Republican Yea
Mickey Petitto Republican Yea
Pat McGeehan Republican Not Voting
Patrick Lucas Republican Yea
Phil Mallow Republican Yea
Ray Canterbury Republican Yea
Rick Hillenbrand Republican Yea
Roger Hanshaw Republican Yea
Roy Cooper Republican Yea
Ryan Browning Republican Yea
S. Chris Anders Republican Yea
Sarah Drennan Republican Yea
Scot C. Heckert Republican Yea
Stanley Adkins Republican Yea
Tresa Howell Republican Yea
Tristan Leavitt Republican Not Voting
Vacant1 Republican Yea
Vernon Criss Republican Yea
Walter Hall Republican Yea
Wayne Clark Republican Yea
William Anderson Republican Yea

Official roll call →

Subjects

healthcare health-insurance
Cross-referencing the record. Reading this bill against every other bill in the corpus by meaning, not keywords. Only the first open is slow. It’s instant for you after this. Matching · Ranking · Engrossing

Frequently asked questions

What does HB 5430 do?
Relating to pharmaceutical benefits
Who sponsors HB 5430?
HB 5430 is sponsored by Evan Worrell (Republican) and Mickey Petitto (Republican).
What is the current status of HB 5430?
This bill has been enacted into law. Introduced February 11, 2026. Enacted.
Where can I track HB 5430?
Track HB 5430 free on One Click Politics — get push/email alerts when it moves.

Make your voice heard on HB 5430

Find the representatives who decide this bill and tell them where you stand — for yourself, or mobilize your whole list in one click with One Click Politics advocacy software.

Find my representatives → Run a campaign

Stay ahead of HB 5430

Last checked for changes about 2 months ago · updated continuously

One Click Politics tracks every bill in Congress and all 50 states.

Track this bill →