A new West Virginia PBM bill (HB 5430), effective immediately, prohibits spread pricing and requires PBM fees to be transparent and independent of drug cost.

Under the bill, PBMs may not bill customers more than NADAC plus the $10.49 dispensing fee when NADAC exists for the drug cost portion of a claim. When NADAC does not exist, PBMs may not bill customers more than the amount paid to the dispensing pharmacy. This provision will ensure payors have full transparency into their PBM administrative fees, and that those fees are independent of, and not contingent on, the actual drug price.

Because workers’ compensation claims represent only a small portion of overall national pharmacy spend, broad legislation can create unintended consequences for WC PBMs and insurers. These laws often do not account for the distinct regulatory structure and oversight of workers’ compensation programs. Healthesystems is evaluating the requirements, taking steps to ensure compliance, and has begun notifying customers who may be affected.