§33-51-3. Definitions
For purposes of this article: “340B entity” means an entity participating in the federal 340B drug discount program, as described in 42 U.S.C. 256b, including its pharmacy or pharmacies, or any pharmacy or pharmacies, contracted with the participating entity to dispense drugs purchased through such program. “Affiliate” means a pharmacy, pharmacist, or pharmacy technician which, […]
§33-51-4. Procedures for Conducting Pharmacy Audits
(a) An entity conducting a pharmacy audit under this article shall conform to the following rules: (1) Except as otherwise provided by federal or state law, an auditing entity conducting a pharmacy audit may have access to a pharmacys previous audit report only if the report was prepared by that auditing entity.
§33-51-5. Appeals Process
A pharmacy may appeal a final audit report in accordance with the procedures established by the entity conducting the pharmacy audit.
§33-51-6. Limitations
(a) The provisions of this article do not apply to an investigative audit of pharmacy records when: (1) Fraud, waste, abuse or other intentional misconduct is indicated by physical review or review of claims data or statements; or
§33-51-7. Pharmacy Benefits Manager and Auditing Entity Registration
(a) Prior to conducting business in the State of West Virginia, except as provided in subsection (d) of this section, an auditing entity shall register with the Insurance Commissioner. The commissioner shall make an application form available on its publicly accessible Internet website that includes a request for the following information: (1) The identity, address, […]
§33-51-8. Licensure of Pharmacy Benefit Managers
(a) A person or organization may not establish or operate as a pharmacy benefits manager in the state of West Virginia without first obtaining a license from the Insurance Commissioner pursuant to this section: Provided, That a pharmacy benefit manager registered pursuant to 33-51-7 of this code may continue to do business in the state […]
§33-51-9. Regulation of Pharmacy Benefit Managers
(a) A pharmacy, a pharmacist, and a pharmacy technician shall have the right to provide a covered individual with information related to lower cost alternatives and cost share for the covered individual to assist health care consumers in making informed decisions. Neither a pharmacy, a pharmacist, nor a pharmacy technician may be penalized by a […]
§33-50-2. Information Available to the Public and Disclosures Required of Health Carriers
(a) The commissioner shall on his or her website provide information regarding the qualified health plans being offered for sale through the exchange in a format easily found by a consumer on such website. Information may be provided through links to specific information, including through links to the website of each health carrier offering a […]
§33-50-3. Rule-Making Authority
The commissioner may propose rules for legislative approval in accordance with the provisions of article three, chapter twenty-nine-a of this code to implement the provisions of this article.
§33-51-1. Short Title
This article may be cited and known as the Pharmacy Audit Integrity Act.