In the first quarter of 2024, our team was happy to see two bills signed, one in West Virginia and the other in Kentucky, by both states’ Governors, Jim Justice (WV) and Andy Beshear (KY).
West Virginia Senate Bill 453Â
- Establishes transparent, cost-based reimbursement to pharmacies serving members of the West Virginia Public Employees Insurance Agency (PEIA).
- Creates a reimbursement floor for West Virginia pharmacies of at least the National Average Drug Acquisition Cost (NADAC) + a professional dispensing fee equal to West Virginia Medicaid ($10.49 currently) for outpatient drugs dispensed under PEIA.
- Prevents “below cost” dispensing for PEIA prescriptions and seeks to stabilize West Virginia’s independent pharmacy infrastructure related to PEIA.
- Requires a pharmacy benefit manager (PBM) that contracts with PEIA to be transparent in providing complete data and requires a PEIA pharmacy transparency to be completed before 2025.
- The provisions in this bill go into effect for the Public Employees Insurance Agency plan year beginning on July 1, 2024.
Kentucky Senate Bill 188
- Control drug costs in Kentucky, provide transparency for patients, employers, and the Commonwealth regarding their prescription drug benefits programs, and establish greater oversight of the pharmacy benefit managers (PBMs) that administer those benefits.
- Requires pharmacy reimbursement in the commercial market and in most state employee plans of NADAC plus a professional dispensing fee. The mandatory dispensing fee will be $10.64 beginning January 1, 2025, and that rate will remain in place until the Department of Insurance (DOI) can collaborate with the Board of Pharmacy to do a comprehensive dispensing fee cost report and set the rate at whatever that cost report determines to be appropriate.
- The rate set by DOI shall be in place by January 1, 2027, and the rate shall be adjusted every 2 years, if appropriate.
- Only applies the minimum dispensing fee of $10.64 from January 1, 2025, until January 1, 2027, to independent pharmacies. Beginning January 1, 2027, the minimum dispensing fee as determined by DOI will apply to all pharmacies, except mail-order pharmaceutical distributors, including mail order pharmacies.
- Addresses network adequacy, limiting the role of mail order and ensuring patients access to pharmacies within either thirty miles or 30 minutes’ drive from their residence. Among its many provisions, SB 188 prohibits fees and other reimbursement reductions, including those made retroactively, prohibits lower reimbursement to non-PBM owned or affiliated pharmacies, and limits what PBMs can deem specialty drugs.
- This bill takes effect on January 1, 2025.
EPIC Rx would like to extend a huge thank you to all those in the independent pharmacy community who engaged with legislators and staff to advocate for these critical pieces of legislation. EPIC Rx Director of Government Affairs, Brittany LaPorta says that “your efforts played a big role in getting these across the finish line!”
To learn more about our Government Affairs team, click here.
Brittany earned her master’s degree in public administration from West Virginia University. She has years of experience in government affairs, specifically public policy and government relations.