Become a member of WVIPA
Join WVIPA to support pharmacy transparency, fair reimbursement, and improved patient care in your community.
Past Achievements
Since late 2016, the West Virginia Independent Pharmacy Association has successfully advocated for various pieces of legislation that have become law in West Virginia under the Pharmacy Audit Integrity Act (WV Code, Chapter 33, Article 51) - see the Act HERE. West Virginia’s pharmacy laws now rank as some of the strongest in the nation, with enhanced protections for pharmacies and patients related to reimbursement, transparency, network participation, audit protections, and more.
Recent Progress
The WVIPA is collaborating with the West Virginia Public Employees Insurance Agency (PEIA) to reform its reimbursement model and improve transparency related to its PBM operations. Senate Bill 453, the WVIPA’s #1 priority item, has passed the West Virginia Legislature! The reimbursement increase takes effect on July 1, 2024, and the transparency report is due by December 31, 2024. The WVIPA will continue to monitor this new law as it is implemented by PEIA.
Future Goals
The WVIPA will continue to aggressively take on PBMs and others that take advantage of pharmacies and patients in West Virginia. This includes Medicaid, PEIA, commercial insurance, and other payors. The WVIPA continues to look to Medicare for opportunities to improve access for patients and protect West Virginia pharmacies. The WVIPA will continue to advocate for increases to the dispensing fees paid to West Virginia pharmacies for all plans and payors. Additionally, the association is committed to supporting them.
WVIPA: Key Milestones
Since its formation, the West Virginia Independent Pharmacy Association (WVIPA) has been instrumental in advocating for pharmacy regulations, transparency, and patient protections. This timeline highlights the significant legislative and regulatory milestones achieved by WVIPA from 2016 to 2024, reflecting its continuous efforts to enhance the pharmacy landscape in West Virginia.
2024
Requirements for PBM data transparency and prohibition of 340B contract pharmacy restrictions.
- SB 453 required PBM data transparency, mandatory PEIA pharmacy study by independent vendor.
SB 325 prohibited drug manufacturer 340B contract pharmacy restrictions, $50,000 per violation fine.
2024
2023
Resolution of PBM complaints and adoption of new Medicaid reimbursement model for PEIA
- PBM complaints filed/resolved; ongoing PBM investigations.
SB 453 adopted NADAC + WV Medicaid dispensing fee reimbursement model for PEIA.
2022
Expansion of healthcare payor definitions and adoption of new PBM legislative rules
- HB 4112 expanded “health care payor” definition and required adequate notice by PBMs for contract changes.
SB 345 & 347 adopted 114 CSR 99 (PBM legislative rules) under WVOIC.
2022
2021
Inclusion of “any willing pharmacy” in PBM networks and creation of specialty drug review process
- HB 2263 included “any willing pharmacy” PBM network participation and drug rebate shared savings.
HB 4112 defined “specialty drug” and created complaint process for specialty drug review.
2020
Authorization for pharmacists to administer vaccines and enhanced PBM penalties.
- SB 544 authorized pharmacists/pharmacy interns to administer vaccines.
HB 4058 enhanced PBM penalties up to $10,000 per violation.
HB 2263 adopted NADAC + $10.49 reimbursement model for commercial and ERISA plans.
2020
2019
Adoption of 340B reimbursement protections and PBM oversight rules.
- 340B discriminatory reimbursement protections adopted - complaints filed/resolved with PBM fines.
WVOIC legislative rules adopted related to PBM licensure/oversight.
2018
Full PBM licensure requirement by WVOIC
- WV Medicaid implemented NADAC + $10.49 reimbursement model.
SB 522 created the “Pharmacy Audit Integrity Act” under WV Code 33-51.
“PAIA” included PBM registration and audit protections.
SB 46 prohibited PBM gag clauses, required PBM fees to be itemized/described.
2018
2017
Implementation of new Medicaid reimbursement model and creation of Pharmacy Audit Integrity Act.
- WV Medicaid implemented NADAC + $10.49 reimbursement model.
SB 522 created the “Pharmacy Audit Integrity Act” under WV Code 33-51.
“PAIA” included PBM registration and audit protections.
SB 46 prohibited PBM gag clauses, required PBM fees to be itemized/described.
2016
Formation of WV Independent Pharmacy Association and initial Medicaid pharmacy transparency study
- WV had no PBM regulation/oversight or pharmacy/patient protections.
WV Independent Pharmacy Association formed.
WV Medicaid pharmacy transparency/rebate study began.
WV Medicaid pharmacy “carve out” from MCOs/PBMs implemented.
2016
