Become a member of WVIPA
Join WVIPA to support pharmacy transparency, fair reimbursement, and improved patient care in your community.
The article “Building from the Ground Up” by Chris Linville, managing editor of America’s Pharmacist®, details the origins and efforts of the West Virginia Independent Pharmacy Association (WVIPA).
The article “The Winding Road to Success” by Chris Linville, managing editor of America’s Pharmacist®, chronicles the grassroots efforts leading to a significant legislative victory in West Virginia. The passage of Senate Bill 453, signed into law by Governor Jim Justice, mandates transparent pharmacy reimbursement under the state’s Public Employees Insurance Agency (PEIA), ensuring payments based on the National Average Drug Acquisition Cost (NADAC) plus a professional dispensing fee.
This legislation, driven by the West Virginia Independent Pharmacy Association (WVIPA) and its allies, marks a crucial step in PBM reform and supports independent pharmacies, particularly in rural areas.
The collaborative advocacy and relationship-building within the community highlight the importance of local engagement in achieving policy changes, serving as a model for other states.
The article “Building the Beacon in West Virginia” by B. Douglas Hoey, Pharmacist, MBA, Chief Executive Officer of the National Community Pharmacists Association (NCPA), highlights a significant legislative victory for community pharmacies in West Virginia.
Te West Virginia Legislature spent the 2023 session addressing issues to keep the state’s Public Employees Insurance Agency financially sustainable, but the next battleground may be over pharmacy benefits.
In 2017, using actual acquisition cost as the basis for its reimbursement methodology. Remember, NADAC is a benchmark developed by consistently surveying retail community pharmacies across the country, collecting data on outpatient drug ingredient costs. It’s been around since 2013 and is often updated on a weekly basis.
A quick note: If NADAC is not available for a drug, the law calls for Wholesale Acquisition Cost (WAC) to be the reimbursement methodology. PBMs and insurance companies may claim that increased dispensing fees are the driver of higher pharmacy costs, but this is a red herring. The real drivers of higher pharmacy costs are PBMs and their spread pricing tactics, which means charging a health plan more for a drug than the pharmacy is paid. If your company has a health plan, ask your PBM if your health plan is being charged the same amount for your drugs that the pharmacy is being paid. If not, your plan is being taken advantage of.
