West Virginia has made progress in healthcare price transparency on several fronts, including implementing an APCD, passing legislation easing access to medical records, and creating annual financial disclosure requirements for facilities in order to determine the reasonableness of healthcare costs among providers. West Virginia also closely regulates hospital prices, requiring hospitals to submit all changes and amendments to hospital charges for approval. However, competition in the insurance market is weak, as only one carrier issues qualified health plans on the individual insurance market and premiums for employer-sponsored plans are some of the highest in the country.
West Virginia had joined a growing number of states that aim to reduce the cost of prescription drugs by increasing transparency around pricing. In the 2019 legislative session, West Virginia continued to focus its efforts on prescription drug prices and introduced a number of legislation aimed to reduce consumer cost-sharing for pharmaceuticals. Notably, all of its drug importation legislation failed (SB 250, HB 2319, HB 2428).
The state successfully enacted the Pharmacy Audit Integrity and Transparency Act in 2018 (SB 46), which provides that a pharmacy may inform consumers of lower cost alternatives and cost share to assist health care consumers, and penalizes any pharmacy benefit managers that attempt to prohibit such disclosure. In 2019, the legislature continued to expand the authority to regulate pharmacy benefit managers, and passed SB 489 (expanding the Pharmacy Audit Integrity Act) and HB 2770 (Fairness in Cost-Sharing Calculation Act).
In the 2017 legislative session, West Virginia Governor Jim Justice signed HB 2459, which exempts financially distressed hospitals in acquisition proceedings from going through the traditional Certificate of Need process.
The State Database
The Source tracks state activities impacting healthcare price and competition in both legislation and litigation in a searchable database to help stakeholders at the state level understand their legal and regulatory environment as they make efforts to improve access, quality, and efficiency, and reduce costs in healthcare.
LEGISLATION: The Database of State Laws Impacting Healthcare Cost and Quality (SLIHCQ), created by The Source on Healthcare Price & Competition and Catalyst for Payment Reform, catalogues state legislation governing price transparency, provider market power, provider payment, provider networks, and benefit design. The database also includes pharmaceutical legislation beginning in the 2017-2018 legislative session. *Note: Current legislative session bill updates are ongoing. Check back weekly for updates.
LITIGATION: The Source tracks major litigation and antitrust enforcement action by federal entities (FTC or DOJ), state attorney generals, and private parties in the main provider and insurer markets, particularly legal challenges of healthcare consolidation and anticompetitive contract provisions. Additionally, the database contains major pharmaceutical cases including legislation challenges and significant appellate cases.
Search the database across all jurisdictions on the State Overview page, or view and filter existing legislation or litigation on individual state pages. The database allows customized search and filter by keyword, status, and/or key issue category. *Multiple filter/selections enabled. Click here for User Guide.