This bill creates the West Virginia Prescription Drug Affordability Board (the Board), a new state entity designed to address high prescription drug costs. The Board will consist of five members appointed by various state officials, who must have expertise in healthcare economics or clinical medicine. The Board will establish a 26-member Stakeholder Council to provide input on its decisions. Key responsibilities include studying the pharmaceutical distribution system, collecting transparency data on drug pricing, and conducting cost reviews of prescription drugs that may create affordability challenges. The Board can potentially set upper payment limits for prescription drugs purchased by state and local government entities, with a careful process that includes monitoring drug availability and avoiding shortages. To fund its operations, the Board will collect annual fees from manufacturers, pharmacy benefits managers, insurers, and wholesale distributors, not exceeding $2 million per year. The bill requires the Board to submit annual reports on drug price trends and recommendations for making prescription drugs more affordable. Importantly, the Board must protect confidential business information and follow strict conflict of interest guidelines. By 2028, the Board will evaluate the potential for expanding its authority to set upper payment limits across all prescription drug purchases in West Virginia.