Legislation


SB 366 – West Virginia

Status: Enacted
Year Introduced: 2016
Link: https://legiscan.com/WV/text/SB366/2015

PATIENT PROTECTION AND TRANSPARENCY ACT: requires the West Virginia Insurance Commissioner to provide on the Department’s website information regarding qualified health plans being offered for sale through the exchange. Required information includes: (i) the names of physicians, hospitals, and other health care providers that are in network; (ii) a list of the type of specialists in network; (iii) exclusions from coverage by category of benefits; (iv) restrictions on use and quantities; (v) the dollar amount of copayments; (vi) the percentage of coinsurance by item and service; (vii) require cost-sharing; (viii) information sufficient to determine whether a drug is on a formulary; (ix) clinical pre-requisites and authorization requirements; (x) a description of how medications will be included/excluded from the deductible; (xi) a description of out-of-pocket costs; (xii) information sufficient to determine whether a specific drug is covered or furnished by a physician/clinic; (xii) an explanation of out-of—network providers or noncovered services; (xiv) the appeals process; and (xv) contact information for the plan.

PHARMACEUTICAL COST MANAGEMENT: would require the Health Care Authority subcommittee to explore requirements and criteria for prescription drug manufacturers to disclose expenditures for advertising, marketing, and promotion based on aggregate national data gathered by federal sources through the ACA.

Enacted at W. Va. Code § 33-50.


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