West Virginia has made progress in healthcare price transparency on several fronts, including implementing an all-payer claims database (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.
2020 Legislative Session: 1/8/2020 - 3/7/2020 (2020 term). *Current session bill updates are ongoing. Check back weekly for updates.