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Bill

HB 5109

Update the regulation of pharmacy benefit managers

2026 Regular Session Introduced by Michael Amos and 1 co-sponsor

HB 5109 updates West Virginia's pharmacy benefit manager regulations to modernize oversight of drug benefit management practices and their impact on prescription costs and pharmacy access.

To House Health and Human Resources
#insurance
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WeVote Research Nonpartisan
Bill Summary · HB 5109

Legislative bill overview

HB 5109 proposes updates to West Virginia's regulatory framework governing pharmacy benefit managers (PBMs)—intermediaries that manage prescription drug benefits for insurance plans. The bill aims to modernize oversight of PBM practices, though specific regulatory changes are not detailed in the available information at this early legislative stage.

Why is this important

PBMs significantly influence drug pricing, pharmacy network access, and patient out-of-pocket costs. Updated regulations could affect prescription affordability and medication accessibility for West Virginia residents, as well as operational practices of pharmacies and insurance companies operating in the state.

Potential points of contention

  • Pricing transparency requirements — Stakeholders may disagree on how much PBM pricing information should be disclosed to patients, insurers, and regulators, with concerns about competitive disadvantage versus consumer protection
  • Pharmacy network requirements — Disputes could arise over PBM obligations to maintain in-network pharmacies, potentially affecting rural access and independent pharmacy viability
  • Prior authorization and formulary restrictions — Balancing PBM cost-control mechanisms against patient access to desired medications and physician prescribing autonomy remains contentious

Compiled from official sources — confirm details with the bill’s official record.

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