WV HB3092

Insurers and pharmacy benefits managers must count all cost sharing amounts paid by or on behalf of an insured—including third-party assistance such as manufacturer copay cards—toward the insured's deductible, copayment, and out-of-pocket maximum requirements

The federal annual limitation on cost sharing under 42 U.S.C. § 18022(c)(1) is extended to apply to all health care services covered under any health plan issued in West Virginia, not just those federally required

Insurers, pharmacy benefits managers, and third-party administrators are prohibited from altering health plan coverage terms or benefit design based on the availability or amount of financial assistance for a prescription drug

Violations are subject to civil penalties of up to $10,000 per violation, with the Insurance Commissioner authorized to order restitution to affected persons after notice and hearing

The 2025 amendments take effect for health plans beginning on or after January 1, 2026, and apply across accident and sickness insurance, group insurance, hospital/medical service corporations, health care corporations, and HMOs