WV SB852

Creates exemptions to the pharmacy benefit manager (PBM) minimum reimbursement requirements starting January 1, 2026, allowing PBMs to pay below the national average drug acquisition cost plus $10.49 dispensing fee if the pharmacy submits lower charges or if the insured's cost sharing amount is less than what the health plan requires

Limits insured point-of-sale payments to the lesser of their health plan cost share or the cash price for the prescription drug

Establishes that if the cash payment amount is lower than the insured's cost share, the cash payment is considered payment in full for the prescription drug

Amends existing PBM regulations under the Pharmacy Audit Integrity Act (§33-51-9) to clarify pricing and reimbursement rules between pharmacies, PBMs, and health plans