WV HB5365

Defines "specialty drug" as a drug used to treat chronic, complex, or rare medical conditions requiring special handling, administration, provider coordination, or patient education that cannot be provided by a non-specialty pharmacy

Requires pharmacy benefit managers (PBMs) serving PEIA to operate as "transparent PBMs" and prohibits them from unreasonably designating covered drugs as specialty drugs to limit patient access to enrolled pharmacies

Prohibits PBMs from requiring PEIA beneficiaries to use mail-order pharmacies exclusively or imposing higher costs or more restrictive conditions for using retail pharmacies compared to mail-order options

Authorizes the PEIA director to establish a special investigation unit to investigate false, fraudulent, or fictitious claims made against PEIA plans

Grants the Insurance Commissioner authority to examine, regulate, and enforce compliance by PBMs serving PEIA, including imposing civil penalties, corrective action orders, and suspension or revocation of licensure for violations