WV HB5470

Requires insurers and pharmacy benefits managers to count all cost sharing payments—including those made by third parties on behalf of the insured—toward the patient's deductible, copayment, and out-of-pocket maximum calculations.

Extends federal annual cost sharing limits under 42 U.S.C. § 18022(c)(1) to all health plans issued in West Virginia, not just those previously subject to the requirement.

Prohibits insurers, pharmacy benefits managers, and third-party administrators from altering health plan coverage terms based on the availability or amount of prescription drug financial assistance programs.

Establishes civil penalties of up to $10,000 per violation, with the Insurance Commissioner authorized to order restitution to affected individuals after notice and hearing.

Amendments apply to health plans beginning on or after January 1, 2027, and affect multiple insurance code articles covering accident/sickness, group, hospital/medical service corporations, health care corporations, and HMOs.