WV HB5483

Requires insurers and pharmacy benefits managers to count third-party payments (such as manufacturer copay assistance) toward an insured's deductible, copayment, and coinsurance obligations when calculating cost-sharing contributions.

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

Extends the federal annual out-of-pocket cost-sharing limit under 42 U.S.C. § 18022(c)(1) to all health plans issued in West Virginia, not just those federally required to comply.

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 take effect for health plans beginning on or after January 1, 2027, and apply across multiple insurance code articles covering individual, group, HMO, and health service corporation plans.