WV SB1028

Requires insurers and pharmacy benefits managers to count all cost-sharing payments toward deductibles and out-of-pocket maximums, including payments made on behalf of the insured by third parties such as patient assistance programs.

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 federal annual cost-sharing limits under 42 U.S.C. § 18022(c)(1) to apply to all health plans issued in West Virginia, not just ACA-compliant plans.

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 policies beginning on or after January 1, 2027, and affect accident and sickness insurance, group insurance, hospital/medical service corporations, health care corporations, and HMOs.