Friday, June 2, 2023

Interim Report: Joint Standing Committee on Insurance and PEIA

On Sunday afternoon, the Joint Standing Committee on Insurance and PEIA listened to testimony from Matt Walker, Executive Director of the Independent Pharmacy Association of West Virginia, regarding the state’s Pharmacy Benefit Management program and independent pharmacy reimbursements.

The Legislature is in Huntington on the campus of Marshall University through Tuesday for May interim meetings.

The West Virginia Independent Pharmacy Association was formed in 2016 to provide a unified voice for independent pharmacies in public policy discussions. The organization represents more than 100 community pharmacies across the state.

Currently PEIA uses a pharmacy benefit management program, Express Scripts Inc., to process prescription drug claims. Walker emphasized it is important for PEIA to use a PMB program to process the large number of claims, but that the manner in which it has been used has caused frustration for pharmacists and pharmacy owners around the state.

According to Walker, pharmacies are reimbursed by PEIA well below the costs of purchasing the prescription drugs at 95 percent of brand drugs. While pharmacy reimbursements for generic drugs allow pharmacies to make a small profit, those profits are often negated due to the losses from ordering brand name prescription drugs.

Walker warned lawmakers of possible future pharmacy access issues for those insured by PEIA, noting that Kroger has already left Express Scripts, meaning they no longer accept PEIA to fill prescriptions. Walker said many smaller pharmacies are also considering dropping PEIA due to the financial difficulties the program creates.

Walker recommended PEIA consider a model used by West Virginia’s Medicaid program using the National Average Drug Acquisition Cost (NADOC) plus $10.49 reimbursement system. NADOC is a national survey showing what pharmacies are paying for prescription drugs.

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