STATE OF WEST VIRGINIA
Offices of the Insurance Commissioner
James A. Dodrill
Insurance Commissioner
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Company Analysis & Examinations

Pharmacy Benefit Managers and Auditing Entities

The West Virginia  Pharmacy Audit Integrity Act applies to pharmacy benefit managers that perform pharmacy benefit management for covered entities and persons or companies that perform pharmacy audits.

Licensing Requirements

 

 

West Virginia's Pharmacy Audit Integrity Act was enacted by the 2019 legislature.  The Act requires that effective October 1, 2020,  Pharmacy Benefit Managers (PBM) and Auditing Entities must be licensed in order to operate within the state of West Virginia.

Here are the steps to apply for licensure as a PBM:

  1. Complete the PBM Licensing application.
  2. See the Network Adequacy's information below.
  3. West Virginia PBM Bond Form.
  4. Include an initial application fee of $2,500, payable to: WVOIC with the completed application and bond form.  Mail to:  WVOIC, PBM Licensing, PO Box 50540, Charleston, WV  25305-0540

Apply for licensure as an Auditing Entity:

  • Complete the Pharmacy Auditing Entity application. Include the application with a fee of $500, payable to WVOIC and mail to:  WVOIC, PBM Licensing, PO Box 50540, Charleston, WV  25305-0540

 

 FAQs for PBM Licensing  - Updated November 23, 2020

 

 

Network Adequacy

The PBM must provide an adequate and accessible pharmacy network that meets the requirements of West Virginia Code §33-51-8(d).  Applicants need to submit information through our portal: Instructions for Using PBM Network Portal

PBM Network Portal

Reporting Forms and Changes

Required Reporting for PBMs.

Changes to the network

  •  The PBM is responsible for updating changes in our portal within 30 days of a change to the network.  Each PBM is assigned a unique link to the portal upon registering. If you need help with this change, please email OICPBM@wv.gov

 

PBM corporate change information should be reported within 30 days of change.

 

Annual Report 

  • more information to be provided