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. Complete the Network Adequacy's Templates 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  

 

 

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 the following documents electronically to our office.  The portal is under-construction and expected to be completed in the next 60 days.  Please do not mail the templates, you will receive an email when the portal is ready.  Send an email to OICPBM@wv.gov to request portal instructions once the portal is available to receive templates.

The Network Template will identify each unique network the PBM uses in West Virginia and the Network Service Area.

The Provider Template is required for each Network.  This template lists each participating pharmacy and their identifying information.

 

Number of Pharmacies in West Virginia

The West Virginia Board of Pharmacy provides our office an updated list of licensed pharmacies by county each quarter.  Click here for the most current list.