DIR Fees Law – WEST VIRGINIA
WEST VIRGINIA SUMMARY OF EXISTING LAW
A pharmacy benefit manager may only directly or indirectly charge or hold a pharmacy, a pharmacist, or a pharmacy technician responsible for a fee related to the adjudication of a claim if:
Link to Existing Law: W. Va. Code, § 33-51-9
PRACTICAL NOTE FOR EXISTING LAW
This law permits DIR fees, but only where the PBM has identified the fees “specifically” on a remittance advice for each claim. This would require more robust reporting of these fees from PBMs and could potentially address the issue of DIR and GER/BER that arises when PBMs assess fees in the aggregate, as opposed to on particular, identified claims. It must be noted that these requirements are limited to insurance plans regulated by the State, and may exclude Medicare Part D, TRICARE, and possibly ERISA-regulated plans.
