§5A-3C-6. Creation of program; administrative support; medicaid and chip program


Published: 2015

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WEST VIRGINIA CODE











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WVC 5 A- 3 C- 6

§5A-3C-6. Creation of program; administrative support; medicaid

and chip program.

(a) There is hereby created in the state a program to obtain

favorable pharmaceutical prices for state agencies and other

qualified entities pursuant to this article.

(b) The medicaid program and the West Virginia children's

health insurance program may be exempt from participation in this

program until approval by the center for medicare and medicaid

services has been granted if it is determined to be required by the

council.

(c) Administrative staff support for the council created by

this article shall be provided by the departments represented on

the council.

(d) The council shall establish a pricing schedule using or

referencing the FSS prices, or using or referencing to the price,

as adjusted for currency valuations, set by Canada patented

medicine prices review board (PMPRB) or any other appropriate

referenced price that will maximize savings to the broadest

percentage of the population of this state.

(e) By September fifteenth of two thousand four, the council

shall report back to the Legislature the pricing schedule developed

and a strategic plan for implementation. The council shall

implement the proposed pricing schedule and strategic plan upon

concurrent resolution of the Legislature. If, at the time of the

acceptance or rejection of the concurrent resolution to implement the proposed pricing schedule and strategy, the concurrent

resolution is not passed due to the Legislature's lack of

acceptance of the same, the Legislature shall accept or reject a

concurrent resolution to implement the pricing schedule and

strategy using or referencing the FSS: Provided, That acceptance

or rejection of the above referenced resolutions shall occur prior

to the end of the regular session of the Legislature in two

thousand five.

(f) If neither of the above referenced resolutions pass during

the regular session of the Legislature in two thousand five, the

Legislature may, at any time in the future, pass a concurrent

resolution to implement the above referenced pricing schedule and

strategy or any subsequent recommendation of the council to the

Legislature and the Legislature determines that the proposed

pricing schedule and strategy are the most effective method of

reducing pharmaceutical prices for the citizens of the state.

(g) Qualified entities including, but not limited to, licensed

private insurers, self insured employers, free clinics and other

entities who provide pharmaceuticals either directly or through

some form of coverage to the citizens of West Virginia shall have

an option to apply for participation in the program established by

this article in the form and manner established by the council.

The council, in its sole discretion, shall approve or deny

participation through review of documentation determined to be

necessary for full consideration and as established by rule. The council shall consider, but not be limited to, the fiscal stability

and the size of each applicant.

(h) Pharmaceutical manufacturers may request a waiver from

the pricing schedule to be granted by the council for a particular

drug in which the development, production, distribution costs,

other reasonable costs and reasonable profits, but exclusive of

all marketing and advertising costs as determined by the council,

is more than the pricing schedule rate of the pharmaceutical or in

those cases in which the pharmaceutical in question has a sole

source. The determination of reasonable costs and reasonable

profits may fluctuate between different pharmaceuticals under

consideration by the council. The council shall determine by

legislative rule fees to be paid by the applicant at the time a

waiver request is made and documentation required to be submitted

at the time of the waiver request.





Note: WV Code updated with legislation passed through the 2015 Regular Session

The WV Code Online is an unofficial copy of the annotated WV Code, provided as a convenience. It has NOT been edited for publication, and is not in any way official or authoritative.