WEST VIRGINIA CODE
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
(c) Administrative staff support for the council created by
this article shall be provided by the departments represented on
(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
(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
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