Are there any laws governing the prescription of drugs in managed care and other cost containment programs?

In West Virginia, there are laws that govern the prescription of drugs in managed care and other cost containment programs. The legislature has provided several statutes in this area, such as the Managed Care Act and the Pharmacy Benefit Management Act. The Managed Care Act provides protection to consumers and establishes the minimum standards for health plans operating in the state. The Pharmacy Benefit Management Act provides additional protection to consumers and establishes the minimum standards for pharmacy benefit managers (PBMs). Under the Managed Care Act, managed care organizations must provide access to all medically necessary services, as prescribed by a provider. Additionally, managed care organizations must provide access to medically necessary prescription drugs listed on their formularies. Managed care organizations also must provide coverage for drugs that either treat the same condition or are therapeutically equivalent to drugs listed on their formularies. Under the Pharmacy Benefit Management Act, PBMs must have an accurate and accessible formulary that is available to both providers and consumers. PBMs must also maintain a timely and accurate record of all transactions with pharmacies and providers. This includes providing paid invoices and documentation that any benefit was properly and accurately paid. PBMs are also subject to certain fee schedules and other regulations that are designed to ensure cost-effectiveness in the prescription drug system. In summary, West Virginia has established laws governing the prescription of drugs in managed care and other cost containment programs. These state laws are designed to protect consumers and ensure access to medically necessary services and prescription drugs. Additionally, PBMs must meet certain standards to remain compliant with the regulations.

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Are there any laws governing the prescription of drugs in managed care and other cost containment programs?

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