West Virginia Takes Action Against Unlicensed Pharmacy Managers

The West Virginia Office of the Insurance Commissioner (“WV OIC”) recently took regulatory action against four unaffiliated pharmacy benefit managers (“PBMs”) who conducted business in West Virginia without a PBM license. These regulatory actions are summarized below:

• On February 7, 2024, the WV OIC entered into a consent order with a PBM that allegedly conducted business in West Virginia without a PBM license, in violation of the W.Va. Code. § 33-51-1, et seq. In the consent order, the WV OIC maintains that it received information that the PBM was conducting business in West Virginia without a PBM license. The PBM informed the WV OIC that it was unaware that West Virginia had passed a law authorizing PBMs and understood that the proposed law would require a PBM license only when it provides management of pharmacy benefits to health plans located in the State of West Virginia. The consent order added that the PBM did not provide services under any West Virginia-based plan and administered pharmacy benefits for 58 covered individuals in that state.

Under the terms of the consent order, the PBM is in the process of applying for a PBM license in West Virginia. PBM also agreed to pay an administrative penalty of PLN 30,000. dollars.

• On March 4, 2024, the WV OIC entered into a consent order with a PBM that allegedly conducted business in West Virginia without a PBM license, in violation of the W.Va. Code. § 33-51-1, et seq. The WV OIC indicates that it received information that this PBM was operating in West Virginia without a PBM license. The PBM admitted that it had been operating in West Virginia as a PBM since at least October 2023.

The PBM and WV OIC agreed to resolve the matter under a Consent Order by agreeing to the PBM to obtain a West Virginia PBM license as quickly as possible and to pay an administrative penalty of $23,000.

• On March 7, 2024, the WV OIC entered into a consent order with a PBM that allegedly conducted business in West Virginia without a PBM license, in violation of the W.Va. Code. § 33-51-1, et seq. According to WV, the OIC received information that this PBM was conducting business in West Virginia without a PBM license. The PBM admitted that it had operated in West Virginia as a PBM since June 2023 without a PBM license.

The WV OIC and the PBM entered into a Consent Order in which the PBM agreed to obtain a PBM license in West Virginia as soon as possible and agreed to pay an administrative penalty of $26,000.

• On March 11, 2024, the WV OIC Commissioner entered into a consent order with a PBM that allegedly conducted business in West Virginia without a PBM license, in violation of the W.Va. Code. § 33-51-1, et seq. The WV OIC also indicated that it had received information that this PBM was conducting business in West Virginia without a PBM license. The PBM admitted that it had been operating in West Virginia without a PBM license since at least April 2023.

The Consent Order stated that this PBM had already applied for a license as a PBM and required the PBM to make every effort to complete the application process. PBM also agreed to pay an administrative penalty of PLN 29,000. dollars.