West Virginia Insurance Commissioner Will Enforce Prior Authorization Law
June 18, 2024
Recently, the West Virginia Offices of the Insurance Commissioner (OIC) released Bulletin No. 24-01 regarding the portion of West Virginia’s prior authorization law requiring a three-day prescription drug allowance for most prescription drugs at the time of an inpatient discharge, which has been in effect since January 1, 2020. An additional enforcement section became effective on January 1, 2024, that states that the OIC may assess a civil penalty for a violation of West Virginia’s prior authorization law pursuant to W.Va. Code §33-3-11.2 which states that, in lieu of licensure suspension or revocation, the OIC may, by order, require an insurer to pay a penalty in a sum not exceeding $10,000, and upon the failure of the insurer to pay such penalty within thirty (30) days after notice, the OIC may revoke or suspend the license of such insurer.
This bulletin gives notice that the OIC will begin issuing civil penalties pursuant to W.Va. Code §33-3-11 for violations of West Virginia’s prior authorization law if a health insurer, or its PBM, does not permit a three-day prescription drug allowance at the time of an inpatient discharge when otherwise required.
Employers in West Virginia should be aware of this inpatient discharge requirement.
West Virginia Insurance Bulletin No. 24-01