West Virginia was an early adopter of the NADAC-plus-dispensing-fee floor that several states have since followed. Under HB 2263 (2021), codified at W. Va. Code § 33-51-9(f), a PBM may not reimburse a pharmacy less than NADAC plus a $10.49 professional dispensing fee — or, where no NADAC is available, the wholesale acquisition cost plus $10.49.
A common point of confusion
The operative commercial-market law is HB 2263 of 2021, effective January 1, 2022. It is sometimes confused with SB 453 of 2024, which is a separate, later measure applying “NADAC-plus” to the state Public Employees Insurance Agency (PEIA) — a different statute (§ 5-16-9) with different dates. This entry covers the general § 33-51-9(f) requirement, not the PEIA track.
Scope and enforcement
Because HB 2263 removed the earlier ERISA exemptions (following Rutledge), the Insurance Commissioner’s bulletin states the reimbursement requirement applies to all plans, both insured and ERISA. Enforcement runs through the Offices of the Insurance Commissioner: pharmacies file complaints, the OIC may order reimbursement for losses, and a PBM facing enforcement may request a hearing under § 33-2-13. There is no fixed, day-counted appeal window in the statute.