West Virginia Code
Article 5. Miscellaneous Provisions
§9-5-15. Medicaid Program; Preferred Drug List and Drug Utilization Review

The Legislature finds that it is a public necessity that trade secrets, rebate amounts, percentage of rebate, manufacturer's pricing and supplemental rebates that are contained in records, as well as any meetings at which this information is negotiated or discussed need confidentiality to insure the most significant rebates available for the state. Information pertaining to similar agreements with the federal government and negotiated by pharmaceutical manufacturers is confidential pursuant to 42 U.S.C. 1396r-8. A rebate as a percentage of average manufacture price is confidential under federal law and the federal rebate could be made known if not protected by state law. Because of the protection afforded by federal law, if this information is not protected by state law, manufacturers will not be willing to offer a rebate in West Virginia. Further, the Legislature finds that the number and value of supplemental rebates obtained by the department will increase, to the benefit of Medicaid recipients, if information related to the supplemental rebates is protected in the records of the department and in meetings in which this information is disclosed because manufacturers will be assured they will not to be placed at a competitive disadvantage by exposure of this information.
The secretary of the Department of Health and Human Resources has the authority to develop a preferred drug list, in accordance with federal law, which shall consist of federally approved drugs. The department, through administration of the Medicaid program, may reimburse, where applicable and in accordance with federal law, entities providing and dispensing prescription drugs from the preferred drug list.
The secretary of the department is hereby authorized to negotiate and enter into agreements with pharmaceutical manufacturers for supplemental rebates for Medicaid reimbursable drugs.
The provisions of article three, chapter five-a of this code shall not apply to any contract or contracts entered into under this section.
Trade secrets, rebate amounts, percentage of rebate, manufacturer's pricing and supplemental rebates which are contained in the department's records and those of its agents with respect to supplemental rebate negotiations and which are prepared pursuant to a supplemental rebate agreement are confidential and exempt from all of article one, chapter twenty-nine-b of this code.
Those portions of any meetings of the committee at which trade secrets, rebate amounts, percentage of rebate, manufacturer's pricing and supplemental rebates are disclosed for discussion or negotiation of a supplemental rebate agreement are exempt from all of article nine-a, chapter six of this code.
The secretary of the department will monitor and evaluate the effects of this provision on Medicaid recipients, the Medicaid program, physicians and pharmacies.
The commissioner shall implement a drug utilization review program to assure that prescribing and dispensing of drug products result in the most rational cost-effective medication therapy for Medicaid patients.
Any moneys received in supplemental rebates will be deposited in the medical services fund established in section two, article four, chapter nine of this code.

Structure West Virginia Code

West Virginia Code

Chapter 9. Human Services

Article 5. Miscellaneous Provisions

§9-5-1. Exemption of Grants From Certain Taxes and Claims

§9-5-2. Release of Liens and Reassignment of Insurance Policies

§9-5-3. Recipient of Assistance Not a Pauper

§9-5-4. Penalties for False Statements, etc.

§9-5-5. Recipients of Cash Grants

§9-5-6. Attorney General and Prosecuting Attorneys to Render Legal Services to Commissioner

§9-5-7. Visitation by County Employees

§9-5-8. Authority to Examine Witnesses, Administer Oaths and Take Affidavits

§9-5-8a. Authority to Subpoena Witnesses and Documents When Investigating the Provision of Medical Assistance Programs

§9-5-8b. Authority of Investigations and Fraud Management Division to Subpoena Witnesses and Documents

§9-5-9. Direct Cremation or Direct Burial Expenses for Indigent Persons

§9-5-10. Continuation of Present Aid; Contributions by Counties

§9-5-11. Definitions; Assignment of Rights; Right of Subrogation by the Department for Third-Party Liability; Notice Requirement for Claims and Civil Actions; Notice Requirement for Settlement of Third-Party Claim; Penalty for Failure to Notify the D...

§9-5-11a. Notice of Action or Claim

§9-5-11b. Release of Information

§9-5-11c. Right of the Department of Health and Human Resources to Recover Medical Assistance

§9-5-12. Medicaid Program; Maternity and Infant Care

§9-5-12a. Medicaid Program; Dental Care

§9-5-13. Pilot Program for Certain Aid Recipients Seeking Self-Employment

§9-5-14. Medicaid Program; Health Care Facilities Financed by Bonds; Rules Regarding Reimbursement of Capital Costs

§9-5-15. Medicaid Program; Preferred Drug List and Drug Utilization Review

§9-5-16. Medicaid Program; Legislative Purpose; Health Care Provider Reimbursement Study by Department; Hearings; Report

§9-5-16a. Medicaid-Certified Nursing Homes; Screening of Applicants and Residents for Mental Illness; Reimbursement of Hospitals

§9-5-17. Nonprofit Agency or Facility, in Receipt of Medicaid Moneys, Shall Provide Annual Accounting of Gross Receipts and Disbursements Including Salaries

§9-5-19. Summary Review for Certain Behavioral Health Facilities and Services

§9-5-20. Medicaid Program; Chronic Kidney Disease; Evaluation and Classification

§9-5-21. Annual Report to Joint Committee on Government and Finance Regarding Treatment for Autism Spectrum Disorders Provided by the Bureau for Medical Services

§9-5-22. Medicaid Managed Care Reporting

§9-5-23. Bureau of Medical Services Information

§9-5-24. Requiring Substance Abuse Treatment Providers to Give Pregnant Woman Priority Access to Services

§9-5-25. Medicaid Program Compact

§9-5-26. Supplemental Medicare and Medicaid Reimbursement

§9-5-27. Transitioning Foster Care Into Managed Care

§9-5-28. Requirement for Telehealth Rates

§9-5-29. Payments to Substance Use Disorder Residential Treatment Facilities Based Upon Performance-Based Outcomes

§9-5-30. Certified Community Behavioral Health Clinics