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West Virginia PBM MAC rights
Status No usable MAC appeal right
What the law says
NADAC floor but NO MAC appeal. W. Va. Code § 33-51-9(e) bars reimbursement below NADAC + a $10.49 professional dispensing fee (WAC + $10.49 if NADAC is unavailable) — the strongest reimbursement floor in the country. But there is no MAC list right, no update cadence, no appeal window, no response deadline and no denial disclosure anywhere in art. 33-51 or 114 CSR 99. The only MAC-appeal language, § 33-51-9(h)(1), requires PBMs to file their appeal methodologies with the Commissioner as confidential documents exempt from FOIA. Practical remedy: § 33-51-9(g) — the commissioner "may order reimbursement" for a monetary loss. Penalty $10,000/violation (114 CSR 99 § 8.1). Amended 2026 (HB 5430, eff. 13 Mar 2026)
How we determined that
W. Va. Code § 33-51-9 · 114 CSR 99
This is worth knowing precisely
Several widely used sources still describe rights in states that repealed them, or quote bills that never passed. If you have been told you have an appeal right here, check the statute before you rely on it. What we found.
Your contract may still give you more than the statute does, and the request letter costs you nothing to send.
Sources
- code.wvlegislature.gov — 33-51-9
- apps.sos.wv.gov — rule
- wvlegislature.gov — bills_history.cfm
- wvinsurance.gov — PBM Complaint Form
Think this is wrong? Tell us and we will check it. A repeal we missed, or a provision we read past, is exactly what we want to hear about.
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