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West Virginia officials say a state pharmacy benefit manager mandate is helping to hold down employers' group health insurance premiums.
The state began to license PBMs in 2020. In 2022, the state began to require insurers to pass all prescription drug rebates and other prescription drug discounts on to health insurance purchasers in 2022.
For group health insurance plans for 2026, the rebate pass-through mandate cut the average rate increase to 12.6%, from 19.5%, according to data calculated by the insurers and published in a report compiled by the West Virginia Offices of the Insurance Commissioner.
The pass-through mandate cut the average increase by 7.8 percentage points.
The 7.8 percentage decrease meant that the size of the average rate increase was 40% smaller than it would have been without the rebate pass-through mandate, according to the report data.
The pass-through mandate caused one insurer to cut its large-group rates by 2.91%, rather than increasing its premiums by 5.09%.
At the other plans included in the report, the mandate cut rate increases by 13% to about 58%.
For 2025 coverage, the mandate led to a 43% decrease in the size of the average group health premium increase and a 52% decrease in the size of the average decrease for small group health plans.
PBMs help health insurers, self-insured employer plans and other "payers" provide health benefits.
The backdrop: Pharmacists, drug manufacturers and some employers have accused the PBMs of using strategies that push up retail prices for drugs and of keeping too much of the discounts they negotiate.
The PBMs have argued that they are getting pushback because other prescription drug supply-chain players are angry about PBMs' success at narrowing the other players' profit margins.
The $1.2 trillion spending package that passed in the House today includes a federal employer PBM rebate pass-through provision.
At press time, the bill was on the desk of President Donald Trump.
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