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West Virginia Code Chapter 33. Insurance § 33-56-1. Services provided by pharmacists

Current as of January 01, 2024 | Updated by Findlaw Staff

(a) For health plans, policies, contracts, or agreements issued, amended, adjusted, or renewed on or after January 1, 2021:

(1) Benefits may not be denied for any health care service performed by a pharmacist licensed under § 30-5-1 et seq. of this code if:

(A) The service performed was within the lawful scope of the pharmacist’s license;

(B) The plan would have provided benefits if the service had been performed by another health care provider; and

(C) The pharmacist is included in the plan’s network of participating providers.

(2) The health plan shall include an adequate number of pharmacists in its network of participating health care providers.

(b) The participation of pharmacies in the plan network’s drug benefit does not satisfy the requirement that plans include pharmacists in their network of participating health care providers.

(c) Health benefit plans, policies, contracts, or agreements issued, amended, adjusted, or renewed on or after January 1, 2020, but before January 1, 2021, that delegate credentialing agreements to contracted health care facilities shall accept credentialing for pharmacists employed or contracted by those facilities. Health plans shall reimburse facilities for covered services provided by network pharmacists within the pharmacists’ scope of practice per negotiations with the facility.

(d) For purposes of this section, health plans, policies, contracts, or agreements do not include Medicaid or Children’s Health Insurance Program health plans, policies, contracts, or agreements that are approved by the Department of Health and Human Resources Bureau of Medical Services.

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Cite this article: FindLaw.com - West Virginia Code Chapter 33. Insurance § 33-56-1. Services provided by pharmacists - last updated January 01, 2024 | https://codes.findlaw.com/wv/chapter-33-insurance/wv-code-sect-33-56-1/

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