In recent years, the cost of health care and the increase in out-of-pocket (OOP) costs for prescription drugs have become areas of interest for state policymakers. To address this issue, West Virginia (WV) House Bill 2263 was passed into law in 2021. The first-of-its-kind bill requires Pharmacy Benefit Managers (PBMs) to pass through 100% of rebates and discounts received from manufacturers directly to patients at the pharmacy point of sale, rather than retaining them.
A new study presented at the Academy of Managed Care Pharmacy Annual Conference in Nashville evaluated the impacts of pass-through legislation on patient OOP costs and medication use in the short term. Researchers compared annual outcomes in patients in commercial health insurance plans from West Virginia to those of Kentucky as a comparator state with geographic proximity, similar population characteristics and policy environment, except that it had not adopted rebate pass-through legislation.
The findings of this study suggest that the West Virginia legislation was associated with relatively lower OOP costs and increased number of prescriptions and days of supply for West Virginia residents in commercial health insurance plans compared to those in Kentucky. The observed changes were concentrated among medium and high utilizers - patients with greater medication needs and higher exposure to OOP costs. In addition, though OOP costs rose across the U.S., West Virginia recorded one of the smallest OOP increases nationwide, as well as the largest increase in days of supply, a standard measure of medication dispensing, as shown in the study’s additional, descriptive 2021-to-2023 comparison across all other individual states.
Results of the study should be interpreted as descriptive, not causal, but they offer important, early insights into the changes associated with policies that reduce patient OOP cost. Further research may explore additional approaches for causal inference, such as synthetic controls. Findings of this and future research may help inform states evaluating similar policies to reduce OOP burdens and expand patient access.
This research was funded by Johnson & Johnson Innovative Medicine. For full details on the study design, methods and limitations,see:Chang H, Doherty B, Neumann U. Changes in Patient Out-Of-Pocket (OOP) Costs and Medication Use Following West Virginia’s Rebate Pass-Through Legislation. Journal of Managed Care & Specialty Pharmacy. Volume 32. https://www.jmcp.org/supplements/meeting-abstracts. Presented at: Academy of Managed Care Pharmacy (AMCP); Nashville, TN, US; April 13-16, 2026.
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