Insurance Commissioner Allan McVey announced an $800,000 civil penalty on PBM Navitus for violating state laws governing pharmacy reimbursement, rebate pass‑through requirements and audit standards. State regulators found that Navitus failed to fully pass through negotiated drug rebates as required by state law, and, in some cases, reimbursed pharmacies below the mandated minimum of NADAC plus a $10.49 dispensing fee. Regulators also determined that Navitus paid its affiliated specialty pharmacy significantly higher rates than non‑affiliated pharmacies for certain drugs, creating an improper competitive advantage. The enforcement action reflects West Virginia’s aggressive oversight of PBMs since implementing licensure requirements in 2020 and signals increasing regulatory scrutiny of PBM transparency, affiliate relationships and reimbursement practices.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.