Prior Authorization in West Virginia
West Virginia enacted SB 432 (2020) requiring step therapy exception protections. Insurers must grant exceptions for contraindications, prior failures, and expected inefficacy. WV mandates timely PA decisions and provides external review for adverse determinations.
Key Facts About PA in West Virginia
- ✓ Step therapy exception protections enacted in 2020
- ✓ PA decisions must be timely with expedited review available
- ✓ External review available through the WV Offices of the Insurance Commissioner
- ✓ Highmark BCBS West Virginia is the dominant carrier
Quick Stats
- Typical Appeal Filing Window: 30 days
- External Review Available: Yes
- Major Payers: 4
Top Payers in West Virginia
RxCheckUp generates payer-specific Letters of Medical Necessity for each of these West Virginia carriers:
Highmark BCBS West VirginiaUnitedHealthcareThe Health PlanAetna