HB4965

Allows patients to receive alternative treatments without additional prior authorization if medically appropriate and cost-effective.

West Virginia HB4965 introduces patient-centered treatment flexibility within the Public Employees Insurance Agency. It allows patients who have received prior authorization for a medical treatment to receive an alternative covered treatment for the same condition without needing additional prior authorization, provided the alternative treatment is medically appropriate and does not exceed the cost of the originally authorized treatment. The agency must cover the alternative treatment and cannot deny coverage solely because the alternative treatment was not separately prior authorized.