The bill amends the Revised Code of Washington (RCW) to enhance the regulation of health care benefit managers, introducing new definitions and requirements. It defines "health care benefit manager" to include entities that influence health care benefits, such as pharmacy and radiology benefit managers. The bill mandates that these managers register with the commissioner, provide operational details, and comply with state and federal laws. It also holds health carriers and employee benefits programs accountable for the compliance of any entities acting on their behalf. Significant deletions from current law narrow the definition of health care benefit managers and emphasize the need for transparency, requiring managers to maintain records for seven years and respond to commissioner inquiries.

Additionally, the bill revises regulations concerning pharmacy benefit managers (PBMs) and their interactions with network pharmacies. It redefines "multiple source drug" and imposes new requirements on PBMs to ensure drug availability and prohibit fees related to claim adjudication. The bill protects pharmacies from retaliation for reporting potential violations and establishes an appeals process for reimbursement disputes. It also mandates clear communication from PBMs regarding legal processes and sets conditions to prevent excessive patient costs for prescriptions. The provisions will take effect on January 1, 2026, and apply to self-funded group health plans if they opt to participate.

Statutes affected:
Original Bill: 48.200.020, 48.43.005, 48.200.280
Second Substitute: 48.200.020, 48.43.005, 48.200.280
Engrossed Second Substitute: 48.200.020, 48.200.030, 48.200.050, 48.200.210, 48.39.005
Bill as Passed Legislature: 48.200.020, 48.200.030, 48.200.050, 48.200.210, 48.39.005
Session Law: 48.200.020, 48.200.030, 48.200.050, 48.200.210, 48.39.005