The bill seeks to enhance the regulation of pharmacy benefit managers (PBMs) in Washington State by introducing new definitions and requirements while removing outdated language. It establishes clear roles for health care benefit managers and PBMs, mandating that PBMs register with the commissioner, submit detailed applications, and pay associated fees. The legislation emphasizes transparency and accountability, requiring PBMs to maintain written agreements for administering pharmacy benefits plans, file contracts with the commissioner, and respond promptly to inquiries. Non-compliance can result in penalties, including the denial or revocation of registration.

Additionally, the bill introduces specific consumer protections, prohibiting PBMs from mandating the use of mail order pharmacies for prescriptions unless they are specialty drugs and requiring affirmative authorization from covered individuals. It ensures that network pharmacies are reimbursed at contracted prices and cannot be excluded from networks based on their newness or location changes. The bill also outlines duties for PBMs, such as allowing pharmacies to decline filling prescriptions with inadequate reimbursement rates and establishing an appeals process for reimbursement disputes. The act is set to take effect on January 1, 2025.

Statutes affected:
Original Bill: 48.200.020, 48.43.005, 48.200.280