The bill aims to reduce prescription drug costs by removing barriers to accessing biosimilar medicines and interchangeable biological products. It amends several sections of the Revised Code of Washington (RCW) to enhance the prescription drug utilization management process. Key provisions include requiring health carriers to provide a clear and accessible process for patients and prescribing practitioners to request exceptions for coverage of prescribed drugs, with specific criteria for approval. Additionally, health carriers must disclose all rules related to the utilization management process and must cover emergency supply fills when necessary. The bill also mandates that patients be allowed to remain on their current medication during the exception request process and requires timely notifications regarding the status of these requests.

Significant changes include the insertion of a requirement that, starting January 1, 2026, health carriers may require patients to try a biosimilar before covering the equivalent branded prescription drug. The bill also modifies existing language regarding the substitution of therapeutically equivalent drugs, allowing pharmacists to substitute unless explicitly instructed otherwise by the prescriber. Furthermore, it clarifies that pharmacists may substitute interchangeable biological products based on cost considerations, ensuring that patients are not burdened with higher out-of-pocket expenses. Overall, the bill seeks to improve access to affordable medications while maintaining patient safety and provider autonomy.

Statutes affected:
Original Bill: 48.43.420, 41.05.410, 69.41.120, 18.64.245
Substitute Bill: 48.43.420, 41.05.410, 69.41.120, 18.64.245
Engrossed Substitute: 48.43.420, 41.05.410, 69.41.120, 18.64.245