CERTIFICATION OF ENROLLMENT
SUBSTITUTE SENATE BILL 5610
Chapter 228, Laws of 2022
67th Legislature
2022 Regular Session
PRESCRIPTION DRUG COST SHARING—ENROLLEE CONTRIBUTION CALCULATION
EFFECTIVE DATE: June 9, 2022
Passed by the Senate March 7, 2022 CERTIFICATE
Yeas 48 Nays 1
I, Sarah Bannister, Secretary of
the Senate of the State of
DENNY HECK Washington, do hereby certify that
President of the Senate the attached is SUBSTITUTE SENATE
BILL 5610 as passed by the Senate
and the House of Representatives on
the dates hereon set forth.
Passed by the House March 2, 2022
Yeas 96 Nays 0
SARAH BANNISTER
LAURIE JINKINS Secretary
Speaker of the House of
Representatives
Approved March 30, 2022 2:46 PM FILED
March 31, 2022
Secretary of State
JAY INSLEE State of Washington
Governor of the State of Washington
 SUBSTITUTE SENATE BILL 5610
AS AMENDED BY THE HOUSE
Passed Legislature - 2022 Regular Session
State of Washington 67th Legislature 2022 Regular Session
By Senate Health & Long Term Care (originally sponsored by Senators
Frockt, Cleveland, Conway, Dhingra, Hasegawa, Honeyford, Keiser,
Kuderer, Liias, Lovelett, Lovick, Randall, Robinson, Saldaña,
Salomon, Stanford, Van De Wege, and C. Wilson)
READ FIRST TIME 01/27/22.
1 AN ACT Relating to requiring cost sharing for prescription drugs
2 to be counted against an enrollee's out-of-pocket costs, deductible,
3 cost sharing, out-of-pocket maximum, or similar enrollee obligation,
4 regardless of the source of the payment; amending RCW 41.05.017; and
5 adding a new section to chapter 48.43 RCW.
6 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:
7 NEW SECTION. Sec. 1. A new section is added to chapter 48.43
8 RCW to read as follows:
9 (1)(a) Except as provided in (b) of this subsection, when
10 calculating an enrollee's contribution to any applicable cost-sharing
11 or out-of-pocket maximum, a health carrier offering a
12 nongrandfathered health plan with a pharmacy benefit, or a health
13 care benefit manager administering benefits for the health carrier,
14 shall include any cost-sharing amounts paid by the enrollee directly
15 or on behalf of the enrollee by another person for a covered
16 prescription drug that is:
17 (i) Without a generic equivalent or a therapeutic equivalent
18 preferred under the health plan's formulary;
19 (ii) With a generic equivalent or a therapeutic equivalent
20 preferred under the health plan's formulary where the enrollee has
21 obtained access to the drug through:
p. 1 SSB 5610.SL
 1 (A) Prior authorization;
2 (B) Step therapy; or
3 (C) The prescription drug exception request process under RCW
4 48.43.420; or
5 (iii) With a generic equivalent or therapeutic equivalent
6 preferred under the health plan's formulary, throughout an exception
7 request process under RCW 48.43.420, including any appeal of a denial
8 of an exception request. If the health carrier utilizes a health care
9 benefit manager to approve or deny exception requests, the exception
10 request process for the purposes of this subsection (1)(a)(iii) also
11 includes any time between the completion of the exception request
12 process, including any appeal of a denial, and when the health care
13 benefit manager communicates the status of the request to the health
14 carrier.
15 (b) When calculating an enrollee's contribution to any applicable
16 deductible, any amount paid on behalf of the enrollee by another
17 person for a prescription drug that is not subject to payment of a
18 deductible need not be included in the calculation, unless the terms
19 of the enrollee's health plan require inclusion.
20 (2) Any cost-sharing amounts paid directly by or on behalf of the
21 enrollee by another person for a covered prescription drug under
22 subsection (1) of this section shall be applied towards the
23 enrollee's applicable cost-sharing or out-of-pocket maximum in full
24 at the time it is rendered.
25 (3) The commissioner may adopt any rules necessary to implement
26 this section.
27 (4) This section applies to nongrandfathered health plans issued
28 or renewed on or after January 1, 2023.
29 (5) This section does not apply to a qualifying health plan for a
30 health savings account to the extent necessary to preserve the
31 enrollee's ability to claim tax exempt contributions and withdrawals
32 from the enrollee's health savings account under internal revenue
33 service laws, regulations, and guidance.
34 (6) For purposes of this section:
35 (a) "Health care benefit manager" has the same meaning as in RCW
36 48.200.020.
37 (b) "Person" has the same meaning as in RCW 48.01.070.
38 Sec. 2. RCW 41.05.017 and 2021 c 280 s 2 are each amended to
39 read as follows:
p. 2 SSB 5610.SL
1 Each health plan that provides medical insurance offered under
2 this chapter, including plans created by insuring entities, plans not
3 subject to the provisions of Title 48 RCW, and plans created under
4 RCW 41.05.140, are subject to the provisions of RCW 48.43.500,
5 70.02.045, 48.43.505 through 48.43.535, 48.43.537, 48.43.545,
6 48.43.550, 70.02.110, 70.02.900, 48.43.190, 48.43.083, 48.43.0128,
7 section 1 of this act, and chapter 48.49 RCW.
Passed by the Senate March 7, 2022.
Passed by the House March 2, 2022.
Approved by the Governor March 30, 2022.
Filed in Office of Secretary of State March 31, 2022.
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Statutes affected:
Original Bill: 48.01.070
Substitute Bill: 48.01.070
Bill as Passed Legislature: 48.01.070
Session Law: 48.01.070