Recent changes to Washington’s HCBM laws and rules

E2SSB 5213 made several changes to HCBM law which take effect on January 1, 2026. These changes include updates to definitions and new duties and prohibited practices for pharmacy benefit managers (PBM). We're updating our rules to administer these changes. Learn more about the rulemaking process and how you can participate.

Starting January 1, 2026, self-funded group health plans can opt-in to certain sections of Chapter 48.200 RCW. A PBM contracted exclusively with an opt-in self-funded plan won't be required to register with our office, but must comply with specific sections of the law listed in RCW 48.200.330(2).

As of January 18, 2025, HCBMs must: 

  • Report Washington annual gross income from HCBM services provided in the previous calendar year, for each contracted entity.
  • Submit amendments to reported income for the previous calendar year by April 15.

Effective July 6, 2024, HCBMs must submit a completed service of process form (PDF 802.93KB). 

Technical assistance advisories

Technical assistance advisories (TAA), or bulletins, are statements about how we interpret the law.

Who needs to register

You need to register if your services directly or indirectly affect patient access to health care services, drugs and supplies. Examples of these services include:

  • Prior authorization or preauthorization of benefits or care
  • Certification of benefits or care
  • Medical necessity decisions
  • Utilization reviews
  • Benefit decisions
  • Claims processing and repricing
  • Outcome management
  • Payment or payment authorization to providers and facilities
  • Dispute resolution, grievances or appeals to benefit decisions
  • Provider network management
  • Disease management

If you service non-exempt plans in addition to exempt plans, you must apply.

Who doesn’t need to register

You don't need to register if you provide services or act on behalf of these health plans:

  • Self-insured health plans (unless the plan is PEBB or SEBB)
  • Medigap plans
  • Medicare Advantage plans
  • Medicaid
  • Union plans

Plans that provide monetary payment, such as income replacement disability plans or life insurance accelerate benefits, are exempt if they do not directly or indirectly impact patient access to health care services, drugs, and supplies.

How to register

Registrations are valid from the effective date on your certificate to June 30. To register:

  1. Fill out the Account Creation and Request for Application form. We’ll send a confirmation email to confirm your request.
  2. Once we approve your request, we’ll email instructions for paying your $200 registration fee.
  3. After you pay the fee, we’ll send a receipt and links to the HCBM application form and DocuSign portal where you’ll upload your application.
  4. Upload the completed application and all supporting documents to the DocuSign portal. Sign the application and choose “Finish” to submit your application.

Under the Public Records Act, all information you submit is a public record. Marking your submission as “private” or “confidential” does not prevent it from being publicly available.

After you apply

We review applications in the order we receive them. How long it takes us depends on how many applications we get. Once we finish reviewing your application, we’ll email your certificate of registration. You aren't registered until you receive your certificate.

You can request a refund for one of the following reasons:

  • You provide written confirmation that you're exempt from registration.
  • You withdraw your registration before we approve it.

You must keep your registration information up to date by reporting any material changes within 30 days. You can notify us of changes via email. Failure to report changes in a timely manner may result in enforcement actions. 

How to renew your registration

You need to renew your registration by March 1 each year. Renewals are valid from July 1 to June 30.

To renew your registration:

  1. By March 1, log into the Filing and Payment Center to access your annual gross income report.
  2. Use the annual gross income report to submit your state gross business income and supporting documents.
  3. By June 1, we'll send you an invoice for the renewal fee. You can also find it in the Filing and Payment Center.
  4. By July 15, pay your renewal fee online or mail it with a printed invoice that includes your WAOIC number to:

    Washington State Office of the Insurance Commissioner
    PO Box 40255
    Olympia, WA 98504-0255

If you don't pay by July 15, we may:

  • Delay your renewal.
  • Deny your renewal.
  • Take regulatory enforcement action.
RCW/WAC
WAC 284-180
RCW 48.200