We'll review your appeal or send it to the Office of Administrative Hearings (OAH).

What you need to submit

Submit these documents with your appeal:

  • All documents you and the pharmacy benefit manager (PBM) provided as part of your original appeal
  • Invoice
  • Maximum allowable cost (MAC) list
  • The PBM's decision
  • Other documents to support your appeal

WAC 284-180-520 requires these documents.

If you have questions about the documents you need to submit, contact our Hearings Unit.

How to file an appeal

You can file an appeal online.

You won't upload any documents at this time. After you submit an appeal, we or OAH will contact you to explain how to upload your documents.

After you file an appeal

We or OAH will contact you with instructions and notify the PBM. The PBM can then respond and submit their own documents.  

Our presiding officer or an administrative law judge from OAH will review your appeal and the documents from you and the PBM. If they need more information or documents, you'll have seven days to provide them, unless they give you more time. The presiding officer or administrative law judge may also allow each side to give testimony by phone, videoconference, or in person.

Once the time to submit documents is over, the presiding officer or administrative law judge will review what you and the PBM submitted. Then they'll make an initial decision, which becomes final after 21 days. 

The appeal process lasts 30 calendar days. This period starts once both sides have submitted all their appeal documents.   

If disagree with the initial decision, you can ask us to review it within 21 days. If you still disagree with the final decision, you may be able to file an appeal in Superior Court.