Relating to health care benefit managers (R 2024-02)

E2SSB 5213 (Chapter 242, Laws of 2024) amends state law concerning the business practices of health care benefit managers (HCBMs) and pharmacy benefit managers (PBMs, which are a type of HCBM). The law’s provisions address, among other issues: PBM reimbursement to pharmacies for dispensing prescription drugs; consumer access to mail order and retail pharmacies; consumer out-of-pocket costs for prescription drugs; HCBM registration and reporting; and the Office of the Insurance Commissioner (OIC)’s oversight authority regarding HCBM registration and operations. Rulemaking was necessary to revise existing HCBM rules at Chapter 284-180 Washington Administrative Code (WAC) and to ensure that all affected entities understand their rights and obligations under the new law. 

In addition, rulemaking related to HCBMs was necessary to ensure that OIC can effectively oversee HCBMs in light of recent health care industry developments. OIC revised provisions of Chapter 284-180 WAC to accomplish this.