Small pharmacies and Pharmacy Benefit Managers (PBM) can request a review of the initial order (second-tier appeal) issued by the Office of the Insurance Commissioner (OIC) or the Office of Administrative Hearings (OAH), if they are dissatisfied with the outcome. The OIC presiding officer will review the petition, then issue a final order.
Either party can request a review by filing out the petition for review form and filing it with the OIC Administrative Hearings Unit in accordance with WAC 284-180-530.
The request for review must be received within 21 days after service of the initial order otherwise the order is considered final.
How to request a review
You will need to complete and submit the Petition for Review of Initial Order within 21 days after the initial order is served.
Completing your petition
All petitions for review of an initial order must be submitted electronically. To complete and submit your petition:
- Fill out the petition and give the reason(s) you are requesting a review.
- You must attach a copy of the initial order and any evidence or documents you want the reviewing officer to consider.
- After completing the petition, you will send it to the Administrative Hearings Unit at hearingsu@oic.wa.gov.
- Serve a copy of the petition for review and any other documents submitted with the review on all parties to the case (required). Service will be by electronic delivery in accordance with WAC 284-180-540(2).
You are required to submit the petition for review electronically. If supporting documents are too large to submit with your petition by email, please contact us for further instructions.
Responding to the petition for review
If you are not the party requesting review, you can file a response and any relevant evidence or documents to be considered by the presiding officer. Responses are due within seven (7) days of receipt of the Petition for Review and can be emailed to the Administrative Hearings Unit hearingsu@oic.wa.gov. Your response must be served on all parties listed in the petition in accordance with WAC 284-180-540(2).
How the review is conducted
The OIC Presiding Officer will review and decide your case. The presiding officer considers the following evidence (although these need not be the exclusive basis for the decision):
- The initial order,
- The record from the appeal, including the recording of any hearing held in the case, and
- Any records or documents submitted to the presiding officer.
The presiding officer may request additional evidence from either party. The party has seven days after service of the request to provide the evidence to the presiding officer and to the other parties.
In most cases, the presiding officer decides the case by reviewing the records and documents received. However, the presiding officer may decide that oral testimony is needed and will schedule a time for both parties to present that testimony by telephone.
There may be a reason to convert the brief adjudicative proceeding to a formal proceeding. If this instance occurs, then a motion will be presented by the OIC’s Presiding Officer or a party in the case.
When is a decision made?
The presiding officer will make a decision and issue a final order within 20 days after receipt of the petition for review, unless there are continuances. If the presiding officer does not issue a final order, the petition for review is deemed denied and the initial order becomes the final order, in accordance with RCW 34.05.491(5).
Where can I view petitions for review and final orders?
Petitions for review and final orders are available through the OIC’s consumer toolkit. You can search by:
- Name or order number (click the “Orders” tab)
- Company (click the “Agency and Company Lookup” tab)