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284-180-460  <<  284-180-500 >>   284-180-505

(Effective January 1, 2022)

PDFWAC 284-180-500

Applicability and scope.

This subchapter applies to health care benefit managers providing pharmacy benefit management services, referred to as pharmacy benefit managers in this subchapter.
(1) Specifically, this subchapter applies to the actions of pharmacy benefit managers regarding contracts with pharmacies on behalf of an insurer, a third-party payor, or the prescription drug purchasing consortium established under RCW 70.14.060 in regard to:
(a) Fully insured health plans; and
(b) Medicaid plans. However, the appeal requirements of RCW 19.340.100 do not apply to medicaid plans.
(2) This subchapter does not apply to the actions of pharmacy benefit managers acting as third-party administrators regarding contracts with pharmacies on behalf of an insurer, a third-party payor, or the prescription drug purchasing consortium established under RCW 70.14.060 in regard to:
(a) Self-insured health plans; and
(b) Medicare plans.
[Statutory Authority: RCW 48.02.060 and 48.200.900. WSR 21-02-034, ยง 284-180-500, filed 12/29/20, effective 1/1/22.]
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