Effective Jan. 1, 2026, private self-funded group health plans operating under the federal Employee Retirement Income Security Act (ERISA) may participate in E2SSB 5213.
RCW 48.200.330 allows ERISA-governed self-funded group health plans to participate in:
- RCW 48.200.280 (Predetermination of reimbursement costs—Appeals—review by commissioner) - Allows small pharmacies to appeal drug reimbursement by PBM’s that is less than the pharmacy’s cost for the drug.
- RCW 48.200.310 (Prohibitions and duties) - Bans PBM “spread pricing” and gives enrollees more choices and rights in how they get prescription drugs
- RCW 48.200.320 (Prohibitions on retaliation) - Protects pharmacies from retaliation by PBMs.
Submit your opt-in form and attestation
Each self-funded group health plan that elects to participate in this law must complete and submit a request to opt -in and an attestation to our office at least 15 days before Jan. 1 of a calendar year or the first day of the plan year. The opt-in is for one full year unless the self-funded plan elects to automatically renew each year until it notifies OIC that it wants to terminate its opt-in. A plan that wants to terminate its opt-in must notify the OIC at least 15 days before the end of the calendar year or its plan year.
Note: The PBM acting on behalf of your plan will be required to follow the opt-in provisions above and OIC’s corresponding regulations regarding its conduct on your behalf.
Note: The opt-in is not available to self-funded group health plans not governed by ERISA (for example, local government plans).
Submit a request to opt-in and your attestation
The information you submit will appear publicly on data.wa.gov.
Self-funded group health plans participating in this law
Access a list of self-funded group health plans that have submitted an opt-in form and attestation to participate in this law.