Small pharmacy reimbursement appeals
A small pharmacy located in Washington state can submit an appeal to our office to review a Pharmacy Benefit Manager's (PBM) decision regarding the reimbursement of a drug's cost.
Find Initial and Final Orders from our Legal Affairs team and Administrative Hearings Unit.
We'll send your complaint to the insurer or agent and ask for a response. If we can't help you because of jurisdiction, we'll refer you to someone who can.
Quick tip
Appeal rights have been updated, allowing small pharmacies to challenge reimbursement for any drug and to submit appeals through an authorized representative, such as a PSAO. PBMs are also required to provide specified plan identification information to pharmacies within four business days upon request.
Related topics
Public meetings & notices
Our office is required to provide information on various public hearings, meetings, and events.
Administrative hearings
The Hearings Unit acts as the judicial branch of the agency. If an individual or entity disagrees with an action, order, or decision of the Insurance Commissioner, they can request an administrative hearing.