Health care benefit managers (R 2025-11)

E2SSB 5213 was signed into law on March 25, 2024. E2SSB 5213 amends state law (Chapter 48.200 RCW) to regulate 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; health carriers’ filing of HCBM contracts; and the commissioner’s HCBM oversight authority.  

Parts of E2SSB 5213 that took effect June 6, 2024: Section 1 (RCW 48.200.020), 2 (RCW 48.200.030), 3 (RCW 48.200.050), 4 (RCW 48.200.210), 6 (RCW 48.200.300), 10 (RCW 41.05.017) and 11. 

Parts of E2SSB 5213 that take effect January 1, 2026: Sections 5 (RCW 48.200.280), 7 (RCW 48.200.310), 8 (RCW 48.200.320) and 9 (RCW 48.200.330). 

On Dec. 18, 2024, the commissioner adopted a rule (R 2024-02, WSR 25-02-024) implementing E2SSB 5213 and updating other HCBM regulations. This rule was effective Jan. 18, 2025. OIC released a technical assistance advisory related to health care benefit managers on September 15, 2025. 

This rule is necessary to further implement the provisions of E2SSB 5213 that go into effect Jan.1, 2026 and ensure that affected entities understand their rights and obligations under these new provisions. In addition, this rule is necessary to update other HCBM regulations outside of E2SSB 5213 and ensure OIC can continue to effectively oversee HCBMs.