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 HCBM oversight authority of the Office of the Insurance Commissioner (OIC). Sections 1, 2, 3, 4, 6, 10, and 11 of E2SSB 5213 took effect June 6, 2024. Sections 5, 7, 8, and 9 will take effect Jan. 1, 2026.    

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. 

Rulemaking regarding HCBMs may be 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, rulemaking to update other HCBM regulations may be necessary to ensure OIC can continue to effectively oversee HCBMs. OIC may revise Chapter 284-180 WAC to accomplish these goals.