For Consumers

Prior authorization of pharmacy benefits (R 2014-13)

These rules are required by RCW 48.165.0301 (ESSB 6511) to improve the prior authorization process within the pharmacy benefit. The rules implement the recommendations of a work group convened by OneHealthPort, the lead organization designated by the legislature. The work group examined the prior authorization process and made recommendations to streamline the process. The work group considered those issues identified in SB 6511 and focused its initial efforts on pharmacy. Information regarding the work group is available on OneHealthPort’s website (

Additional background information

Rule adopted November 25, 2015

Proposed rule filed September 23, 2015

  • CR 102 text (PDF 213, KB)
  • New WAC sections include: WAC 284-43-325 and WAC 284-43-420
  • Amended WAC sections include: WAC 284-43-130, WAC 284-43-410, and WAC 284-43-818

Impact of changes made from June 10, 2015 stakeholder draft

Stakeholder draft released June 10, 2015

Preproposal filed November 3, 2014