This section adds a new section to an existing chapter 48.43. Here is the modified chapter for context.
Health carriers, for health plans issued or renewed on or after January 1, 2022, that include prescription drug coverage, must ensure enrollees are protected from unintentional use of or enrollment in a nonresident pharmacy.
The health carrier must include in any contract with a pharmacy benefit manager, as defined in RCW 48.200.020, a requirement that the pharmacy benefit manager require any contracted nonresident pharmacy to obtain affirmative authorization, in writing or through electronic communication, from a health plan enrollee prior to filling an enrollee's prescription and billing the enrollee's health plan. The authorization from the enrollee may permit the use of a nonresident pharmacy for the plan year.
Each nonresident pharmacy shipment must include a notice to the enrollee clearly describing the actions that the enrollee can take to terminate use of the nonresident pharmacy.
The health plan must allow enrollees to opt out of mandatory use of a nonresident pharmacy, and include information in the enrollee health plan booklet explaining the requirement to obtain the enrollee's affirmative authorization prior to filling a prescription through a nonresident pharmacy.
The health plan may not, as a condition of payment or reimbursement, require an enrollee to purchase pharmacy services exclusively through a nonresident pharmacy.
This section does not apply to nonresident pharmacies with specialty pharmacy accreditation from a nationally recognized accreditation entity.
For the purposes of this section, "nonresident pharmacy" has the same meaning as in RCW 18.64.360.