Washington Insurance Commissioner rulemaking (insurers and regulated entities) · January 24, 2026 · Primary source
Health care benefit managers (R 2025-11)
Summary
Washington's Office of the Insurance Commissioner adopted a final rule effective January 24, 2026, implementing new requirements for health care benefit managers and pharmacy benefit managers under E2SSB 5213 (Chapter 48.200 RCW). The rule addresses PBM reimbursement to pharmacies for dispensing prescription drugs, consumer access to mail-order and retail pharmacies, consumer out-of-pocket costs, HCBM registration and reporting, health carrier filing of HCBM contracts, and OIC oversight authority. A new WAC 284-180-550 establishes enrollee rights and PBM obligations, and several existing WAC sections governing registration, pharmacy reimbursement, and appeals are amended.
What this may mean
PBMs and other health care benefit managers operating in Washington face new operational and reporting obligations under the amended and new WAC sections, including revised pharmacy reimbursement standards, updated registration requirements, and new enrollee rights provisions, all effective January 24, 2026. Health carriers must file their HCBM contracts with OIC under the new requirements. Network pharmacies gain additional appeal rights against HCBMs and to the OIC commissioner under the updated rules.
Informational only. Not legal, medical, financial, or other professional advice. Always consult a qualified professional familiar with your specific facts before relying on any item.
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