48.200.280 – Predetermination of reimbursement costs—Appeals—Review by commissioner.
RCW 48.200.280 Predetermination of reimbursement costs—Appeals—Review by commissioner. (1) The definitions in this subsection apply throughout this section unless the context clearly requires otherwise. (a) “List” means the list of drugs for which predetermined reimbursement costs have been established, such as a maximum allowable cost or maximum allowable cost list or any other benchmark prices […]
48.200.290 – Enforcement—Disputes—Civil penalties.
RCW 48.200.290 Enforcement—Disputes—Civil penalties. (1) The commissioner shall have enforcement authority over this chapter and shall have authority to render a binding decision in any dispute between a pharmacy benefit manager, or third-party administrator of prescription drug benefits, and a pharmacy arising out of an appeal under RCW 48.200.280(6) regarding drug pricing and reimbursement. (2) […]
48.200.010 – Findings—Intent.
RCW 48.200.010 Findings—Intent. (1) The legislature finds that growth in managed health care systems has shifted substantial authority over health care decisions from providers and patients to health carriers and health care benefit managers. Health care benefit managers acting as intermediaries between carriers, health care providers, and patients exercise broad discretion to affect health care […]
48.200.020 – Definitions.
RCW 48.200.020 Definitions. The definitions in this section apply throughout this chapter unless the context clearly requires otherwise. (1) “Affiliate” or “affiliated employer” means a person who directly or indirectly through one or more intermediaries, controls or is controlled by, or is under common control with, another specified person. (2) “Certification” has the same meaning […]
48.200.030 – Registration requirements—Application—Fees—Retention of transaction records.
RCW 48.200.030 Registration requirements—Application—Fees—Retention of transaction records. (1) To conduct business in this state, a health care benefit manager must register with the commissioner and annually renew the registration. (2) To apply for registration under this section, a health care benefit manager must: (a) Submit an application on forms and in a manner prescribed by […]
48.200.040 – Contract requirements—Written agreement describing rights and responsibilities—Filing of contracts—Confidentiality.
RCW 48.200.040 Contract requirements—Written agreement describing rights and responsibilities—Filing of contracts—Confidentiality. (1) A health care benefit manager may not provide health care benefit management services to a health carrier or employee benefits programs without a written agreement describing the rights and responsibilities of the parties conforming to the provisions of this chapter and any rules […]