Washington State

House of Representatives

Office of Program Research



Health Care & Wellness Committee

ESSB 5557

This analysis was prepared by non-partisan legislative staff for the use of legislative members in their deliberations. This analysis is not a part of the legislation nor does it constitute a statement of legislative intent.

Brief Description: Addressing services provided by pharmacists.

Sponsors: Senate Committee on Health Care (originally sponsored by Senators Parlette, Conway, Rivers, Dammeier, Becker, Frockt, Schoesler, Keiser, Jayapal, Warnick and Honeyford).

Brief Summary of Engrossed Substitute Bill

  • Requires a health carrier to reimburse for services provided by a pharmacist acting within his or her scope of practice under certain circumstances.

  • Connects the Every Category of Provider Law to the essential health benefits instead of the Basic Health Plan.

Hearing Date: 3/18/15

Staff: Jim Morishima (786-7191).


The Every Category of Provider Law.

Under Washington's "Every Category of Provider Law," health carriers must permit every category of health care provider to provide health services or care for conditions included in the Basic Health Plan (a discontinued state program that provided coverage to low-income individuals for health services, including physician services, inpatient and outpatient hospital services, and prescription drugs and medication) if:

Pharmacists under the Every Category of Provider Law.

Pharmacists are licensed by the Pharmacy Quality Assurance Commission and may provide a variety of services, including:

In 2013, an informal Attorney General Opinion stated that pharmacists are health care providers for purposes of the Every Category of Provider law and therefore must be compensated for services included in the Basic Health Plan that are within the pharmacist's scope of practice if the pharmacist abides by standards relating to cost containment, management, and clinically efficacious health services.

Essential Health Benefits.

The federal Patient Protection and Affordable Care Act requires individual and small group market health plans to offer 10 categories of "essential health benefits" both inside and outside of Washington's health benefit exchange. The essential health benefits are established on a state-by-state basis using a supplemented chosen by each state. Washington's benchmark plan is the largest small group market plan in the state.

Summary of Bill:

Health plans issued or renewed on or after January 1, 2016, may not deny benefits for health care services provided by licensed pharmacists if:

For purposes of the Every Category of Provider Law:

Appropriation: None.

Fiscal Note: Available.

Effective Date: The bill takes effect 90 days after adjournment of the session in which the bill is passed.