PREPROPOSAL STATEMENT OF INQUIRY

INSURANCE COMMISSIONER

[Insurance Commissioner Matter R 2019-11—Filed September 4, 2019, 10:08 a.m.]

Subject of Possible Rule Making: Prescription drug utilization management (ESHB 1879).

Statutes Authorizing the Agency to Adopt Rules on this Subject: ESHB 1879 (chapter 427, Laws of 2019 – effective date January 1, 2021), RCW 48.02.060.

Reasons Why Rules on this Subject may be Needed and What They Might Accomplish: The legislature passed ESHB 1879 during the 2019 session. The bill requires health carriers and prescription drug utilization management companies which restrict prescription drug coverage through use of utilization management protocols to provide both the patient and the prescribing practitioner access to a clear, readily accessible, and a timely exception process. Furthermore, it requires utilization management protocols to be evidence-based and creates requirements and timelines for step therapy exception requests. The office of the insurance commissioner needs to develop rules to establish how the notice to participating providers would be given the standard process requirements and external review options.

Other Federal and State Agencies that Regulate this Subject and the Process Coordinating the Rule with These Agencies: Not applicable.

Process for Developing New Rule: Submit written comments by December 31, 2019.

Interested parties can participate in the decision to adopt the new rule and formulation of the proposed rule before publication by contacting Scott Bird, 302 Sid Snyder Avenue S.W., Olympia, WA 98504, phone 360-725-77169 [360-725-7169], fax 360-586-3109, TTY 360-586-0241, email rulescoordinator@oic.wa.gov, web site www.insurance.wa.gov.

Insurance Commissioner