6119-S

AN ACT Relating to insurance coverage for prescription medicine; adding a new section to chapter 48.20 RCW; adding a new section to chapter 48.21 RCW; adding a new section to chapter 48.44 RCW; adding a new section to chapter 48.46 RCW; adding a new section to chapter 43.70 RCW; and creating new sections.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:

NEW SECTION. Sec. 1. The legislature finds that many health care insurance policies that include prescription coverage severely restrict the citizens' choice of available pharmacies. The legislature further finds that such restrictions infringe on the citizens' freedom to have their prescriptions filled at the pharmacy and by the pharmacist of their choice.

NEW SECTION. Sec. 2. A new section is added to chapter 48.20 RCW to read as follows:

(1) Each disability insurance policy issued or renewed after July 1, 1996, that provides for payment of all or a portion of prescription costs, or reimbursement of prescription costs, may not limit purchase of prescription medicines to a designated pharmacy nor provide for the payment of additional fees or deductibles by the covered pharmacy patient as a condition of obtaining prescription benefits from a pharmacy other than a designated pharmacy.

(2) The policy may not prohibit a qualified provider of pharmacy services from becoming a designated provider under the provisions of the policy if the applicant pharmacy indicates a desire to be recognized as a designated provider and meets all the applicable terms and conditions of the policy contract.

(3) All qualified providers of pharmacy services shall be subject to the same terms and conditions for becoming a designated provider.

(4) A pharmacy filling prescriptions under this section agrees to provide pharmaceutical services under the same terms, including administrative, financial, and professional conditions, as those provided by the designated pharmacy.

NEW SECTION. Sec. 3. A new section is added to chapter 48.21 RCW to read as follows:

(1) Each group disability insurance policy issued or renewed after July 1, 1996, that provides for payment of all or a portion of prescription costs, or reimbursement of prescription costs, may not limit purchase of prescription medicines to a designated pharmacy nor provide for the payment of additional fees or deductibles by the covered pharmacy patient as a condition of obtaining prescription benefits from a pharmacy other than a designated pharmacy.

(3) All qualified providers of pharmacy services shall be subject to the same terms and conditions for becoming a designated provider.

NEW SECTION. Sec. 4. A new section is added to chapter 48.44 RCW to read as follows:

(1) Each health care service contract issued or renewed after July 1, 1996, that provides for payment of all or a portion of prescription costs, or reimbursement of prescription costs, may not limit purchase of prescription medicines to a designated pharmacy nor provide for the payment of additional fees or deductibles by the covered pharmacy patient as a condition of obtaining prescription benefits from a pharmacy other than a designated pharmacy.

(3) All qualified providers of pharmacy services shall be subject to the same terms and conditions for becoming a designated provider.

NEW SECTION. Sec. 5. A new section is added to chapter 48.46 RCW to read as follows:

(1) Each health maintenance agreement issued or renewed after July 1, 1996, that provides for payment of all or a portion of prescription costs, or reimbursement of prescription costs, may not limit purchase of prescription medicines to a designated pharmacy nor provide for the payment of additional fees or deductibles by the covered pharmacy patient as a condition of obtaining prescription benefits from a pharmacy other than a designated pharmacy.

(3) All qualified providers of pharmacy services shall be subject to the same terms and conditions for becoming a designated provider.

(5) A health maintenance organization, to the extent that it directly employs pharmacists licensed under chapter 18.64 RCW, is in compliance with this section so long as the health maintenance organization complies with section 6 of this act.

NEW SECTION. Sec. 6. A new section is added to chapter 43.70 RCW to read as follows:

(1) The Washington state board of pharmacy may recommend to the secretary the adoption of rules providing for standards of patient care with respect to the terms and conditions of a contract or agreement between a pharmacist licensed under chapter 18.64 RCW and a health maintenance organization to the extent that the health maintenance organization directly employs pharmacists. Recommendations shall be considered by the secretary only if the proposed rule would foster strict compliance with standards of patient care, professional conduct, and scopes of practice; would promote quality medical and health practice to improve the public's health status; would prevent unreasonable interference with patient access to needed health services; and would protect the public health and safety.

(2) The secretary is authorized to adopt rules based upon recommendations made in accordance with subsection (1) of this section. When practical and appropriate, and with the approval of the Washington state board of pharmacy, the secretary shall apply the rules to all pharmacists licensed under chapter 18.64 RCW to promote consistent standards for contracting between pharmacists licensed under chapter 18.64 RCW and all health maintenance organizations to the extent that the health maintenance organizations directly employ pharmacists.

(3) Beginning one year after the promulgation of standards of patient care under this section, the secretary may impose such standards of patient care as a condition of licensure under chapter 18.64 RCW. It is a violation of practice requirements to enter into a contract that does not meet such standards with a health maintenance organization to the extent that the health maintenance organization directly employs pharmacists.

NEW SECTION. Sec. 7. (1) All carriers, as defined in RCW 48.43.005, who violate this act or any rule adopted under this act shall pay a civil penalty of not less than one thousand dollars nor more than fifty thousand dollars for each violation. The attorney general shall bring an action in superior court to enforce the provisions of this act.

(2) Any person may bring a civil action against any carrier to recover damages suffered as the result of a violation of this act or of a rule adopted under this act. Proof of a violation constitutes prima facie evidence of damages. The court shall award treble the amount of damages.