SB 5030 - DIGEST

(SEE ALSO PROPOSED 1ST SUB)

     Creates the Washington pharmacy access program within the Washington state health care authority.  The administrative head and appointing authority of the program is the administrator of the Washington state health care authority.  The program shall include the following components:

     (1) A self-funded prescription drug insurance plan, designed and implemented pursuant to this act;

     (2) Prescription drug information and education grants awarded to local organizations pursuant to this act; and

     (3) Assistance to eligible individuals in obtaining free or low cost prescription drugs from existing public and private sources pursuant to this act.

     Provides that the plan shall pay the costs of all generic and preferred prescription drugs and pharmacy services for an enrollee once that enrollee's out-of-pocket expenditures in a calendar year on prescription drugs and pharmacy services exceeds the lesser of: (1) Ten percent of the enrollee's gross annual household income; or (2) two thousand dollars.  For purposes of this provision, out-of-pocket expenditures do not include monthly premiums, for which an enrollee remains responsible.

     Directs the Washington state health care authority, and any entity with which it contracts, to inform enrollees in writing of the plan's scope, coverage, cost-sharing requirements, and any limitations on access to prescription drugs.  The Washington state health care authority, and any entity with which it contracts, shall provide for a clear and timely process by which enrollees can appeal a decision by the health care authority or any contracted entity to deny or limit coverage or benefits under this act.

     Provides that the act shall be null and void if appropriations are not approved.