SB 5923 - DIGEST

Directs the authority to use its powers and rule-making authority under chapter 41.05 RCW to develop a program to protect patient access to medical treatments provided by any health profession under RCW 18.130.040. The program must be based on the following operational principles and state agencies must bring their rules into compliance with these principles: (1) When any treatment is subject to prior authorization, the agency must provide health professions and patients with a specific set of clinical criteria setting forth the terms under which the treatment is authorized for coverage;

(2) When authorization for any treatment is denied, the agency must promptly provide both the patient and health professional with a written explanation of the reasons for denial. The explanation must be specific to the individual patients' condition and be written in clear language that is comprehensible to the patient;

(3) When a health professional and patient have established a successful treatment regimen that is covered under an agency's program, the agency may not place restrictions or exclusions on any part of the established treatment regimen, including prescription medicines;

(4) A pharmacist filling a prescription under a state program using a preferred drug list or formulary drug schedule may not substitute a preferred drug or formulary drug within a given therapeutic class when the prescribing health professional has indicated on the prescription that the nonpreferred or nonformulary drug must be dispensed as written; and

(5) Before making a decision to restrict access to treatment for a medical problem, the agency must seek and consider comments from practicing health professionals and patient groups familiar with the medical problem.

Requires the program under this act to provide for regular reports to the legislature on health care outcomes and overall financial impacts on the provision of health care services.