BILL REQ. #:  S-1025.1 

Read first time 01/31/2005.   Referred to Committee on Health & Long-Term Care.

     AN ACT Relating to insurance coverage of pharmacy services; adding new sections to chapter 48.43 RCW; creating a new section; and prescribing penalties.

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

NEW SECTION.  Sec. 1   The legislature intends health care insurers to have open pharmacy networks. Insurers must offer contractual agreements to all pharmacies willing to meet applicable terms and conditions of the policy contract. Insurers may not impose upon a beneficiary a copay, deductible, coinsurance, or prescription quantity limit that is not imposed upon all beneficiaries in the plan. Pharmacy services are known to be a necessary component in the overall health care system. Therefore, the legislature intends to promote access to ensure the citizens of Washington state can easily obtain their pharmacy services.

NEW SECTION.  Sec. 2   Every health plan delivered, issued for delivery, or renewed by a health carrier on and after January 1, 2006, that provides for payment of all or a portion of prescription costs, or reimbursement of prescription costs, must:
     (1) Not limit the purchase of prescription medicines to specific pharmacies;
     (2) Not discriminate between different providers of pharmacy services by requiring the payment of different copayments, coinsurance levels, deductibles, or prescription quantity limits by the covered pharmacy patient depending on the identity or nature of the provider of pharmacy services;
     (3) Not prohibit a qualified provider of pharmacy services from becoming a provider under the policy if the applicant pharmacy indicates a desire to be recognized as a provider and meets all the applicable terms and conditions of the policy contract; and
     (4) Offer a provider of pharmacy services the same terms and conditions.

NEW SECTION.  Sec. 3   Section 2 of this act does not apply to:
     (1) A provider of pharmacy services if that provider cannot or will not meet all of the applicable terms and conditions of the policy contract; or
     (2) A health maintenance organization that provides pharmaceutical services through pharmacists it employs at pharmacies it owns. A health maintenance organization is exempt in geographic areas in which it owns the pharmacy or pharmacies, but is not exempt in other geographic areas in which the health maintenance organization does not provide pharmacy services through its own pharmacy and employees.

NEW SECTION.  Sec. 4   (1) A health carrier, as defined in this chapter, who violates section 2 of this act or a rule adopted under that section may be subject to a penalty of not less than one thousand dollars nor more than fifty thousand dollars for each violation, payable to the health services account.
     (2) A person may bring action against a carrier to recover damages suffered as the result of a violation of section 2 of this act or a rule adopted under that section. Proof of a violation constitutes prima facie evidence of damages.

NEW SECTION.  Sec. 5   Sections 2 through 4 of this act are each added to chapter 48.43 RCW.