WSR 12-05-057




[ Insurance Commissioner Matter No. R 2012-03 -- Filed February 15, 2012, 9:32 a.m. ]

Subject of Possible Rule Making: Prescription drug and pharmacy services coverage benefit standards for health benefit plans offered in the individual and group markets.

Statutes Authorizing the Agency to Adopt Rules on this Subject: RCW 48.02.060, 48.02.062, 48.44.020(2), 48.46.200, 48.02.160 and potentially, under RCW 48.30.010. A rule aligning the state's requirements with the federal standards related to contraceptive coverage is also authorized, and the part of the subject of this rule making, pursuant to P.L. 111-148 (2010) as amended.

Reasons Why Rules on this Subject may be Needed and What They Might Accomplish: Prescription drug coverage is offered in individual and small group health plans. Complaints received by the commissioner indicate clarifying rules may be required regarding the benefit design and the scope of the benefit to ensure that covered persons are not de facto denied prescription coverage necessary to treat a medical condition or mental health condition that is otherwise covered under the health benefit plan and for which premium is collected by the carrier. In addition, the federal government by regulation implementing the P.L. 1111-148 [111-148] (2010) as amended requires health carriers to offer contraceptive coverage effective August 1, 2012, and imposes additional requirements related to prescription benefits. Conforming to the federal standard in TITLE 284 WAC may assist in avoiding confusion about whether the prescription coverage offered through health benefit plans in Washington must include these types of drugs in their pharmacy benefit.

Other Federal and State Agencies that Regulate this Subject and the Process Coordinating the Rule with These Agencies: The federal United States Department of Health and Human Services (HHS) and its subagencies also regulate this subject. Coordination with HHS includes monitoring their issued bulletins and guidance related to prescription drug coverages for individual and group health plans.

Process for Developing New Rule: Submit written comments by April 4, 2012.

Interested parties can participate in the decision to adopt the new rule and formulation of the proposed rule before publication by contacting Meg L. Jones, P.O. Box 20574, Olympia, WA 98504, phone (360) 725-7170, e-mail There are no meetings currently scheduled on the subject. Please send comments to the individual identified above.

February 15, 2012

Mike Kreidler

Insurance Commissioner

Washington State Code Reviser's Office