WA| TA Advisory Letter 2025-02, issued by Washington Office of Insurance Commissioner, provides interpretive guidance from the Washington State Office of the Insurance Commissioner on the application of Chapter 48.200 RCW and new legislation (E2SSB 5213) affecting health care benefit managers, including pharmacy benefit managers, in Washington as of September 2025.
Main Points:
- Health care benefit managers (HCBMs), including pharmacy benefit managers (PBMs), are required to register with the Insurance Commissioner, file contracts and amendments, and comply with annual renewal and regulatory oversight under Chapter 48.200 RCW.
- The new provisions clarify that certain plans and entities are excluded from these requirements, while self-funded group health plans governed by ERISA may choose to “opt in” to select pharmacy benefit management regulations, with the Insurance Commissioner providing a public list of opted-in plans by December 2025.
- The OIC is initiating further rulemaking and will update regulations to align with E2SSB 5213, enhancing oversight of HCBMs and PBMs; stakeholders may contact the OIC’s Company Licensing Unit for questions regarding compliance.