WAC 284-180-500. Applicability and scope

This subchapter applies to pharmacy benefit managers as defined in RCW 48.200.020 .

(1) Specifically, this subchapter applies to the actions of pharmacy benefit managers regarding contracts with pharmacies on behalf of a carrier, employee benefits program, or medicaid managed care program in regard to:

(a) Fully insured health plans; and

(b) Medicaid managed care plans. However, the appeal requirements of RCW 48.200.280 do not apply to medicaid managed care plans.

(2) This subchapter does not apply to:

(a) The actions of pharmacy benefit managers contracting with third-party administrators to administer prescription drug benefits for self-funded group health plans or union plans, unless a self-funded group health plan or union plan governed by the provisions of the federal Employee Retirement Income Security Act of 1974 (29 U.S.C. Sec. 1001 et seq.) has elected to participate in RCW 48.200.280 , 48.200.310 , and 48.200.320 under WAC 284-180-465 ; and

(b) The actions of pharmacy benefit managers contracting to administer prescription drug benefits for medicare plans.