Requires health carriers to calculate an enrollee's coinsurance or deductible obligation for a prescription drug based on the price of the drug minus all rebates received for that drug. Requires that a pharmacy benefit manager may only derive income for pharmacy benefit management services provided to a health carrier through a fixed management fee.
Requires health carriers to calculate an enrollee's coinsurance or deductible obligation for a prescription drug based on the price of the drug minus all rebates received for that drug. Requires that a pharmacy benefit manager may only derive income for pharmacy benefit management services provided to a health carrier through a fixed management fee.
Increasing access to insulin for individuals under the age of 21. The Health Care Authority (HCA) is directed to establish a bulk purchasing and distribution program for insulin for individuals under the age of 21 similar to the opioid overdose reversal medication bulk purchasing and distribution program. The HCA is authorized to purchase or enter into contracts to purchase and distribute insulin; bill, charge, and receive payment from health carriers, managed health care systems, and self-insured plans that choose to participate; and perform any other function as necessary to establish and administer the program.
Removing the expiration date on the cost-sharing cap for insulin. The expiration date limiting out-of-pocket expenses to $35 for a 30-day supply of insulin is removed.
Creating temporary exemptions from certificate of need requirements for kidney disease centers.
Creating exemptions from certificate of need requirements for kidney disease centers.
Adds penalties to cost growth benchmark implementation. The Transparency Board may use information received from existing data sources, such as the Washington Health Benefit Exchange and the Prescription Drug Affordability Board. The Transparency Board may share its data with the Prescription Drug Affordability Board and other health care cost analysis efforts. In addition, the Transparency Board may collect necessary data from payers and health care providers and levy civil fines on those who violate data submission requirements. The Health Care Authority (Authority) is expressly authorized to conduct activities to support the Transparency Board, including [...]
Adds penalties to cost growth benchmark implementation. The Transparency Board may use information received from existing data sources, such as the Washington Health Benefit Exchange and the Prescription Drug Affordability Board. The Transparency Board may share its data with the Prescription Drug Affordability Board and other health care cost analysis efforts. In addition, the Transparency Board may collect necessary data from payers and health care providers and levy civil fines on those who violate data submission requirements. The Health Care Authority (Authority) is expressly authorized to conduct activities to support the Transparency Board, including [...]
This bill amends RCW 74.09.5225 to change the rate multiplier used for hospitals that qualify for a sole community hospital rate enhancement. It codifies the increase from 125 percent to 150 percent of fee for service rates. This amount has been in proviso since FY 2021. Since FY 2022, the 150 percent only applied to sole community hospitals that accepted single bed certifications. This change would codify that percentage without requiring single bed certifications.
