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Washington Revised Code Title 48. Insurance § 48.43.094. Pharmacist provided services--Health plan requirements (Effective until July 1, 2022)

Current as of April 06, 2022 | Updated by FindLaw Staff

(1) For health plans issued or renewed on or after January 1, 2017:

(a) Benefits shall not be denied for any health care service performed by a pharmacist licensed under chapter 18.64 RCW if:

(i) The service performed was within the lawful scope of such person's license;

(ii) The plan would have provided benefits if the service had been performed by a physician licensed under chapter 18.71 or 18.57 RCW, an advanced registered nurse practitioner licensed under chapter 18.79 RCW, or a physician's assistant licensed under chapter 18.71A or 18.57A RCW;  and

(iii) The pharmacist is included in the plan's network of participating providers;  and

(b) The health plan must include an adequate number of pharmacists in its network of participating medical providers.

(2) The participation of pharmacies in the plan network's drug benefit does not satisfy the requirement that plans include pharmacists in their networks of participating medical providers.

(3) For health benefit plans issued or renewed on or after January 1, 2016, but before January 1, 2017, health plans that delegate credentialing agreements to contracted health care facilities must accept credentialing for pharmacists employed or contracted by those facilities.  Health plans must reimburse facilities for covered services provided by network pharmacists within the pharmacists' scope of practice per negotiations with the facility.

(4) This section does not supersede the requirements of RCW 48.43.045.

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Cite this article: FindLaw.com - Washington Revised Code Title 48. Insurance § 48.43.094. Pharmacist provided services--Health plan requirements (Effective until July 1, 2022) - last updated April 06, 2022 | https://codes.findlaw.com/wa/title-48-insurance/wa-rev-code-48-43-094/

Read this complete Washington Revised Code Title 48. Insurance § 48.43.094. Pharmacist provided services--Health plan requirements (Effective until July 1, 2022) on Westlaw

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