WA SB 5213 Pharmacy Benefit Mandate effective January 1, 2026

Starting January 1, 2026, fully insured groups in Washington state will switch to a new pharmacy model required by Senate Bill 5213. This law sets rules for pricing and how pharmacy benefits are designed.

If your group renewed in February 2025 or later, you’ll receive a letter explaining the new pharmacy benefits. This letter is required by the Washington State Office of the Insurance Commissioner and will be mailed on October 31.

Here’s what’s changing:

• Members can choose Accredo (current specialty pharmacy) or Walgreens Specialty Pharmacy.
• Members are no longer limited to Express Scripts for mail orders and can choose any in-network pharmacy.
• Members will pay the same price for a 90-day prescription whether it’s mail order or an in-network retail pharmacy.

Questions? Reach out to your Premera representative or producer to learn more.