WA SB 5213 Pharmacy Benefit Mandate effective January 1, 2026

Starting January 1, 2026, fully insured groups in Washington 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 a group renewed in February 2025 or later, they’ll receive a letter explaining the new pharmacy benefits. The Washington Office of Insurance Commissioner requires this letter. It 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 order. Members can pick any in-network pharmacy.
• Members 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 account representative.