Prior Authorization in Washington
Washington enacted SB 5765 (2024) comprehensive PA reform requiring electronic PA, gold card exemptions, and standardized PA forms. The law requires PA decisions within 5 days for standard and 24 hours for urgent requests. Washington also provides strong step therapy override protections.
Key Facts About PA in Washington
- ✓ Comprehensive 2024 PA reform with electronic PA mandate and gold card provisions
- ✓ Standard PA decisions within 5 days; urgent within 24 hours
- ✓ Strong step therapy override protections
- ✓ WA Office of the Insurance Commissioner oversees external review
Quick Stats
- Typical Appeal Filing Window: 30 days
- External Review Available: Yes
- Major Payers: 4
Top Payers in Washington
RxCheckUp generates payer-specific Letters of Medical Necessity for each of these Washington carriers:
Premera Blue CrossRegence BCBS WashingtonKaiser Permanente WAMolina