Washington Health Insurance Enforcement and Consumer Protections Grant Award

Cycle I Grant Application Summary

Washington Grantee: Washington State Office of Insurance Commissioner

Award Date: October 31, 2016

Total Award: $791,808.60

Baseline Award: $476,998

Selected Market Reforms Amount: $90,000

Workload Award Amount: $224,810.60

Section 2707- The Washington State Office of the Insurance Commissioner will develop a standard operating procedure (SOP) to enhance Washington’s existing policy form and System for Electronic Rate and Form Filing (SERFF) Binder review processes to ensure health insurance plans do not include discriminatory benefit designs that discourage people with potentially high-cost medical conditions from enrolling in those plans. The SOP would help identify how the specific placement of drugs into cost-sharing tiers and the selection of drugs in the prescription drug formulary creates discriminatory benefit designs. The SOP would also help identify how health insurance issuers’ application of utilization management tools, such as prior approval or pre-authorization, step therapy protocols, and limitations on the quantities of medication dispensed at a single time, result in discriminatory benefit design. The Washington Office of the Insurance Commissioner will also evaluate the cost-sharing for the prescription drug benefit in health plans in the individual and small group markets and determine whether the variation in cost-sharing creates a discriminatory benefit design and results in adverse selection.