WA SB5324

Requires health carriers, public employee health plans, and Medicaid managed care organizations to establish prior authorization APIs consistent with final federal CMS rules published in the federal register, with enforcement beginning January 1, 2027

Mandates separate interoperable electronic processes for prescription drug prior authorizations beginning January 1, 2027, allowing providers to identify requirements, exchange requests/determinations, and receive information on covered alternative drugs

Maintains existing response timeframes: 3 calendar days for electronic standard requests, 1 day for electronic expedited requests, 5 days for non-electronic standard requests, and 2 days for non-electronic expedited requests

Removes previous provisions allowing carriers to submit narrative justifications for delayed compliance and receive one-year enforcement delays from the insurance commissioner or health authority

Requires clinical review criteria to be evidence-based, peer-reviewed, updated annually, and accommodate emerging information related to appropriateness for Black and Indigenous people, other people of color, gender, and underserved populations