Small Pharmacy appeals | Washington State Office of the Insurance Commissioner

What is your name?

First Name

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What email will be used to track the pharmacy appeals and receive decisions?

Please confirm your email address.

Is the appeal from a small pharmacy in WA State?

Is the appeal specific to only the reimbursement cost of the drug?

Is the PBM reimbursement rate being appealed for a multi-source generic drug?

Do you have the authority to submit an appeal on behalf of the pharmacy?

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