5 Things Washington: Pharmacies & PBMs, 2023 peer support specialists bill, Q&A on rural student mental health


Eli Kirshbaum


Special shoutout to our reporter Shane Ersland, who has done some great reporting in the state recently and is an instrumental part of State of Reform’s presence in Washington. Feel free to reach out to Shane at any time with story leads as he continues to track the most pressing topics in Washington State health policy.

This edition features pharmacy stakeholders’ remarks about how PBM practices continue to affect their ability to operate, DSHS’s plans for supporting the long-term care workforce going forward, and a conversation with a WSU professor who led a study that showed significantly lower rates of mental health diagnoses in rural schools compared to urban schools.

Also, a reminder that our 2023 Washington State of Reform Conference is less than a month away! With over 300 registrants so far and a slew of high-caliber speakers, this is sure to be a can’t-miss event for state health policy stakeholders. Be sure to register if you haven’t already, and I hope to see you there!

Thanks for reading!

Eli Kirshbaum
State of Reform


1. Washington pharmacies list PBM-related challenges

During a House Health Care & Wellness Committee hearing earlier this month, stakeholders discussed the “predatory” practices of pharmacy benefit managers and how it impacts pharmacies’ ability to operate in the state. “PBM business practices are harming patient access to quality care in communities all over Washington,” said WA Pharmacy Association President Ryan Oftebro. “They have grown wildly in power and control.”

Restrictive contracting practices in which PBMs can set pharmacy reimbursement rates and patient copays are leaving pharmacies with insufficient financial support and impeding patient access to medications, Oftebro said. PBM “clawbacks” and “spread pricing” and their impact on pharmacy finances have led many pharmacies to close in recent years. He said more policy action in addition to the state’s recent action to regulate PBMs will be needed—namely, legislation to ensure PBMs can’t use ERISA as a reason for refusing to comply with state regulations.


2. DSHS outlines plan for supporting LTC workforce in 2023

Washington State’s long-term care provider-to-patient ration is projected to decrease from 6-to-1 to 3-2-1 by 2040, according to DSHS’s Bea Rector. With LTC patients often needing to wait 60 days or more for a LTC provider, and a consequent decrease in nursing home occupancy, Rector discussed the LTC workforce’s main areas of need and how the state is planning to support it at a recent legislative meeting.

Noting that the purchasing power of LTC wages has fallen nearly 10% over the last decade, and that current assisted living facility rates are only 68% of recommended rates, Rector said DSHS is working with the governor’s office to produce legislation for the 2023 session that would raise reimbursement rates. “Long-term care is difficult work. It needs to be appropriately compensated in order for individuals to be interested in entering this workforce and, more importantly, staying in this workforce.”


3. What They’re Watching: Ingrid Ulrey, US Department of Health and Human Services

In this edition of “What They’re Watching,” Ingrid Ulrey, Regional Director of District 10 for the US Department of Health and Human Services, illustrates the importance of remaining vigilant on COVID-19 response efforts. She said all Washingtonians should continue to prioritize getting vaccinated as they enter the winter months.

“Because many of us had our original series or booster quite some time ago, the risk of outbreaks is very high. If we can get people to vaccinate at the same level as people vaccinated last year for flu, we have modeling that shows it would prevent 100,000 deaths and nearly 1 million hospitalizations.”

4. Q&A: WSU professor discusses rural student mental health challenges

Dr. Janessa Graves, an Associate Professor at WSU’s College of Nursing, led a recent study that found rural public schools have more difficulty diagnosing students with mental health issues than urban schools in the state. In this Q&A, Graves talks about the study’s findings, the rise in suicide deaths in rural schools, and how stakeholders can work to address this disparity in school-based mental healthcare.

“We know [that with] rural schools, inadequate access to professionals, and inadequate funding were cited as factors that limit efforts to provide school-based mental health services.” Graves said a temporary solution is to increase rural schools’ telehealth capabilities so they can better meet the demand for mental healthcare, but a more ideal long-term solution would be to recruit and retain more health professionals in rural communities of the state.


5. Rep. Lauren Davis to introduce legislation to support peer support specialists

Rep. Lauren Davis plans to introduce legislation that would establish certified peer support specialists as a recognized profession under Title 18 during the upcoming legislative session. The bill would create more jobs and opportunities for Washington peers, who work with those suffering from mental health or substance abuse disorders.

Peers are currently limited to serving only Medicaid recipients and working at community behavioral health agencies, so those without commercial insurance have no access to their services. Davis’s bill would create peer job openings in settings that bill commercial carriers. “Peers are so fundamental to the recovery process,” Davis told State of Reform. “So it’s problematic that people who need services can’t get them.”