This bill creates new coverage requirements and makes related statutory changes to require health plan coverage of pharmacogenetic/pharmacogenomic testing for psychotropic medications. For health plans issued or renewed on or after January 1, 2026, health carriers must cover pharmacogenetic testing for psychotropic medications when supported by medical and scientific evidence (examples listed include FDA-approved or cleared tests, CMS national or local coverage determinations, nationally recognized clinical practice guidelines, clinical trials and research studies, and consensus statements). The bill bars health carriers, and the state authority and Medicaid managed care organizations, from imposing prior authorization or step therapy requirements for this required coverage. The authority and Medicaid managed care organizations must also provide such coverage by January 1, 2026, and the authority must seek available federal financial participation under Title XIX (Medicaid), Title XXI (CHIP), and other federal funding sources when administering the program. Legally, the act adds a new section to chapter 48.43 RCW and a new section to chapter 74.09 RCW and reenacts and amends RCW 41.05.017, making certain plans under that chapter subject to the new coverage requirement. The bill defines key terms in statute (including “pharmacogenetic testing,” “consensus statements,” and “nationally recognized clinical practice guidelines”) but the provided text uses both “pharmacogenomic” and “pharmacogenetic” without explaining the difference. The text refers to “the authority” and to “health carriers” and plans under various RCW chapters but does not define those entities within the extracted facts. The excerpt does not include details about enforcement, penalties, reimbursement amounts or rates, or other implementation procedures.

If enacted, beginning January 1, 2026 health carriers offering plans issued or renewed on or after that date, plans referenced in RCW 41.05.017, and the state authority and Medicaid managed care organizations must cover pharmacogenetic testing for psychotropic medications when the test is supported by specified medical and scientific evidence, and they may not require prior authorization or step therapy for that coverage. In practice this means patients prescribed psychotropic drugs and their clinicians can access single‑gene and multigene tests that identify genetic variants affecting medication response without those utilization controls, and those tests must meet evidence standards such as FDA clearance, CMS coverage decisions, or recognized clinical guidelines. The groups most affected are private health carriers, the state authority referenced in chapter 74.09 RCW, and Medicaid managed care organizations: they will have new coverage responsibilities and potential cost exposure for these tests, while the state authority is required to seek available federal financial participation under Medicaid (Title XIX) and CHIP (Title XXI). The extracted text leaves important implementation details unclear, including which entity is meant by “the authority,” how the bill treats the terms “pharmacogenomic” versus “pharmacogenetic,” and how reimbursement levels, enforcement, and oversight will be handled.