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Chapter 182-530 WAC

Last Update: 2/6/13

PRESCRIPTION DRUGS (OUTPATIENT)

WAC Sections

182-530-1000 Outpatient drug program--General.
182-530-1050 Definitions.
182-530-1075 Requirements -- Use of tamper-resistant prescription pads.
COVERAGE
182-530-2000 Covered--Outpatient drugs, devices, and drug-related supplies.
182-530-2100 Noncovered--Outpatient drugs and pharmaceutical supplies.
182-530-2200 How the medicaid agency develops and maintains the formulary.
182-530-2300 The medicaid agency's nonformulary justification process.
AUTHORIZATION
182-530-3000 When the department requires authorization.
182-530-3100 How the department determines when a drug requires authorization.
182-530-3200 The department's authorization process.
QUALITY OF CARE
182-530-4000 Drug use review (DUR) board.
182-530-4050 Drug use and claims review.
182-530-4100 Washington preferred drug list (PDL).
182-530-4125 Generics first for a client's first course of treatment.
182-530-4150 Therapeutic interchange program (TIP).
BILLING
182-530-5000 Billing requirements--Pharmacy claim payment.
182-530-5050 Billing requirements--Point-of-sale (POS) system/prospective drug use review (Pro-DUR).
182-530-5100 Billing requirements--Unit dose.
MAIL-ORDER SERVICES
182-530-6000 Mail-order services.
REIMBURSEMENT
182-530-7000 Reimbursement.
182-530-7050 Reimbursement--Dispensing fee determination.
182-530-7100 Reimbursement--Pharmaceutical supplies.
182-530-7150 Reimbursement--Compounded prescriptions.
182-530-7200 Reimbursement--Out-of-state prescriptions.
182-530-7250 Reimbursement--Miscellaneous.
182-530-7300 Reimbursement--Requesting a change.
182-530-7350 Reimbursement--Unit dose drug delivery systems.
182-530-7400 Reimbursement--Compliance packaging services.
182-530-7500 Drug rebate requirement.
182-530-7600 Reimbursement--Clients enrolled in managed care.
182-530-7700 Reimbursement--Dual eligible clients/medicare.
182-530-7800 Reimbursement--Clients with third-party liability.
182-530-7900 Drugs purchased under the Public Health Service (PHS) Act.
REIMBURSEMENT METHODOLOGY
182-530-8000 Reimbursement method--Estimated acquisition cost (EAC).
182-530-8050 Reimbursement--Federal upper limit (FUL).
182-530-8100 Reimbursement--Maximum allowable cost (MAC).
182-530-8150 Reimbursement--Automated maximum allowable cost (AMAC).