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296-20-17002  <<  296-20-17004 >>   296-20-19000

Billing and payment for initial prescription drugs.

(1) Pharmacies may bill the department for initial prescription drugs prior to claim acceptance upon the presentation to the pharmacy of a state fund identification card or a copy of the Report of Industrial Injury or Occupational Disease with a valid claim number.
(2) The department will pay pharmacies or reimburse the worker for initial prescription drugs prescribed during the initial visit except when the prescription is:
(a) A second or subsequent filling of the initial prescription drugs prescribed for the same industrial injury or occupational disease prior to claim acceptance; or
(b) Associated with a self-insurer claim.
(3) Payment for initial prescription drugs shall be in accordance with the department's fee schedule including, but not limited to screening for drug utilization review (DUR) criteria, the preferred drug list (PDL) provision and formulary status.
[Statutory Authority: RCW 51.04.020, 51.04.030 and 2007 c 134. WSR 08-02-021, § 296-20-17004, filed 12/21/07, effective 1/21/08.]