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Last Update: 3/1/17

Chapter 182-530 WAC

PRESCRIPTION DRUGS (OUTPATIENT)

WAC Sections

Outpatient drug program—General.
Definitions.
Requirements—Use of tamper-resistant prescription pads.
COVERAGE
Covered—Outpatient drugs, devices, and drug-related supplies.
Noncovered—Outpatient drugs and pharmaceutical supplies.
AUTHORIZATION
When the medicaid agency requires authorization.
How the medicaid agency determines when a drug requires authorization.
The medicaid agency's authorization process.
QUALITY OF CARE
Drug use review (DUR) board.
Drug use and claims review.
Medicaid preferred drug list (medicaid PDL).
Generics first for a client's first course of treatment.
Therapeutic interchange program (TIP).
BILLING
Billing requirements—Pharmacy claim payment.
Billing requirements—Point-of-sale (POS) system/prospective drug use review (Pro-DUR).
Billing requirements—Unit dose.
MAIL-ORDER SERVICES
Mail-order and specialty pharmacy services.
REIMBURSEMENT
Reimbursement.
Reimbursement—Dispensing fee determination.
Reimbursement—Pharmaceutical supplies.
Reimbursement—Compounded prescriptions.
Reimbursement—Out-of-state prescriptions.
Reimbursement—Miscellaneous.
Reimbursement—Requesting a change.
Reimbursement—Unit dose drug delivery systems.
Reimbursement—Compliance packaging services.
Drug rebate requirement.
Reimbursement—Clients enrolled in managed care.
Reimbursement—Dual eligible clients/medicare.
Reimbursement—Clients with third-party liability.
Drugs purchased under the Public Health Service (PHS) Act.
REIMBURSEMENT METHODOLOGY
Reimbursement method—Actual acquisition cost (AAC).
Reimbursement—Federal upper limit (FUL).
Reimbursement—Maximum allowable cost (MAC).
Reimbursement—Automated maximum allowable cost (AMAC).
DISPOSITION OF SECTIONS FORMERLY CODIFIED IN THIS CHAPTER
182-530-2200
How the medicaid agency develops and maintains the formulary. [Statutory Authority: RCW 41.05.021 and section 1927 of the Social Security Act. WSR 12-18-062, § 182-530-2200, filed 8/31/12, effective 10/1/12.] Repealed by WSR 13-18-035, filed 8/28/13, effective 9/28/13. Statutory Authority: RCW 41.05.021.
182-530-2300
The medicaid agency's nonformulary justification process. [Statutory Authority: RCW 41.05.021 and section 1927 of the Social Security Act. WSR 12-18-062, § 182-530-2300, filed 8/31/12, effective 10/1/12.] Repealed by WSR 13-18-035, filed 8/28/13, effective 9/28/13. Statutory Authority: RCW 41.05.021.
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