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Chapter 182-530 WAC

|Hide DispositionsLast Update: 10/23/24

PRESCRIPTION DRUGS (OUTPATIENT)

WAC Sections

HTMLPDF182-530-1000Outpatient drug program—General.
HTMLPDF182-530-1050Definitions.
HTMLPDF182-530-1075Requirements—Use of tamper-resistant prescription pads.
HTMLPDF182-530-1080Requirements for prescribing and dispensing controlled substances—Prescription monitoring program (PMP).
COVERAGE
HTMLPDF182-530-2000Covered—Outpatient drugs, devices, and drug-related supplies.
HTMLPDF182-530-2100Noncovered—Outpatient drugs and pharmaceutical supplies.
AUTHORIZATION
HTMLPDF182-530-3000When the medicaid agency requires authorization.
HTMLPDF182-530-3100How the medicaid agency determines when a drug requires authorization.
HTMLPDF182-530-3200The medicaid agency's authorization process.
QUALITY OF CARE
HTMLPDF182-530-4000Drug use review (DUR) board.
HTMLPDF182-530-4050Drug use and claims review.
HTMLPDF182-530-4100Medicaid preferred drug list (medicaid PDL).
HTMLPDF182-530-4125Generics first for a client's first course of treatment.
HTMLPDF182-530-4150Therapeutic interchange program (TIP).
BILLING
HTMLPDF182-530-5000Billing requirements—Pharmacy claim payment.
HTMLPDF182-530-5050Billing requirements—Point-of-sale (POS) system/prospective drug use review (Pro-DUR).
HTMLPDF182-530-5100Billing requirements—Unit dose.
MAIL-ORDER SERVICES
HTMLPDF182-530-6000Mail-order and specialty pharmacy services.
REIMBURSEMENT
HTMLPDF182-530-7000Reimbursement.
HTMLPDF182-530-7050Reimbursement—Dispensing fee determination.
HTMLPDF182-530-7100Reimbursement—Pharmaceutical supplies.
HTMLPDF182-530-7150Reimbursement—Compounded prescriptions.
HTMLPDF182-530-7200Reimbursement—Out-of-state prescriptions.
HTMLPDF182-530-7250Reimbursement—Miscellaneous.
HTMLPDF182-530-7300Reimbursement—Requesting a change.
HTMLPDF182-530-7350Reimbursement—Unit dose drug delivery systems.
HTMLPDF182-530-7400Reimbursement—Compliance packaging services.
HTMLPDF182-530-7500Drug rebate requirement.
HTMLPDF182-530-7600Reimbursement—Clients enrolled in managed care.
HTMLPDF182-530-7700Reimbursement—Dual eligible clients/medicare.
HTMLPDF182-530-7800Reimbursement—Clients with third-party liability.
HTMLPDF182-530-7900Drugs purchased under the Public Health Service (PHS) Act.
REIMBURSEMENT METHODOLOGY
HTMLPDF182-530-8000Reimbursement method—Actual acquisition cost (AAC).
HTMLPDF182-530-8050Reimbursement—Federal upper limit (FUL).
HTMLPDF182-530-8100Reimbursement—Maximum allowable cost (MAC).
DISPOSITION OF SECTIONS FORMERLY CODIFIED IN THIS TITLE
182-530-2200How 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.
182-530-2300The 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.
182-530-8150Reimbursement—Automated maximum allowable cost (AMAC). [Statutory Authority: RCW 41.05.021 and 41.05.160. WSR 17-07-001, § 182-530-8150, filed 3/1/17, effective 4/1/17; WSR 16-01-046, § 182-530-8150, filed 12/9/15, effective 1/9/16. WSR 11-14-075, recodified as § 182-530-8150, filed 6/30/11, effective 7/1/11. Statutory Authority: RCW 74.04.050, 74.08.090, 74.09.530, and 74.09.700. WSR 07-20-049, § 388-530-8150, filed 9/26/07, effective 11/1/07.] Repealed by WSR 24-22-005, filed 10/23/24, effective 11/23/24. Statutory Authority: RCW 41.05.021 and 41.05.160.