Wash. Admin. Code ch. 182-530 – Prescription Drugs (Outpatient) | Midpage

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Washington Administrative Code (WAC)

Chapter 530

Wash. Admin. Code ch. 182-530

Prescription Drugs (Outpatient)

HEALTH CARE AUTHORITY

182-530-1000Outpatient drug program—General 182-530-1050Definitions 182-530-1075Requirements—Use of tamper-resistant prescription pads 182-530-1080Requirements for prescribing and dispensing controlled substances—Prescription monitoring program (PMP)182-530-2000Covered—Outpatient drugs, devices, and drug-related supplies 182-530-2100Noncovered—Outpatient drugs and pharmaceutical supplies 182-530-3000When the medicaid agency requires authorization 182-530-3100How the medicaid agency determines when a drug requires authorization 182-530-3200The medicaid agency's authorization process 182-530-4000Drug use review (DUR) board 182-530-4050Drug use and claims review 182-530-4100Medicaid preferred drug list (medicaid PDL)182-530-4125Generics first for a client's first course of treatment 182-530-4150Therapeutic interchange program (TIP)182-530-5000Billing requirements—Pharmacy claim payment 182-530-5050Billing requirements—Point-of-sale (POS) system/prospective drug use review (Pro-DUR)182-530-5100Billing requirements—Unit dose 182-530-6000Mail-order and specialty pharmacy services 182-530-7000Reimbursement 182-530-7050Reimbursement—Dispensing fee determination 182-530-7100Reimbursement—Pharmaceutical supplies 182-530-7150Reimbursement—Compounded prescriptions 182-530-7200Reimbursement—Out-of-state prescriptions 182-530-7250Reimbursement—Miscellaneous 182-530-7300Reimbursement—Requesting a change 182-530-7350Reimbursement—Unit dose drug delivery systems 182-530-7400Reimbursement—Compliance packaging services 182-530-7500Drug rebate requirement 182-530-7600Reimbursement—Clients enrolled in managed care 182-530-7700Reimbursement—Dual eligible clients/medicare 182-530-7800Reimbursement—Clients with third-party liability 182-530-7900Drugs purchased under the Public Health Service (PHS) Act 182-530-8000Reimbursement method—Actual acquisition cost (AAC)182-530-8050Reimbursement—Federal upper limit (FUL)182-530-8100Reimbursement—Maximum allowable cost (MAC)