- (1) The medicaid agency reimburses for outpatient prescription drugs only when they are supplied by manufacturers who have a signed drug rebate agreement with the federal Department of Health and Human Services (DHHS), according to 42 U.S.C. 1396r-8. The manufacturer must be listed on the list of participating manufacturers as published by the Center for Medicare and Medicaid Services (CMS).
- (2) The fill date must be within the manufacturer's beginning and ending eligibility dates to be reimbursed by the agency.
- (3) The agency may extend this rebate requirement to any outpatient drug reimbursements as allowed or required by federal law.
(4) The agency may exempt drugs from the rebate requirement, on a case-by-case basis, when:
- (a) It determines that the availability of a single source drug or innovator multiple source drug is essential to the health of beneficiaries; and
- (b) All other rebate exemption requirements of SSA Sec. 1927 (42 U.S.C. 1396r-8)(3) are also satisfied.
[Statutory Authority: RCW 41.05.021 and 41.05.160. WSR 16-01-046, § 182-530-7500, filed 12/9/15, effective 1/9/16. WSR 11-14-075, recodified as § 182-530-7500, 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, § 388-530-7500, filed 9/26/07, effective 11/1/07.]