Section 182-530-4125. Generics first for a client's first course of treatment.

The medicaid agency uses point-of-sale (POS) claim messaging to tell pharmacies to use a preferred generic drug for the client's first course of treatment in specific drug classes.

(1) The agency may require preferred generic drugs on the Washington preferred drug list (PDL) be used before any brand name or nonpreferred generic drugs for a client's first course of treatment within that therapeutic class of drugs, when:

(a) There is a less expensive, equally effective therapeutic alternative generic product available to treat the condition; and

(b) The drug use review (DUR) board established under WAC 182-530-4000 has reviewed the drug class and recommended to the agency that the drug class is appropriate to require generic drugs as a client's first course of treatment.

(2) For drug classes selected by the agency that meet the criteria of subsection (1) of this section, only preferred generic drugs are covered for a client's first course of treatment, except as identified in subsection (3) of this section.

(3) Endorsing practitioners' prescriptions written "Dispense as written (DAW)" for preferred and nonpreferred brand name drugs and nonpreferred generics in the specific drug classes on the Washington PDL reviewed by the DUR board will be subject to authorization to establish medical necessity as defined in WAC 182-500-0070.

[Statutory Authority: RCW 41.05.021 and 41.05.160. WSR 15-12-093, § 182-530-4125, filed 6/2/15, effective 7/3/15. WSR 11-14-075, recodified as § 182-530-4125, filed 6/30/11, effective 7/1/11. Statutory Authority: RCW 74.04.050, 74.09.700, 74.08.090, 2009 c 575. WSR 10-06-011, § 388-530-4125, filed 2/19/10, effective 3/22/10.]

RCW 41.05.021 and 41.05.160. WSR 15-12-093, § 182-530-4125, filed 6/2/15, effective 7/3/15. WSR 11-14-075, recodified as § 182-530-4125, filed 6/30/11, effective 7/1/11. Statutory Authority: RCW 74.04.050, 74.09.700, 74.08.090, 2009 c 575. WSR 10-06-011, § 388-530-4125, filed 2/19/10, effective 3/22/10.

Rules

182-530-4000,182-500-0070,