Section 182-530-7100. Reimbursement—Pharmaceutical supplies.

(1) The medicaid agency reimburses for selected pharmaceutical supplies through the pharmacy point-of-sale (POS) system when it is necessary for client access and safety.

(2) The agency bases reimbursement of pharmaceutical items or supplies that are not payable through the POS on agency-published fee schedules.

(3) The agency uses any or all of the following methodologies to set the maximum allowable reimbursement rate for drugs, devices, and drug-related supplies:

(a) A pharmacy provider's acquisition cost. Upon review of the claim, the agency may require an invoice which must show the name of the item, the manufacturer, the product description, the quantity, and the current cost including any free goods associated with the invoice;

(b) Medicare's reimbursement rate for the item; or

(c) A specified discount off the item's list price or manufacturer's suggested retail price (MSRP).

(4) The agency does not pay a dispensing fee for nondrug items, devices, or drug-related supplies. See WAC 182-530-7050.

[Statutory Authority: RCW 41.05.021 and 41.05.160. WSR 16-01-046, § 182-530-7100, filed 12/9/15, effective 1/9/16. WSR 11-14-075, recodified as § 182-530-7100, 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, § 388-530-7100, filed 9/26/07, effective 11/1/07.]

RCW 41.05.021 and 41.05.160. WSR 16-01-046, § 182-530-7100, filed 12/9/15, effective 1/9/16. WSR 11-14-075, recodified as § 182-530-7100, 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, § 388-530-7100, filed 9/26/07, effective 11/1/07.

Rules

182-530-7050,