Section 182-530-8000. Reimbursement method—Estimated acquisition cost (EAC).

(1) The medicaid agency determines estimated acquisition cost (EAC) using:

(a) Acquisition cost data made available to the agency; or

(b) Information provided by any of the following:

(i) Audit agencies, federal or state;

(ii) Other state health care purchasing agencies;

(iii) Pharmacy benefit managers;

(iv) Individual pharmacy providers participating in the agency's programs;

(v) Centers for Medicare and Medicaid Services (CMS);

(vi) Other third-party payers;

(vii) Drug file data bases; and

(viii) Actuaries or other consultants.

(2) The agency implements EAC by applying a percentage adjustment to available reference pricing from national sources such as wholesale acquisition cost, average wholesale price (AWP), average sale price (ASP), and average manufacturer price (AMP).

(3) The agency may set EAC for specified drugs or drug categories at a maximum allowable cost other than that determined in subsection (1)(a) of this section when the agency considers it necessary. The factors the agency considers in setting a rate for a class of drugs under this subsection include, but are not limited to:

(a) Product acquisition cost;

(b) The agency's documented clinical concerns; and

(c) The agency's budget limits.

(4) The agency bases EAC drug reimbursement on the actual package size dispensed.

(5) The agency uses EAC as the agency's reimbursement for a drug when EAC is the lowest of the rates calculated under the methods listed in WAC 182-530-7000, or when the conditions of WAC 182-530-7300 are met.

[Statutory Authority: RCW 41.05.021 and 41.05.160. WSR 16-01-046, § 182-530-8000, filed 12/9/15, effective 1/9/16. WSR 11-14-075, recodified as § 182-530-8000, filed 6/30/11, effective 7/1/11. Statutory Authority: RCW 74.04.050 and 74.08.090. WSR 10-24-021, § 388-530-8000, filed 11/19/10, effective 12/20/10. Statutory Authority: RCW 74.04.050, 74.08.090, 74.09.530, and 74.09.700. WSR 07-20-049, § 388-530-8000, filed 9/26/07, effective 11/1/07.]

RCW 41.05.021 and 41.05.160. WSR 16-01-046, § 182-530-8000, filed 12/9/15, effective 1/9/16. WSR 11-14-075, recodified as § 182-530-8000, filed 6/30/11, effective 7/1/11. Statutory Authority: RCW 74.04.050 and 74.08.090. WSR 10-24-021, § 388-530-8000, filed 11/19/10, effective 12/20/10. Statutory Authority: RCW 74.04.050, 74.08.090, 74.09.530, and 74.09.700. WSR 07-20-049, § 388-530-8000, filed 9/26/07, effective 11/1/07.

Rules

182-530-7000,182-530-7300,