Section 182-530-8150. Reimbursement—Automated maximum allowable cost (AMAC).

(1) The medicaid agency uses the automated maximum allowable cost (AMAC) pricing methodology for multiple-source drugs that are:

(a) Not on the published maximum allowable cost (MAC); and

(b) Produced by two or more manufacturers/labelers, at least one of which must have a current, signed federal drug rebate agreement.

(2) The agency establishes AMAC as a specified percentage of the published average wholesale price (AWP) or other nationally accepted pricing source in order to estimate acquisition cost.

(3) The agency sets the percentage discount from AWP for AMAC reimbursement using any of the information sources identified in WAC 182-530-8000.

(4) The agency may set AMAC reimbursement at different percentage discounts from AWP for different multiple source drugs. The agency considers the same factors as those in WAC 182-530-8000.

(5) AMAC reimbursement for all products with the same ingredient, form and strength is at the AMAC determined for the second lowest priced product, or the AMAC of the lowest priced drug from a manufacturer with a current, signed federal rebate agreement.

(6) The agency recalculates the AMAC each time the drug file contractor provides a pricing update.

(7) Except as provided in WAC 182-530-7300, the agency reimburses at the lowest of the rates calculated under the methods listed in WAC 182-530-7000.

[Statutory Authority: RCW 41.05.021 and 41.05.160. WSR 16-01-046, § 182-530-8150, filed 12/9/15, effective 1/9/16. WSR 11-14-075, recodified as § 182-530-8150, 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, § 388-530-8150, filed 9/26/07, effective 11/1/07.]

RCW 41.05.021 and 41.05.160. WSR 16-01-046, § 182-530-8150, filed 12/9/15, effective 1/9/16. WSR 11-14-075, recodified as § 182-530-8150, 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, § 388-530-8150, filed 9/26/07, effective 11/1/07.

Rules

182-530-8000,182-530-8000,182-530-7300,182-530-7000,