PROPOSED RULES
SOCIAL AND HEALTH SERVICES
Original Notice.
Preproposal statement of inquiry was filed as WSR 02-14-100.
Title of Rule: Chapter 388-530 WAC, Pharmacy services, adopting new WAC 388-530-1270 Mail-order pharmacy services.
Purpose: To establish rules for a Medical Assistance Administration mail-order prescription service, as directed by the legislature.
Statutory Authority for Adoption: RCW 74.08.090 and 74.09.510.
Statute Being Implemented: 2001-03 Revised Omnibus Operating Budget (chapter 371, Laws of 2002).
Summary: This is a new section within the MAA pharmacy chapter. It establishes rules for a contracted mail-order pharmacy. The contractor is selected through competitive procurement, the services are optional for clients, drugs supplied through mail-order are subject to special terms in addition to general pharmacy rules, and the contractor is reimbursed at lower rates than regular outpatient pharmacy services.
Name of Agency Personnel Responsible for Drafting: Myra S. Davis, MAA Rules and Publications, P.O. Box 45533, Olympia, WA, (360) 725-1306; Implementation and Enforcement: Siri Childs, Program Manager, P.O. Box 45506, Olympia, WA, (360) 725-1564.
Name of Proponent: Department of Social and Health Services, Medical Assistance Administration, governmental.
Rule is not necessitated by federal law, federal or state court decision.
Explanation of Rule, its Purpose, and Anticipated Effects: This rule responds to the wishes of the 2002 legislature as expressed in the budget details documents to the 2001-03 Revised Omnibus Operating Budget (chapter 371, Laws of 2002), DSHS medical payments, page 105, item 9. The legislature's stated expectation is that the mail-order pharmacy option will result in substantial savings for taxpayers, and increased convenience for the elderly and disabled.
Proposal Changes the Following Existing Rules: The proposed rule requires MAA to pay the mail-order contractor less that what is paid to providers under other pharmacy rules. Also, it will allow MAA to provide some mail-order prescriptions in a ninety-day supply.
No small business economic impact statement has been prepared under chapter 19.85 RCW. DSHS has determined that this rule will not impose more than minor costs on businesses.
RCW 34.05.328 applies to this rule adoption. MAA has analyzed the proposed rules and concludes that the rules meet the definition of a "significant legislative rule." MAA has prepared an evaluation of probably costs and benefits, which may be obtained by contacting the person at the address listed in Name of Agency Personnel above.
Hearing Location: Blake Office Park (behind Goodyear Courtesy Tire), 4500 10th Avenue S.E., Rose Room, Lacey, WA 98503, on January 22, 2003, at 10:00 a.m.
Assistance for Persons with Disabilities: Contact Andy Fernando, DSHS Rules Coordinator, by January 17, 2003, phone (360) 664-6094, TTY (360) 664-6178, e-mail fernaax@dshs.wa.gov.
Submit Written Comments to: Identify WAC Numbers, DSHS Rules Coordinator, Rules and Policies Assistance Unit, P.O. Box 45850, Olympia, WA 98504-5850, fax (360) 664-6185, e-mail fernaax@dshs.wa.gov, by 5:00 p.m., January 22, 2003.
Date of Intended Adoption: Not sooner than January 23, 2003.
December 3, 2002
Brian H. Lindgren, Manager
Rules and Policies Assistance Unit
3192.1(1) The contracted mail-order pharmacy service is available as an option to all medical assistance clients, subject to the:
(a) Scope of the client's medical care program;
(b) Availability of services from the contracted mail-order provider; and
(c) Special terms and conditions described in subsection (2) and (3) of this section.
(2) The mail-order prescription service may not dispense medication in a quantity greater than authorized by the prescriber. (See RCW 18.64.360(5), Nonresident pharmacies.)
(3) Prescribed medications may be filled by the mail-order pharmacy service within the following restrictions:
(a) Drugs available from mail-order in no more than a ninety day supply include:
(i) Preferred drugs (see WAC 388-530-1260);
(ii) Generic drugs; and,
(iii) Drugs that do not require prior authorization or expedited prior authorization (see WAC 388-530-1200 and 388-530-1250).
(b) Drugs available in no more than a thirty-four-day supply:
(i) Controlled substances (schedules II through V); and
(ii) Drugs requiring prior authorization or expedited prior authorization (see WAC 388-530-1200).
(c) Other pharmacy restrictions (chapter 388-530 WAC, Pharmacy services) continue to apply.
(4) The contracted mail-order pharmacy services are reimbursed at levels lower than those established for the regular outpatient pharmacy services.
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