Washington Administrative Code
2023 Archive

Chapter 182-530 WAC
Last Update: 10/12/23

PRESCRIPTION DRUGS (OUTPATIENT)
PDF of Chapter Digest
WAC Sections
182-530-1000Outpatient drug program—General.
182-530-1050Definitions.
182-530-1075Requirements—Use of tamper-resistant prescription pads.
182-530-1080Requirements for prescribing and dispensing controlled substances—Prescription monitoring program (PMP).
COVERAGE
182-530-2000Covered—Outpatient drugs, devices, and drug-related supplies.
182-530-2100Noncovered—Outpatient drugs and pharmaceutical supplies.
AUTHORIZATION
182-530-3000When the medicaid agency requires authorization.
182-530-3100How the medicaid agency determines when a drug requires authorization.
182-530-3200The medicaid agency's authorization process.
QUALITY OF CARE
182-530-4000Drug use review (DUR) board.
182-530-4050Drug use and claims review.
182-530-4100Medicaid preferred drug list (medicaid PDL).
182-530-4125Generics first for a client's first course of treatment.
182-530-4150Therapeutic interchange program (TIP).
BILLING
182-530-5000Billing requirements—Pharmacy claim payment.
182-530-5050Billing requirements—Point-of-sale (POS) system/prospective drug use review (Pro-DUR).
182-530-5100Billing requirements—Unit dose.
MAIL-ORDER SERVICES
182-530-6000Mail-order and specialty pharmacy services.
REIMBURSEMENT
182-530-7000Reimbursement.
182-530-7050Reimbursement—Dispensing fee determination.
182-530-7100Reimbursement—Pharmaceutical supplies.
182-530-7150Reimbursement—Compounded prescriptions.
182-530-7200Reimbursement—Out-of-state prescriptions.
182-530-7250Reimbursement—Miscellaneous.
182-530-7300Reimbursement—Requesting a change.
182-530-7350Reimbursement—Unit dose drug delivery systems.
182-530-7400Reimbursement—Compliance packaging services.
182-530-7500Drug rebate requirement.
182-530-7600Reimbursement—Clients enrolled in managed care.
182-530-7700Reimbursement—Dual eligible clients/medicare.
182-530-7800Reimbursement—Clients with third-party liability.
182-530-7900Drugs purchased under the Public Health Service (PHS) Act.
REIMBURSEMENT METHODOLOGY
182-530-8000Reimbursement method—Actual acquisition cost (AAC).
182-530-8050Reimbursement—Federal upper limit (FUL).
182-530-8100Reimbursement—Maximum allowable cost (MAC).
182-530-8150Reimbursement—Automated maximum allowable cost (AMAC).
DISPOSITION OF SECTIONS FORMERLY CODIFIED IN THIS TITLE
182-530-2200How the medicaid agency develops and maintains the formulary. [Statutory Authority: RCW 41.05.021 and section 1927 of the Social Security Act. WSR 12-18-062, § 182-530-2200, filed 8/31/12, effective 10/1/12.] Repealed by WSR 13-18-035, filed 8/28/13, effective 9/28/13. Statutory Authority: RCW 41.05.021.
182-530-2300The medicaid agency's nonformulary justification process. [Statutory Authority: RCW 41.05.021 and section 1927 of the Social Security Act. WSR 12-18-062, § 182-530-2300, filed 8/31/12, effective 10/1/12.] Repealed by WSR 13-18-035, filed 8/28/13, effective 9/28/13. Statutory Authority: RCW 41.05.021.