SOCIAL AND HEALTH SERVICES
(Medical Assistance Administration)
Date of Adoption: February 5, 2003.
Purpose: To establish rules for a mail-order prescription service as directed by the legislature, the department is adopting new WAC 388-530-1270 Mail-order services.
Statutory Authority for Adoption: RCW 74.08.090, 74.09.510.
Other Authority: Chapter 371, Laws of 2002 (2001-03 Revised Omnibus Operating Budget - 2002 Supp.).
Adopted under notice filed as WSR 03-01-011 on December 5, 2002.
Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 1, Amended 0, Repealed 0.
Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.
Number of Sections Adopted on the Agency's Own Initiative: New 0, Amended 0, Repealed 0.
Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, Amended 0, Repealed 0.
Number of Sections Adopted Using Negotiated Rule Making:
Pilot Rule Making:
or Other Alternative Rule Making:
Effective Date of Rule: Thirty-one days after filing.
February 5, 2003
Brian H. Lindgren, Manager
Rules and Policies Assistance Unit3192.1
(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.